在基层医疗中实施药师整合的阿片类药物使用障碍药物治疗协作模式：研究设计和方法学考虑。
Implementing a pharmacist-integrated collaborative model of medication treatment for opioid use disorder in primary care: study design and methodological considerations.
机构信息
Northeast Node, NIDA Drug Abuse Treatment Clinical Trials Network, Hanover, NH, USA.
Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.
出版信息
Addict Sci Clin Pract. 2024 Mar 18;19(1):18. doi: 10.1186/s13722-024-00452-y.
BACKGROUND
Pharmacists remain an underutilized resource in the treatment of opioid use disorder (OUD). Although studies have engaged pharmacists in dispensing medications for OUD (MOUD), few studies have evaluated collaborative care models in which pharmacists are an active, integrated part of a primary care team offering OUD care.
METHODS
This study seeks to implement a pharmacist integrated MOUD clinical model (called PrIMO) and evaluate its feasibility, acceptability, and impact across four diverse primary care sites. The Consolidated Framework for Implementation Research is used as an organizing framework for study development and interpretation of findings. Implementation Facilitation is used to support PrIMO adoption. We assess the primary outcome, the feasibility of implementing PrIMO, using the Stages of Implementation Completion (SIC). We evaluate the acceptability and impact of the PrIMO model at the sites using mixed-methods and combine survey and interview data from providers, pharmacists, pharmacy technicians, administrators, and patients receiving MOUD at the primary care sites with patient electronic health record data. We hypothesize that it is feasible to launch delivery of the PrIMO model (reach SIC Stage 6), and that it is acceptable, will positively impact patient outcomes 1 year post model launch (e.g., increased MOUD treatment retention, medication regimen adherence, service utilization for co-morbid conditions, and decreased substance use), and will increase each site's capacity to care for patients with MOUD (e.g., increased number of patients, number of prescribers, and rate of patients per prescriber).
DISCUSSION
This study will provide data on a pharmacist-integrated collaborative model of care for the treatment of OUD that may be feasible, acceptable to both site staff and patients and may favorably impact patients' access to MOUD and treatment outcomes.
TRIAL REGISTRATION
The study was registered on Clinicaltrials.gov (NCT05310786) on April 5, 2022, https://www.
CLINICALTRIALS
gov/study/NCT05310786?id=NCT05310786&rank=1.
背景
药剂师仍然是治疗阿片类药物使用障碍（OUD）的未充分利用的资源。尽管已有研究让药剂师参与 OUD 药物（MOUD）的配药，但很少有研究评估合作护理模式，即在这种模式中，药剂师是初级保健团队的积极、综合成员，提供 OUD 护理。
方法
本研究旨在实施一种药剂师整合的 MOUD 临床模式（称为 PrIMO），并在四个不同的初级保健地点评估其可行性、可接受性和影响。实施研究综合框架被用作研究发展和研究结果解释的组织框架。实施促进被用于支持 PrIMO 的采用。我们使用实施完成阶段（SIC）评估主要结果，即实施 PrIMO 的可行性。我们使用混合方法评估 PrIMO 模型在各个地点的可接受性和影响，并将初级保健地点接受 MOUD 的提供者、药剂师、药剂技术员、管理人员和患者的调查和访谈数据与患者电子健康记录数据相结合。我们假设推出 PrIMO 模型的交付是可行的（达到 SIC 第 6 阶段），并且它是可接受的，将在模型推出后 1 年对患者结果产生积极影响（例如，增加 MOUD 治疗保留率、药物治疗依从性、共病状况的服务利用以及减少物质使用），并将增加每个地点治疗 MOUD 患者的能力（例如，增加患者数量、处方人数和每位处方医生的患者人数）。
讨论
本研究将提供有关治疗 OUD 的药剂师整合协作护理模式的数据，该模式可能具有可行性，既被工作人员又被患者接受，并且可能对患者获得 MOUD 和治疗结果产生有利影响。
试验注册
该研究于 2022 年 4 月 5 日在 Clinicaltrials.gov（NCT05310786）上注册，网址为 https://www.clinicaltrials.gov/study/NCT05310786?id=NCT05310786&rank=1。
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