背景:通过药房扩大纳洛酮的使用是一个重要的政策目标。我们的目标是描述国家县级纳洛酮配药连锁与独立药房的特征。
方法:在我们的纵向分析中,主要暴露量是某县连锁药店的比例,通过美国国土安全部2010年基础设施基础级数据确定。如果至少50%的药店是大型全国性连锁店,我们将县定义为连锁药店的“比例更高”。主要结果是季度(2016Q1-2019Q2)县级SymphonyHealth每100,000人的药房纳洛酮索赔率。我们使用双样本t检验比较了县类型之间的纳洛酮分配率。我们使用具有年度固定效应的线性模型估算了县级连锁药房比例与纳洛酮索赔率之间的关联。
结果:近三分之一的县(n=946)的比例更高。在整个研究期间,较高比例的县的纳洛酮索赔率明显较高,在6个城乡分类中的4个中,在有和没有纳洛酮准入法的县。线性模型证实,较高比例的县的纳洛酮索赔率明显较高,调整城乡指定,收入,人口特征,阿片类药物死亡率,共同制定法律和纳洛酮准入法。
结论:在这项全国性研究中,我们发现纳洛酮配药率与县级连锁(与独立)药房比例之间存在关联.通过教育激励纳洛酮配药,监管,或法律努力可能会提高纳洛酮的可用性和配药率-特别是在独立药房数量较多的县。
BACKGROUND: Expanding access to naloxone through pharmacies is an important policy goal. Our objective was to characterize national county-level naloxone dispensing of chain versus independent pharmacies.
METHODS: The primary exposure in our longitudinal analysis was the proportion of chain pharmacies in a county, identified through the US Department of Homeland Security 2010 Infrastructure Foundation-Level Data. We defined counties as having \"higher proportion\" of chain pharmacies if at least 50% of pharmacies were large national chains. The primary outcome was quarter-year (2016Q1-2019Q2) rate of pharmacy naloxone claims per 100,000 persons from Symphony Health at the county-level. We compared the naloxone dispensing rate between county types using two-sample t-tests. We estimated the association between county-level chain pharmacy proportion and rate of naloxone claims using a linear model with year-quarter fixed effects.
RESULTS: Nearly one third of counties (n=946) were higher proportion. Higher proportion counties had a significantly higher rate of naloxone claims across the study period, in 4 of 6 urban-rural classifications, and in counties with and without naloxone access laws. The linear model confirmed that higher proportion counties had a significantly higher rate of naloxone claims, adjusting for urban/rural designation, income, population characteristics, opioid mortality rate, co-prescribing laws and naloxone access laws.
CONCLUSIONS: In this national study, we found an association between naloxone dispensing rates and the county-level proportion of chain (versus independent) pharmacies. Incentivizing naloxone dispensing through educational, regulatory, or legal efforts may improve naloxone availability and dispensing rates - particularly in counties with proportionately high numbers of independent pharmacies.