Kuhn Silke, Lehmann Kirsten, Schulte Bernd, Verthein Uwe
Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie, Hamburg, Deutschland.
Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie, Hamburg, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2022 Feb;168:57-64. doi: 10.1016/j.zefq.2021.10.003. Epub 2021 Dec 23.
Opioid agonist therapy (OAT) has been established to be the most important therapy option for improving health and social burdens of people with opioid dependence. Pharmacies provide drug substitutes to substitution practices or outpatient clinics and administer drugs to substituted patients (medication under visual control) or supply prescriptions for unsupervised, at-home use by patients. Given the gaps in medical care, the relevance of pharmacies for the comprehensive treatment of opioid-dependent patients will become even more important in the future. The 3 Revision of the Narcotic Drugs Prescription Ordinance (NDPO) adopted sweeping reforms to the framework of OAT in 2017. This paper examines the impact of this reform from the pharmacist's perspective.
Between November 2020 and March 2021, pharmacists in the German federal states of Hamburg, North-Rhine Westphalia, Saxony, and Bavaria were informed by their State Chambers of Pharmacists about participation in this online study. A total of 480 questionnaires were evaluated. The analysis differentiates between pharmacists who are currently involved in the substitution of opioid-dependent patients (54.2%), pharmacists who were involved in the past (21.4%), and those who have never been involved in opioid substitution (24.4%).
Pharmacists involved in OAT have not seen any positive changes resulting from the 3 Revision of the NDPO. According to 97.9% of the pharmacists, remuneration for administering medication under visual control should be analogous to remuneration in doctors' practices. Mixed prescriptions (prescription of take-home dose and intermediate medication under visual control) increase the administrative workload and have been rejected by a quarter of the pharmacists. Non-involved pharmacists significantly overestimated the occurrence of critical situations with substituted patients in the pharmacy. While only 2.7% of pharmacists involved in OAT reported drug emergencies, 23.1% of non-involved pharmacists expressed such concerns. 39.3% of the pharmacists felt they could be motivated to participate in OAT if they were approached directly, and 73.9% of the pharmacists who are currently involved in OAT said they could provide substitution medication under visual control to additional opioid-dependent patients.
The 3 Revision of the NDPO has no influence on the situation and willingness of pharmacists to be involved in OAT. However, to ensure that pharmacists continue to be actively involved in OAT and attract new substituting pharmacies, their importance for comprehensive OAT must be upgraded. This includes, and not least, the funding of pharmacists' administration of substitution drugs under visual control. In addition, knowledge about OAT, attitudes toward opioid-dependent patients, and contact anxiety could be addressed by promoting educational awareness and training.
阿片类激动剂疗法（OAT）已被确立为改善阿片类药物依赖者健康和社会负担的最重要治疗选择。药店向替代治疗机构或门诊诊所提供药物替代品，并为替代治疗的患者给药（可视下给药），或为患者提供非监督性居家使用的处方。鉴于医疗服务存在差距，药店在阿片类药物依赖患者综合治疗中的相关性在未来将变得更加重要。2017年《麻醉药品处方条例》（NDPO）第三次修订对OAT框架进行了全面改革。本文从药剂师的角度审视了这一改革的影响。
2020年11月至2021年3月期间，德国汉堡、北莱茵-威斯特法伦、萨克森和巴伐利亚等联邦州的药剂师由其州药剂师协会告知参与这项在线研究。共评估了480份问卷。分析区分了目前参与阿片类药物依赖患者替代治疗的药剂师（54.2%）、过去参与过的药剂师（21.4%）以及从未参与过阿片类药物替代治疗的药剂师（24.4%）。
参与OAT的药剂师并未看到NDPO第三次修订带来任何积极变化。97.9%的药剂师认为，可视下给药的报酬应与医生诊所的报酬类似。混合处方（带回家剂量的处方和可视下中间药物的处方）增加了行政工作量，四分之一的药剂师拒绝此类处方。未参与的药剂师显著高估了药店中替代治疗患者出现危急情况的发生率。参与OAT的药剂师中只有2.7%报告了药物紧急情况，而未参与 的药剂师中有23.1%表达了此类担忧。39.3%的药剂师表示，如果直接与他们联系，他们可能有动力参与OAT，目前参与OAT的药剂师中有73.9%表示他们可以为更多阿片类药物依赖患者提供可视下替代药物。
NDPO第三次修订对药剂师参与OAT的情况和意愿没有影响。然而，为确保药剂师继续积极参与OAT并吸引新的替代药店，必须提升他们在OAT综合治疗中的重要性。这尤其包括为药剂师可视下管理替代药物提供资金。此外，可以通过提高教育意识和培训来解决有关OAT的知识以及对阿片类药物依赖患者的态度和接触焦虑问题。
