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Criswell A, Duck AA, Hall KC. Willingness to Provide Naloxone Resources for Patients at Risk of Opioid Overdose: A National Survey of Emergency Registered Nurses. J Emerg Nurs 2024:S0099-1767(24)00163-6. [PMID: 39001772 DOI: 10.1016/j.jen.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Opioid-related events continue to claim lives in the United States at alarming rates. Naloxone-dispensing rates fall dramatically short of national expectations. Emergency registered nurses are uniquely poised to connect at-risk patients with naloxone resources. This study sought to (1) describe the emergency registered nurses' willingness to provide naloxone resources and (2) explore variables that may influence the nurse's willingness to provide resources. METHODS A cross-sectional, survey-based design was deployed using an online branch logic approach to include a national sample of emergency registered nurses. The Willingness to Provide, a validated questionnaire, measured the registered nurse's willingness to provide naloxone resources for patients at risk of opioid overdose. Eight variables were assessed for potential influence on willingness. RESULTS A total of 159 nurses from 32 states and the District of Columbia completed the online survey via the Research Electronic Data Capture platform. The results revealed a mean Willingness to Provide score of 38.64 indicating a willingness to provide naloxone resources. A statistically significant relationship was identified between the nurse's willingness and years of nursing experience (P = .001), knowledge (P = .015), desire (P = .001), and responsibility (P < .001). DISCUSSION In this representative sample, emergency nurses are willing to provide naloxone resources; furthermore, results indicate that higher knowledge, desire, and responsibility scores increase the nurse's willingness to provide naloxone resources; with education and clear expectations, emergency nurses may be able to improve the connection of patients at risk of opioid overdose with naloxone, a potentially lifesaving connection.
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Khorassani F, Espejo G. Evaluation of the Impact of Pharmacist-Driven Physician Naloxone Training on an Inpatient Psychiatric Unit. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:148-152. [PMID: 38279070 DOI: 10.1007/s40596-024-01934-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/02/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVES The purpose of this study was to evaluate the impact of pharmacist-driven naloxone training of resident physicians as part of discharge prescribing from an inpatient psychiatric unit. METHODS This is a prospective pilot study in which psychiatric resident physicians (N = 21) were educated on naloxone administration, prescribing, and counseling. A ten-question survey was designed and delivered immediately pre- and post-training to assess resident knowledge of and comfort with naloxone prescribing. Respondents were asked to rate ten statements on a scale from 1 to 5, with 1 corresponding to "strongly disagree" and 5 corresponding to "strongly agree." The primary objective was to evaluate the impact of training on prescriber knowledge and attitudes using the designed questionnaire. The secondary objective was to assess the difference in naloxone prescribing pre- and post-training implementation. Descriptive statistics and paired t-tests were conducted to assess statistical significance. RESULTS Prior to training, 11 resident physicians (approximately 50%) agreed or strongly agreed that they felt knowledgeable about naloxone and approximately 70% (n = 15) felt confident identifying patients who would benefit from naloxone at discharge. Only 10% of resident physicians (n = 2) felt comfortable counseling patients on and administering naloxone during an overdose pre-training compared to 100% after training. Thirty-seven patients were discharged and counseled on naloxone use during the study period. CONCLUSION Pharmacist-driven naloxone training significantly increased physician knowledge and comfort prescribing naloxone and resulted in an increase in naloxone prescriptions upon discharge from an inpatient psychiatric unit.
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Affiliation(s)
- Farah Khorassani
- University of California Irvine School of Pharmacy and Pharmaceutical Sciences, Irvine, CA, USA.
| | - Gemma Espejo
- University of California Irvine School of Medicine, Irvine, CA, USA
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Jankulov A, As-Sanie S, Zimmerman C, Virzi J, Srinivasan S, Choe HM, Brummett CM. Effect of Best Practice Alert (BPA) on Post-Discharge Opioid Prescribing After Minimally Invasive Hysterectomy: A Quality Improvement Study. J Pain Res 2024; 17:667-675. [PMID: 38375407 PMCID: PMC10875180 DOI: 10.2147/jpr.s432262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/28/2023] [Indexed: 02/21/2024] Open
Abstract
Purpose The aim of this study was to describe the effectiveness of an electronic health record best practice alert (BPA) in decreasing gynecologic post-discharge opioid prescribing following benign minimally invasive hysterectomy. Patients and Methods The BPA triggered for opioid orders >15 tablets. Prescribers' options included (1) decrease to 15 ≤ tablets; (2) remove the order/utilize a defaulted order set; or (3) override the alert. Results 332 patients were included. The BPA triggered 29 times. The following actions were taken among 16 patients for whom the BPA triggered: "override the alert" (n=13); "cancel the alert" (n=2); and 'remove the opioid order set' (n=1). 12/16 patients had discharge prescriptions: one patient received 20 tablets; two received 10 tablets; and nine received 15 tablets. Top reasons for over prescribing included concerns for pain control and lack of alternatives. Conclusion Implementing a post-discharge opioid prescribing BPA aligned opioid prescribing following benign minimally invasive hysterectomy with guideline recommendations.
