School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland, First Floor, Ardilaun House (Block B), 111 St Stephen's Green, Dublin 2, D02 VN51, Ireland.
Health Service Executive, National Social Inclusion Office, Mill Lane, Palmerstown, Dublin 20, D20 KH63, Ireland.
Int J Drug Policy. 2022 Aug;106:103768. doi: 10.1016/j.drugpo.2022.103768. Epub 2022 Jun 16.
Emergency contingency guidelines for opioid agonist treatment (OAT) were introduced in Ireland in March 2020, to ensure rapid and uninterrupted access to treatment while mitigating COVID-19 risk. The contingency guidelines deviated, across multiple clinical domains, from pre-pandemic clinical guidelines published in 2016. The objectives of this study are to (1) identify changes introduced to OAT clinical guidelines in Ireland during the pandemic; and (2) develop consensus on whether the new recommendations should be retained beyond the pandemic, using a national Delphi consensus methodology.
Clinical guidance recommendations ('statements') were generated by comparing the newly established contingency guidelines with the national 2016 Clinical Guidelines for OAT. Over two rounds of on-line Delphi testing, a panel of experts (people currently accessing OAT, psychiatrists, general practitioners, community pharmacists, a nurse, a psychologist and support/key workers) independently rated their agreement with each statement and provided comments. Statements with a median score of 4 or 5 and a lower quartile of ≥4 were classified as having reached consensus.
Forty-eight panel members were recruited, with a high participation level at Round 2 (90%, n=43). Consensus was achieved for 12 of the 19 statements at Round 1. The 7 remaining statements were revised, with 2 new statements, resulting in 9 statements at Round 2. Four statements reached consensus at Round 2. The final list includes 16 clinical guidance statements; 9 relating to assessment, 3 to OAT drug choice and dosing, 1 to take-away doses, 2 to overdose prevention and 1 to the continuation of e-prescriptions.
A wide range of stakeholders involved in the delivery and receipt of OAT agreed on 16 clinical guidance statements for inclusion in OAT clinical guidelines as we move beyond the pandemic, rather than reverting to pre-pandemic guidelines. The agreed statements relate to facilitating safe access to OAT with minimal waiting time, supporting patient-centred care to promote health and well-being, and preventing drug overdose. Notably, consensus was not achieved for OAT drug dosage and frequency of urine testing during the stabilisation and maintenance phase of care.
2020 年 3 月，爱尔兰推出了阿片类药物激动剂治疗（OAT）紧急应急指南，以确保在减轻 COVID-19 风险的同时，快速、不间断地获得治疗。应急指南在多个临床领域偏离了 2016 年发布的流行前临床指南。本研究的目的是：(1) 确定在大流行期间爱尔兰 OAT 临床指南中引入的变化；(2) 使用国家德尔菲共识方法，就新建议是否应在大流行后保留达成共识。
通过将新制定的应急指南与国家 2016 年 OAT 临床指南进行比较，生成临床指导建议（“陈述”）。在两轮在线德尔菲测试中，一组专家（目前接受 OAT 治疗的人、精神科医生、全科医生、社区药剂师、护士、心理学家和支持/关键工作人员）独立对每条陈述的同意程度进行评分，并提供意见。中位数评分为 4 或 5，四分位距下限为≥4 的陈述被归类为达成共识。
共招募了 48 名小组成员，第二轮的参与度很高（90%，n=43）。第一轮有 12 项陈述达成共识。对其余 7 项陈述进行了修订，新增 2 项陈述，第二轮共 9 项陈述。第二轮有 4 项陈述达成共识。最终列表包括 16 项临床指导陈述；9 项与评估有关，3 项与 OAT 药物选择和剂量有关，1 项与外出剂量有关，2 项与预防过量有关，1 项与电子处方的延续有关。
参与 OAT 提供和接收的广泛利益相关者就 16 项临床指导陈述达成一致，这些陈述将被纳入 OAT 临床指南，以便我们在大流行结束后继续使用，而不是恢复到大流行前的指南。达成一致的陈述涉及促进安全获得 OAT，尽量减少等待时间，支持以患者为中心的护理，以促进健康和福祉，预防药物过量。值得注意的是，在治疗的稳定和维持阶段，对于 OAT 药物剂量和尿液检测频率，未达成共识。
