社区药房主导的阿片类药物滥用干预：一项小规模随机临床试验。
A community pharmacy-led intervention for opioid medication misuse: A small-scale randomized clinical trial.
机构信息
University of Utah, School of Medicine, Department of Internal Medicine, 30 N 1900 E, Room 4C104, Salt Lake City, Utah, 84132, USA; University of Pittsburgh, School of Social Work 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA, 15260, USA.
University of Pittsburgh, School of Social Work 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA, 15260, USA.
出版信息
Drug Alcohol Depend. 2019 Dec 1;205:107570. doi: 10.1016/j.drugalcdep.2019.107570. Epub 2019 Oct 22.
BACKGROUND
Stemming the opioid epidemic requires testing novel interventions. Toward this goal, feasibility and acceptability of a Brief Motivational Intervention-Medication Therapy Management (BMI-MTM) intervention was examined along with its impact on medication misuse and concomitant health conditions.
METHODS
We conducted a two-group randomized trial in 2 community pharmacies. We screened patients for prescription opioid misuse at point-of-service using the Prescription Opioid Misuse Index. Participants were assigned to standard medication counseling (SMC) or SMC + BMI-MTM (referred to as BMI-MTM herein). BMI-MTM consists of a pharmacist-led medication counseling/brief motivational session and 8-weekly patient navigation sessions. Assessments were at baseline, 2-, and 3-months. Primary outcomes included feasibility, acceptability, and mitigation of opioid medication misuse. Secondary outcomes included pain and depression. Outcomes were analyzed with descriptive and multivariable statistics (intent-to-treat [ITT] and adjusted for number of sessions completed [NUMSESS]).
RESULTS
Thirty-two participants provided informed consent (74.4% consent rate; SMC n = 17, BMI-MTM n = 15; 3-month assessment retention ≥93%). Feasibility was demonstrated by all BMI-MTM recipients completing the pharmacist session and an average of 7 navigation sessions. BMI-MTM recipients indicated ≥4.2 (5 maximum) level of satisfaction with the pharmacist-led session, and 92.4% were satisfied with navigation sessions. Compared to SMC at 3-months, BMI-MTM recipients reported greater improvements in misuse (ITT: Adjusted Odds Ratio [AOR] = 0.13; 95% CI = 0.05, 0.35, p < 0.001.
NUMSESS
AOR = 0.05; 95% CI = 0.01, 0.25; p < 0.001), pain (ITT: В = 8.8, 95% CI=-0.95, 18.5, p = 0.08; NUMSESS: В = 14.0, 95% CI = 3.28, 24.8, p = 0.01), and depression (ITT: B= -0.44; 95% CI=-0.65, -0.22; p < 0.001.
NUMSESS
B= -0.64; 95% CI=-0.82, -0.46; p < 0.001).
CONCLUSIONS
BMI-MTM is a feasible misuse intervention associated with superior satisfaction and outcomes than SMC. Future research should test BMI-MTM in a large-scale, fully-powered trial.
背景
遏制阿片类药物泛滥需要检验新的干预措施。为此，我们研究了一种简短动机干预-药物治疗管理（BMI-MTM）干预措施的可行性和可接受性，以及其对药物滥用和伴随健康状况的影响。
方法
我们在 2 家社区药店进行了一项 2 组随机试验。我们在服务点使用处方阿片类药物滥用指数对患者进行处方阿片类药物滥用筛查。参与者被分配到标准药物咨询（SMC）或 SMC+BMI-MTM（以下简称 BMI-MTM）。BMI-MTM 包括药剂师主导的药物咨询/简短动机会议和 8 周的患者导航会议。评估在基线、2 个月和 3 个月时进行。主要结局包括可行性、可接受性和阿片类药物滥用的缓解。次要结局包括疼痛和抑郁。使用描述性和多变量统计（意向治疗[ITT]和按完成的会话数调整[NUMSESS]）分析结果。
结果
32 名参与者提供了知情同意（74.4%的同意率；SMC n=17，BMI-MTM n=15；3 个月评估保留率≥93%）。所有接受 BMI-MTM 的患者都完成了药剂师的治疗和平均 7 次导航治疗，这证明了其可行性。BMI-MTM 接受者表示对药剂师主导的治疗至少有 4.2（最高 5 分）的满意度，92.4%的人对导航治疗感到满意。与 3 个月时的 SMC 相比，BMI-MTM 接受者报告在滥用方面有更大的改善（ITT：调整后的优势比[OR]为 0.13；95%置信区间[CI]为 0.05，0.35，p<0.001）。NUMSESS：OR 为 0.05；95%CI 为 0.01，0.25；p<0.001）、疼痛（ITT：B=8.8，95%CI=-0.95，18.5，p=0.08；NUMSESS：B=14.0，95%CI=3.28，24.8，p=0.01）和抑郁（ITT：B=-0.44；95%CI=-0.65，-0.22；p<0.001）。NUMSESS：B=-0.64；95%CI=-0.82，-0.46；p<0.001）。
结论
BMI-MTM 是一种可行的滥用干预措施，与 SMC 相比，其满意度和效果都更好。未来的研究应该在大规模、全面的试验中检验 BMI-MTM。
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