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Affiliation(s)
- Alexandra Jankulov
- Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USA
| | - Sawsan As-Sanie
- Department of Obstetrics & Gynecology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Christopher Zimmerman
- Department of Health Information and Technology Services, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jessica Virzi
- Department of Precision Health, University of Michigan Health System, Ann Arbor, MI, USA
| | - Sudharsan Srinivasan
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Hae Mi Choe
- Department of Health Information and Technology Services, University of Michigan Health System, Ann Arbor, MI, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA
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Huang LC, Nibley H, Cheng M, Bleicher J, Ko H, Johnson JE, McCrum ML. Naloxone co-prescriptions for surgery patients prescribed opioids: A retrospective cohort study. SURGERY IN PRACTICE AND SCIENCE 2023; 15:100217. [PMID: 38222465 PMCID: PMC10786360 DOI: 10.1016/j.sipas.2023.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Surgeon-prescribed opioids contribute to 11% of prescription drug overdoses in the United States (US). With prescription opioids involved in 24% of all opioid-related overdose deaths in 2020, the US Centers for Disease Control and Prevention (CDC) recommends naloxone co-prescribing to patients at high-risk of overdose and death as a harm reduction strategy. We sought to 1) examine naloxone co-prescribing rates to surgical patients (using common post-surgical prescribing amounts) and those with potential risk factors for opioid-related overdoses or adverse events, and 2) identify the factors associated with patients receiving naloxone co-prescriptions. Methods We conducted a single-institution, retrospective study using the electronic medical records of all patients undergoing surgery at an academic institution between August 2020 and May 2021. We included post-surgical adults prescribed opioids that were sent to a pharmacy in our health system. The primary outcome was the percentage of co-prescribed naloxone in patients prescribed opioids. Results The overall naloxone co-prescription rate was low (1.7%). Only 14.6% of patients prescribed ≥350 morphine milligram equivalents (MME, equivalent to 46.7 oxycodone 5 mg tablets) and 8.6% of patients using illicit drugs were co-prescribed naloxone. On multivariable analysis, patients who were prescribed >350 MME, used illicit drugs or tobacco, underwent an elective or emergent general surgery procedure, self-identified as Hispanic, or had ASA scores of 2-4 were more likely to receive a naloxone co-prescription. Conclusions Naloxone co-prescribing after surgery remains low, even for high-risk patients. Harm reduction strategies such as naloxone, safe storage, and disposal of leftover opioids could reduce surgeons' iatrogenic contributions to the worsening US opioid crisis.
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Affiliation(s)
- Lyen C. Huang
- Department of Surgery, University of Utah, Utah, Salt Lake City, USA
- Huntsman Cancer Institute, Utah, Salt Lake City, USA
| | - Henry Nibley
- College of Science, University of Utah, Utah, Salt Lake City, USA
| | - Melissa Cheng
- Department of Internal Medicine, University of Utah, Utah, Salt Lake City, USA
| | - Josh Bleicher
- Department of Surgery, University of Utah, Utah, Salt Lake City, USA
| | - Hyunkyu Ko
- Department of Orthopedics, University of Utah, Salt Lake City, USA
| | - Jordan E. Johnson
- Department of Surgery, University of Utah, Utah, Salt Lake City, USA
| | - Marta L. McCrum
- Department of Surgery, University of Utah, Utah, Salt Lake City, USA
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Knudsen HK, Freeman PR, Oyler DR, Oser CB, Walsh SL. Scaling up overdose education and naloxone distribution in Kentucky: adoption and reach achieved through a "hub with many spokes" model. Addict Sci Clin Pract 2023; 18:72. [PMID: 38031180 PMCID: PMC10688494 DOI: 10.1186/s13722-023-00426-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Scaling up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, in communities remains a challenge. Novel models and intentional implementation strategies are needed. Drawing upon the EPIS model's phases of Exploration, Preparation, Implementation, and Sustainment (Aarons et al. in Adm Policy Ment Health 38:4-23, 2011), this paper describes the development of the University of Kentucky's unique centralized "Naloxone Hub with Many Spokes" approach to implementing OEND as part of the HEALing Communities Study (HCS-KY). METHODS To scale up OEND in eight Kentucky counties, implementation strategies were utilized at two levels: a centralized university-based naloxone dispensing unit ("Naloxone Hub") and adopting organizations ("Many Spokes"). Implementation strategies varied across the EPIS phases, but heavily emphasized implementation facilitation. The Naloxone Hub provided technical assistance, overdose education resources, and no-cost naloxone to partner organizations. Implementation outcomes across the EPIS phases were measured using data from internal study management trackers and naloxone distribution data submitted by partner organizations. RESULTS Of 209 organizations identified as potential partners, 84.7% (n = 177) engaged in the Exploration/Preparation phase by participating in an initial meeting with an Implementation Facilitator about the HCS-KY OEND program. Adoption of the HCS-KY OEND program, defined as receipt of at least one shipment of naloxone, was achieved with 69.4% (n = 145) of all organizations contacted. During the Implementation phase, partner organizations distributed 40,822 units of naloxone, with partner organizations distributing a mean of 281.5 units of naloxone (SD = 806.2). The mean number of units distributed per county was 5102.8 (SD = 3653.3; range = 1057 - 11,053) and the mean county level distribution rate was 8396.5 units per 100,000 residents (SD = 8103.1; range = 1709.5-25,296.3). Of the partner organizations that adopted the HCS-KY OEND program, 87.6% (n = 127) attended a sustainability meeting with an Implementation Facilitator and agreed to transition to the state-funded naloxone program. CONCLUSIONS These data demonstrate the feasibility of this "Hub with Many Spokes" model for scaling up OEND in communities highly affected by the opioid epidemic. Trial registration ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939 .
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA.
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science and Center for the Advancement of Pharmacy Practice, College of Pharmacy, University of Kentucky, Lexington, KY, 40536, USA
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, 40536, USA
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, and Center for Health Equity Transformation, University of Kentucky, Lexington, KY, 40536, USA
| | - Sharon L Walsh
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA
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Sze J, Chan T, Dalpoas S, Kiruthi C, Harris CM, Gundareddy V, Parker MS, Jacob E. Implementation of a Pharmacist-Led, Multidisciplinary Naloxone Patient Education Program at an Academic Medical Center. J Pharm Pract 2023; 36:1201-1210. [PMID: 35484711 DOI: 10.1177/08971900221094268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Opioid related overdoses are a leading cause of death in the United States (U.S). National, state and local initiatives have been implemented to combat the opioid crisis. However, there is a paucity of initiatives that examine the role of comprehensive naloxone education interventions for hospitalized patients. Objective: The aim of this study was to design a multidisciplinary, pharmacist-driven, standardized, patient and product tailored, inpatient naloxone education program (NEP) at a U.S. academic medical center, targeting patients at high risk of opioid overdose, and to examine patients' retention of education. Methods: This prospective pilot study targeted hospitalized patients who were considered at high-risk for opioid overdose once discharged. Using daily screening methods and established inclusion criteria, we evaluated the impact of implementing a patient-tailored NEP. The primary outcome measures were patient knowledge and awareness of naloxone use. A paired t-test analysis was conducted to assess for improvement in patient naloxone awareness and knowledge. Results: Of ninety-five patients screened, forty-four patients met inclusion criteria and nineteen patients completed naloxone education along with pre- and post-assessments. Patients more accurately completed the assessment, indicating enhanced knowledge about naloxone use and administration, following the naloxone education (4.68 ± .13 vs 3.42 ± .31 out of 5 questions, mean ± SEM; P = .0016). Conclusion: This study found a positive impact on patient knowledge of naloxone use and administration following implementation of a robust and comprehensive NEP.
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Affiliation(s)
- Jennifer Sze
- OptumRx, Customer Service, United Health Group, Overland Park, KS, USA
| | - Tsz Chan
- OptumRx, Customer Service, United Health Group, Overland Park, KS, USA
| | - Stacy Dalpoas
- Department of Pharmacy, Novant Health, Winston-Salem, NC
| | - Catherine Kiruthi
- Department of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Che Matthew Harris
- Department of General Internal Medicine, Division of Hospital Medicine, Johns Hopkins School of Medicine, and Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Venkat Gundareddy
- Department of General Internal Medicine, Division of Hospital Medicine, Johns Hopkins School of Medicine, and Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Marlena S Parker
- Department of Pharmacy, University of Pittsburgh Medical Center, Harrisburg, PA, USA
| | - Elsen Jacob
- College of Pharmacy & Health Sciences, St. John's University, Queens, NY, USA
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Stephenson A, Calvo-Friedman A, Altshuler L, Zabar S, Hanley K. Educational training to improve opioid overdose response among health center staff: a quality improvement initiative. Harm Reduct J 2023; 20:83. [PMID: 37391790 PMCID: PMC10311901 DOI: 10.1186/s12954-023-00803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 06/06/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND There were seven opioid overdoses in this New York City (NYC) federally qualified health center from December 2018 through February 2019, reflecting the rising rate of overdose deaths in NYC overall at the time. In response to these overdoses, we sought to increase the readiness of health center staff to recognize and respond to opioid overdoses and decrease stigmatizing attitudes around opioid use disorder (OUD). METHODS An hour-long training focusing on opioid overdose response was administered to clinical and non-clinical staff of all levels at the health center. This training included didactic education on topics such as the overdose epidemic, stigma around OUD, and opioid overdose response, as well as discussion. A structured assessment was administered immediately before and following the training to evaluate change in knowledge and attitudes. Additionally, participants completed a feedback survey immediately after the training to assess acceptability. Paired t-tests and analysis of variance tests were used to assess changes in pre- and post-test scores. RESULTS Over 76% of the health center staff participated in the training (N = 310). There were large and significant increases in mean knowledge and attitudinal scores from pre- to post-test (p < .001 and p < .001, respectively). While there was no significant effect of profession on attitudinal change scores, profession did have a significant effect on knowledge change scores, with administrative staff, non-clinical support staff, other healthcare staff, and therapists learning significantly more than providers (p < .001). The training had high acceptability among participants from diverse departments and levels. CONCLUSIONS An interactive educational training increased staff's knowledge and readiness to respond to an overdose as well as improved attitudes toward individuals living with OUD. TRIAL REGISTRATION This project was undertaken as a quality improvement initiative at the health center and as such was not formally supervised by the Institutional Review Board per their policies. Further, per the guidelines of the International Committee of Medical Journal Editors, registration is not necessary for clinical trials whose sole purpose is to assess an intervention's effect on providers.
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Affiliation(s)
- Audrey Stephenson
- NYC Health + Hospitals/Gotham Health, Gouverneur, 227 Madison St., New York, NY, 10002, USA
- West Chester University of Pennsylvania, West Chester, PA, USA
| | - Alessandra Calvo-Friedman
- NYC Health + Hospitals/Gotham Health, Gouverneur, 227 Madison St., New York, NY, 10002, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Lisa Altshuler
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Sondra Zabar
- NYC Health + Hospitals/Gotham Health, Gouverneur, 227 Madison St., New York, NY, 10002, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Kathleen Hanley
- NYC Health + Hospitals/Gotham Health, Gouverneur, 227 Madison St., New York, NY, 10002, USA.
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
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Sugarman OK, Breithaupt J, Wang X, Bachhuber MA. Characteristics and health service use of Medicaid-insured individuals filling naloxone under a standing order in Louisiana. J Am Pharm Assoc (2003) 2023; 63:904-908.e1. [PMID: 36653275 PMCID: PMC11059200 DOI: 10.1016/j.japh.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Naloxone distribution is a key intervention to reduce opioid overdose deaths. On January 23, 2017, Louisiana implemented a standing order that permits pharmacies to dispense naloxone to patients without a patient-specific prescription. OBJECTIVES To examine the characteristics and health service use of Louisiana Medicaid members filling naloxone under the standing order. METHODS We conducted a retrospective cohort study of Louisiana Medicaid members from January 23, 2017 to December 31, 2019. We extracted fee-for-service claims and managed care encounters for naloxone dispensed under the standing order. RESULTS Overall, there were 2053 naloxone fills by 1912 unique individuals. The total number of naloxone fills increased from 22 in 2017 to 1218 in 2019. Most members (n = 1,586, 83.0%) received any type of health service and 20.4% (n = 391) received an opioid-related health service in the 30 days prior to filling naloxone. Additionally, 12.7% (n = 242) of members had received medication for opioid use disorder (MOUD), and 42.6% (n = 815) filled a prescription opioid analgesic within the 60 days prior to filling naloxone. Nineteen members (1.0%) had an emergency department visit for overdose within 90 days after filling naloxone. CONCLUSION Standing orders play an important role in providing access to naloxone, even among Medicaid members who had recent encounters with health care providers. We identified multiple opportunities to improve naloxone prescribing among providers caring for Medicaid-insured people who use opioids, including prescribers of opioid analgesics or MOUD.
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Affiliation(s)
- Olivia K. Sugarman
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD; Program Manager, Louisiana State University Health Sciences Center - New Orleans, School of Medicine, Section of Community and Population Medicine, New Orleans, LA
| | - Jarrod Breithaupt
- University of Louisiana, Monroe, College of Pharmacy, Office of Outcomes Research and Evaluation, Monroe, LA
| | - Xiaojun Wang
- University of Louisiana, Monroe, College of Pharmacy, Office of Outcomes Research and Evaluation, Monroe, LA
| | - Marcus A. Bachhuber
- Louisiana State University Health Sciences Center - New Orleans, School of Medicine, Section of Community and Population Medicine, New Orleans, LA
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Rawal S, Osae SP, Cobran EK, Albert A, Young HN. Pharmacists' naloxone services beyond community pharmacy settings: A systematic review. Res Social Adm Pharm 2023; 19:243-265. [PMID: 36156267 DOI: 10.1016/j.sapharm.2022.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pharmacists' provision of naloxone services in community pharmacy settings is well-recognized. Recently, studies describing pharmacists' naloxone services in settings other than community pharmacies have emerged in the literature. There is a need to synthesize evidence from these studies to evaluate the scope and impact of pharmacists' naloxone services beyond community pharmacy settings. OBJECTIVES The objectives of this systematic review were to a) identify pharmacists' naloxone services and their outcomes, and b) examine knowledge, attitudes, and barriers (KAB) related to naloxone service provision in non-community pharmacy settings. METHODS Eligible studies were identified using PubMed, Web of Science, and CINAHL. Inclusion criteria were as follows: peer-reviewed empirical research conducted in the U.S. from January 2010 through February 2022; published in English; and addressed a) pharmacists' naloxone services and/or b) KAB related to the implementation of naloxone services. PRISMA guidelines were used to report this study. RESULTS Seventy-six studies were identified. The majority were non-randomized and observational; only two used a randomized controlled (RCT) design. Most studies were conducted in veterans affairs (30%) and academic medical centers (21%). Sample sizes ranged from n = 10 to 217,469, and the majority reported sample sizes <100. Pharmacists' naloxone services involved clinical staff education, utilization of screening tools to identify at-risk patients, naloxone prescribing and overdose education and naloxone dispensing (OEND). Outcomes of implementing naloxone services included improved naloxone knowledge, positive attitudes, increased OEND, and overdose reversals. Pharmacists cited inadequate training, time constraints, reimbursement issues, and stigma as barriers that hindered naloxone service implementation. CONCLUSION This systematic review found robust evidence regarding pharmacist-based naloxone services beyond community pharmacy settings. Future programs should use targeted approaches to help pharmacists overcome barriers and enhance naloxone services. Additional research is needed to evaluate pharmacist naloxone services by using rigorous methodologies (e.g., larger sample sizes, RCT designs).
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Affiliation(s)
- Smita Rawal
- Clinical and Administrative Pharmacy, University of Georgia, Athens, GA, USA.
| | - Sharmon P Osae
- Clinical and Administrative Pharmacy, University of Georgia, Albany, GA, USA
| | - Ewan K Cobran
- Department of Quantitative Health Science, Mayo Clinic College of Medicine and Sciences, Scottsdale, AZ, USA
| | - Alexis Albert
- College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Henry N Young
- Clinical and Administrative Pharmacy, University of Georgia, Athens, GA, USA
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Spadaro A, Agarwal AK, Sangha HK, Perrone J, Delgado MK, Lowenstein M. Motivation to Carry Naloxone: A Qualitative Analysis of Emergency Department Patients. Am J Health Promot 2023; 37:200-209. [PMID: 35686433 PMCID: PMC9949384 DOI: 10.1177/08901171221107908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Our aim was to explore perspectives of patients who received naloxone in the emergency department (ED) about (1) naloxone carrying and use following an ED visit and (2) motivation for performing these behaviors. DESIGN Semi-structured interviews of patients prescribed naloxone at ED discharge. SETTINGS Three urban academic EDs in Philadelphia, PA. PARTICIPANTS 25 participants completed the in-depth, semi-structured interviews and demographic surveys. Participants were majority male, African American, and had previously witnessed or experienced an overdose. METHODS Interviews were recorded, transcribed and analyzed using content analysis. We used a hybrid inductive-deductive approach that included prespecified and emergent themes. RESULTS We found that naloxone carrying behavior was variable and influenced by four main motivators: (1) naloxone access; (2) personal experience and salience of naloxone, (3) comfort with naloxone administration, and (4) societal influences on naloxone carrying. In particular, those with personal history of overdose or close friends or family at risk were motivated to carry naloxone. CONCLUSIONS Participants in this study reported several important motivators for naloxone carrying after an ED visit, including ease of naloxone access and comfort, perceived risk of experiencing or encountering an overdose, and social influences on naloxone carrying behaviors. EDs, health systems, and public health officials should consider these factors influencing motivation when designing future interventions to increase access, carrying, and use of naloxone.
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Affiliation(s)
- Anthony Spadaro
- Department of Emergency Medicine, Perelman School of Medicine and the Center for Public Health Initiatives at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anish K. Agarwal
- Department of Emergency Medicine, Perelman School of Medicine the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Hareena K. Sangha
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mucio Kit Delgado
- Department of Emergency Medicine, Perelman School of Medicine the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Margaret Lowenstein
- Division of General Internal Medicine, Perelman School of Medicine and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Chan CT, Carlson J, Lee T, Vo M, Nasr A, Hart-Cooper G. Usability and Utility of Human Immunodeficiency Virus Pre-exposure Prophylaxis Clinical Decision Support to Increase Knowledge and Pre-exposure Prophylaxis Initiations among Pediatric Providers. Appl Clin Inform 2022; 13:1141-1150. [PMID: 36351546 PMCID: PMC9731791 DOI: 10.1055/a-1975-4277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES An effective clinical decision support system (CDSS) may address the current provider training barrier to offering preexposure prophylaxis (PrEP) to youth at risk for human immunodeficiency virus (HIV) infection. This study evaluated change in provider knowledge and the likelihood to initiate PrEP after exposure to a PrEP CDSS. A secondary objective explored perceived provider utility of the CDSS and suggestions for improving CDSS effectiveness. METHODS This was a prospective study using survey responses from a convenience sample of pediatric providers who launched the interruptive PrEP CDSS when ordering an HIV test. McNemar's test evaluated change in provider PrEP knowledge and likelihood to initiate PrEP. Qualitative responses on CDSS utility and suggested improvements were analyzed using framework analysis and were connected to quantitative analysis elements using the merge approach. RESULTS Of the 73 invited providers, 43 had available outcome data and were included in the analysis. Prior to using the CDSS, 86% of participants had never been prescribed PrEP. Compared to before CDSS exposure, there were significant increases in the proportion of providers who were knowledgeable about PrEP (p = 0.0001), likely to prescribe PrEP (p < 0.0001) and likely to refer their patient for PrEP (p < 0.0001). Suggestions for improving the CDSS included alternative "triggers" for the CDSS earlier in visit workflows, having a noninterruptive CDSS, additional provider educational materials, access to patient-facing PrEP materials, and additional CDSS support for adolescent confidentiality and navigating financial implications of PrEP. CONCLUSION Our findings suggest that an interruptive PrEP CDSS attached to HIV test orders can be an effective tool to increase knowledge and likelihood to initiate PrEP among pediatric providers. Continual improvement of the PrEP CDSS based on provider feedback is required to optimize usability, effectiveness, and adoption. A highly usable PrEP CDSS may be a powerful tool to close the gap in youth PrEP access and uptake.
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Affiliation(s)
- Carrie T. Chan
- Lucile Packard Children's Hospital, Palo Alto, California, United States,Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California, United States,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States,Address for correspondence Carrie Chan, MSN, MPH, CPNP Stanford Children's Health750 Welch Road, Suite 212, Palo Alto, CA 94304United States
| | - Jennifer Carlson
- Department of Pediatrics—Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California United States
| | - Tzielan Lee
- Department of Pediatrics—Rheumatology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Megen Vo
- Department of Pediatrics—Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California United States
| | - Annette Nasr
- Lucile Packard Children's Hospital, Palo Alto, California, United States,Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California, United States,Department of Pediatrics-Gastroenterology, Stanford University School of Medicine, Palo Alto, California United States
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Pollini RA, Slocum S, Ozga JE, Joyce R, Xuan Z, Green TC, Walley AY. Pharmacy naloxone codispensing: A mixed methods study of practices and perspectives under a statewide standing order program. J Am Pharm Assoc (2003) 2022; 62:1546-1554. [PMID: 35450833 PMCID: PMC9464657 DOI: 10.1016/j.japh.2022.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In a previous statewide naloxone purchase trial conducted in Massachusetts, we documented high levels of naloxone accessibility, upon patient request, under the state's naloxone standing order (NSO) program. Equally important for reducing overdose mortality rates is expanding naloxone access via codispensing alongside opioid prescription and syringe purchases at pharmacies. OBJECTIVE To understand naloxone codispensing from the perspective of pharmacists under the Massachusetts NSO program. METHODS The study used a mixed methods design involving 3 focus groups and a quantitative survey. Participants in both the focus groups (N = 27) and survey (N = 339) were licensed Massachusetts pharmacists. Focus groups were conducted at 3 separate professional conferences for pharmacists. The survey was conducted using a stratified random sample of 400 chain and independent retail pharmacies across Massachusetts. All data were collected between September 2018 and November 2019. Quantitative and qualitative analyses examined current policies, practices, and attitudes regarding naloxone codispensing for patients at risk of opioid overdose. RESULTS Most pharmacists (69%) reported that they, their pharmacy, or both promoted codispensing alongside opioid prescriptions. A majority promoting naloxone codispensing did so for patients prescribed high opioid dosages (80%); fewer promoted codispensing for patients also prescribed benzodiazepines (20%). Facilitators to codispensing were pre-existing relationships between pharmacists and prescribers, mandatory pharmacist consultation, and universal naloxone promotion to all patients meeting certain criteria. Barriers to codispensing were pharmacists' concerns about offending patients by initiating a conversation about naloxone, insufficient technician training, workflow and resource constraints, and misconceptions surrounding naloxone. We found no substantive differences in outcomes between chain and independent pharmacies. CONCLUSION We documented several facilitators and barriers to naloxone codispensing in Massachusetts pharmacies. Areas amenable to intervention include increased training for front-line pharmacy technicians, mandatory pharmacist consultation for opioid-prescribed patients, workflow reorganization, and addressing stigma concerns on the pharmacist end.
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Affiliation(s)
- Robin A. Pollini
- Associate Professor (pollini), Research Associate (Slocum), Postdoctoral Fellow (Ozga), and Project Coordinator (Joyce), Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown WV
- Associate Professor, Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University
| | - Susannah Slocum
- Associate Professor (pollini), Research Associate (Slocum), Postdoctoral Fellow (Ozga), and Project Coordinator (Joyce), Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown WV
| | - Jenny E. Ozga
- Associate Professor (pollini), Research Associate (Slocum), Postdoctoral Fellow (Ozga), and Project Coordinator (Joyce), Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown WV
| | - Rebecca Joyce
- Associate Professor (pollini), Research Associate (Slocum), Postdoctoral Fellow (Ozga), and Project Coordinator (Joyce), Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown WV
| | - Ziming Xuan
- Associate Professor, Department of Community Health Sciences, School of Public Health, Boston University, Boston MA
| | - Traci C. Green
- Professor, The Opioid Policy Research Collaborative, Institute of Behavioral Health, Heller School for Policy and Management, Brandeis University, Waltham, MA
| | - Alexander Y. Walley
- Professor, Grayken Center for Addiction, Boston Medical Center, Boston University School of Medicine, Boston MA
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Buckel WR, Stenehjem EA, Hersh AL, Hyun DY, Zetts RM. Harnessing the Power of Health Systems and Networks for Antimicrobial Stewardship. Clin Infect Dis 2022; 75:2038-2044. [PMID: 35758333 PMCID: PMC9710658 DOI: 10.1093/cid/ciac515] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 01/17/2023] Open
Abstract
Twenty of 21 health systems and network-based antimicrobial stewardship programs (ASPs) who were invited participated in a questionnaire, a webinar, and focus groups to understand implementation strategies for system-wide antimicrobial stewardship. Four centralized ASPs structures emerged. Of participating organizations, 3 (15%) confirmed classification as collaborative, 3 (15%) as centrally coordinated, 3 (15%) as in between or in transition between centrally coordinated and centrally led, 8 (40%) as centrally led, 2 (10%) as collaborative, consultative network. One (5%) organization considered themselves to be a hybrid. System-level stewardship responsibilities varied across sites and generally fell into 6 major categories: building and leading a stewardship community, strategic planning and goal setting, development of validated data streams, leveraging tools and technology for stewardship interventions, provision of subject-matter expertise, and communication/education. Centralized ASPs included in this study most commonly took a centrally led approach and engaged in activities tailored to system-wide goals.
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Affiliation(s)
- Whitney R Buckel
- Pharmacy Services, Intermountain Healthcare , Taylorsville, Utah , USA
| | - Edward A Stenehjem
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Healthcare , Salt Lake City, Utah , USA
| | - Adam L Hersh
- Division of Pediatric Infectious Diseases, University of Utah School of Medicine , Salt Lake City, Utah , USA
| | - David Y Hyun
- The Pew Charitable Trusts , Washington, District of Columbia , USA
| | - Rachel M Zetts
- The Pew Charitable Trusts , Washington, District of Columbia , USA
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Parmar J, Sacrey LA, Anderson S, Charles L, Dobbs B, McGhan G, Shapkin K, Tian P, Triscott J. Facilitators, barriers and considerations for the implementation of healthcare innovation: A qualitative rapid systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:856-868. [PMID: 34558143 DOI: 10.1111/hsc.13578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
Family caregiving scholars recommend that health providers receive competency-based education to partner with and support family caregivers to care and to maintain their own health. While it may be relatively easy to develop competency-based education for healthcare providers, ensuring widespread uptake and spread and scale of healthcare education is critical to ensuring consistent person-centered support for all family caregivers (FCGs) throughout the care trajectory. The development of novel healthcare innovations requires implementation strategies for uptake and spread, with implementation involving the use of strategies to integrate a novel innovation into healthcare. Research suggests that there are many factors involved in successful implementation and a synthesis of potential factors is warranted. The purpose of this review is to provide an in-depth examination of facilitators, barriers and considerations for implementation of a novel healthcare innovation that will be used to develop an implementation plan for spread and scale of our competency-based education for health providers to learn about person-centered care for FCGs. A systematic review of published and grey literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA [Moher et al., 2015]) guidelines. The systematic review involved searching four databases for original research articles that described barriers, facilitators and/or other considerations when implementing innovations. Twenty-eight articles were included in the qualitative thematic analyses and described three areas of implementation research: barriers, facilitators and recommendations. There were major and parallel themes that emerged under facilitators and barriers. There were a wide variety of strategies that were identified as recommendations. The findings were synthesised into five considerations for implementation: Research and information sharing, intentional implementation planning, organisational underpinnings, creating the clinical context and facilitative training. This review provides an integrative overview of identified facilitators, barriers and recommendations for implementation that may aid in developing implementation strategies that can be tailored to the local context or innovation being implemented.
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Affiliation(s)
- Jasneet Parmar
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- Edmonton Zone Home Living, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lori Ann Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon Anderson
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lesley Charles
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bonnie Dobbs
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gwen McGhan
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | | | - Peter Tian
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jean Triscott
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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Gugala E, Briggs O, Moczygemba LR, Brown CM, Hill LG. Opioid harm reduction: A scoping review of physician and system-level gaps in knowledge, education, and practice. Subst Abus 2022; 43:972-987. [PMID: 35426772 DOI: 10.1080/08897077.2022.2060423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Harm reduction includes treatment and prevention approaches rather than abstinence, as a public health strategy for mitigating the opioid epidemic. Harm reduction is a new strategy for many healthcare professionals, and gaps in knowledge and practices may lead to barriers to optimal treatment. Our objective was to identify and describe gaps in physicians' knowledge, education, and practice in harm reduction strategies related to opioid overdose. Methods: We searched the PubMed, CINAHL, and Web of Science databases for articles published between 2015 and 2021, published in English, containing empirical evidence, addressing opioid harm reduction, and identifying gaps in physicians' knowledge, education, or practice. Results: Thirty-seven studies were included. Studies examined how physicians' perceptions or stigma influenced harm reduction efforts and addressed clinical knowledge gaps in overdose treatment and prevention and OUD treatment. Less than half of the studies addressed access issues at the system level, above the individual healthcare professional. Conclusion: Individual-level interventions should be addressed with professional continuing education and curricular-based changes through experiential and interprofessional education. System-level gaps can be remedied by increasing patient access to care, creating policies favorable to harm reduction, and extending resources to provide harm reduction strategies.
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Affiliation(s)
- Emma Gugala
- TxCORE and PhARM Program, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Owanate Briggs
- TxCORE and PhARM Program, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Leticia R Moczygemba
- TxCORE and PhARM Program, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Carolyn M Brown
- TxCORE and PhARM Program, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Lucas G Hill
- TxCORE and PhARM Program, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
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Willis VC, Thomas Craig KJ, Jabbarpour Y, Scheufele EL, Arriaga YE, Ajinkya M, Rhee KB, Bazemore A. Digital Health Interventions to Enhance Prevention in Primary Care: Scoping Review. JMIR Med Inform 2022; 10:e33518. [PMID: 35060909 PMCID: PMC8817213 DOI: 10.2196/33518] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Disease prevention is a central aspect of primary care practice and is comprised of primary (eg, vaccinations), secondary (eg, screenings), tertiary (eg, chronic condition monitoring), and quaternary (eg, prevention of overmedicalization) levels. Despite rapid digital transformation of primary care practices, digital health interventions (DHIs) in preventive care have yet to be systematically evaluated. Objective This review aimed to identify and describe the scope and use of current DHIs for preventive care in primary care settings. Methods A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and Medical Subject Headings terms covering primary care professionals, prevention and care management, and digital health. A subgroup analysis identified relevant studies conducted in US primary care settings, excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (eg, health care performance and implementation science), and study quality as per Oxford levels of evidence were abstracted. Results The search yielded 5274 citations, of which 1060 full-text articles were identified. Following a subgroup analysis, 241 articles met the inclusion criteria. Studies primarily examined DHIs among health information technologies, including EHRs (166/241, 68.9%), clinical decision support (88/241, 36.5%), telehealth (88/241, 36.5%), and multiple technologies (154/241, 63.9%). DHIs were predominantly used for tertiary prevention (131/241, 54.4%). Of the core primary care functions, comprehensiveness was addressed most frequently (213/241, 88.4%). DHI users were providers (205/241, 85.1%), patients (111/241, 46.1%), or multiple types (89/241, 36.9%). Reported outcomes were primarily clinical (179/241, 70.1%), and statistically significant improvements were common (192/241, 79.7%). Results were summarized across the following 5 topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. The quality of the included studies was moderate to low. Conclusions Preventive DHIs in primary care settings demonstrated meaningful improvements in both clinical and nonclinical outcomes, and across user types; however, adoption and implementation in the US were limited primarily to EHR platforms, and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluations of negative results, effects on health disparities, and many other gaps remain to be explored.
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Affiliation(s)
- Van C Willis
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Kelly Jean Thomas Craig
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yalda Jabbarpour
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Elisabeth L Scheufele
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yull E Arriaga
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Monica Ajinkya
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Kyu B Rhee
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Andrew Bazemore
- The American Board of Family Medicine, Lexington, KY, United States
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Martignetti L, Sun W. Perspectives of Stakeholders of Equitable Access to Community Naloxone Programs: A Literature Review. Cureus 2022; 14:e21461. [PMID: 35223245 PMCID: PMC8858082 DOI: 10.7759/cureus.21461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/02/2022] Open
Abstract
The purpose of this review is to examine the existing literature about facilitators and barriers influencing equitable access to naloxone programs by individuals who use opioids. A total of 49 published articles were examined, which generated four overarching themes:(1) Stigma as a barrier to access; (2) Lack of a wide range of stakeholder perspectives; (3) Need for a comprehensive understanding of factors affecting equitable access to naloxone programs; (4) Facilitators to increase the access of community naloxone programs. Our review highlighted the importance of advocacy in practice, education, administration, and policy to address the health inequities that exist in naloxone distribution programs. Advocacy activities involve the need for health care professionals to engage in social justice practice through evidence-based informed research about the facts of opioid use; challenging the stigma toward victim-blaming against naloxone users; as well as promoting program development and health policy to bring about equitable access to naloxone programs by marginalized and socially disadvantaged populations.
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18
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Chan CT, Vo M, Carlson J, Lee T, Chang M, Hart-Cooper G. Pediatric Provider Utilization of a Clinical Decision Support Alert and Association with HIV Pre-exposure Prophylaxis Prescription Rates. Appl Clin Inform 2022; 13:30-36. [PMID: 35021253 PMCID: PMC8754687 DOI: 10.1055/s-0041-1740484] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES An electronic clinical decision support (CDS) alert can provide real-time provider support to offer pre-exposure prophylaxis (PrEP) to youth at risk for human immunodeficiency virus (HIV). The purpose of this study was to evaluate provider utilization of a PrEP CDS alert in a large academic-community pediatric network and assess the association of the alert with PrEP prescribing rates. METHODS HIV test orders were altered for patients 13 years and older to include a hard-stop prompt asking if the patient would benefit from PrEP. If providers answered "Yes" or "Not Sure," the CDS alert launched with options to open a standardized order set, refer to an internal PrEP specialist, and/or receive an education module. We analyzed provider utilization using a frequency analysis. The rate of new PrEP prescriptions for 1 year after CDS alert implementation was compared with the year prior using Fisher's exact test. RESULTS Of the 56 providers exposed to the CDS alert, 70% (n = 39) responded "Not sure" to the alert prompt asking if their patient would benefit from PrEP, and 54% (n = 30) chose at least one clinical support tool. The PrEP prescribing rate increased from 2.3 prescriptions per 10,000 patients to 6.6 prescriptions per 10,000 patients in the year post-intervention (p = 0.02). CONCLUSION Our findings suggest a knowledge gap among pediatric providers in identifying patients who would benefit from PrEP. A hard-stop prompt within an HIV test order that offers CDS and provider education might be an effective tool to increase PrEP prescribing among pediatric providers.
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Affiliation(s)
- Carrie T. Chan
- Center for Adolescent Health, Lucile Packard Children's Hospital, Palo Alto, California, United States,Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California, United States,Address for correspondence Carrie Chan, MSN, MPH, CPNP Stanford Children's Health750 Welch Road Suite 212, Palo Alto, CA 94304United States
| | - Megen Vo
- Department of Pediatrics—Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California, United States
| | - Jennifer Carlson
- Department of Pediatrics—Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California, United States
| | - Tzielan Lee
- Department of Pediatrics — Rheumatology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Marcello Chang
- Stanford University School of Medicine, Stanford, California, United States
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Behrends CN, Gutkind S, Winkelstein E, Wright M, Dolatshahi J, Welch A, Paone D, Kunins HV, Schackman BR. Costs of opioid overdose education and naloxone distribution in New York City. Subst Abus 2022; 43:692-698. [PMID: 34666633 PMCID: PMC9048167 DOI: 10.1080/08897077.2021.1986877] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Naloxone is an opioid antagonist medication that can be administered by lay people or medical professionals to reverse opioid overdoses and reduce overdose mortality. Cost was identified as a potential barrier to providing expanded overdose education and naloxone distribution (OEND) in New York City (NYC) in 2017. We estimated the cost of delivering OEND for different types of opioid overdose prevention programs (OOPPs) in NYC. Methods: We interviewed naloxone coordinators at 11 syringe service programs (SSPs) and 10 purposively sampled non-SSPs in NYC from December 2017 to September 2019. The samples included diverse non-SSP program types, program sizes, and OEND funding sources. We calculated one-time start up costs and ongoing operating costs using micro-costing methods to estimate the cost of personnel time and materials for OEND activities from the program perspective, but excluding naloxone kit costs. Results: Implementing an OEND program required a one-time median startup cost of $874 for SSPs and $2,548 for other programs excluding overhead, with 80% of those costs attributed to time and travel for training staff. SSPs spent a median of $90 per staff member trained and non-SSPs spent $150 per staff member. The median monthly cost of OEND program activities excluding overhead was $1,579 for SSPs and $2,529 for non-SSPs. The costs for non-SSPs varied by size, with larger, multi-site programs having higher median costs compared to single-site programs. The estimated median cost per kit dispensed excluding and including overhead was $19 versus $25 per kit for SSPs, and $36 versus $43 per kit for non-SSPs, respectively. Conclusions: OEND operating costs vary by program type and number of sites. Funders should consider that providing free naloxone to OEND programs does not cover full operating costs. Further exploration of cost-effectiveness and program efficiency should be considered across different types of OEND settings.
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Affiliation(s)
- Czarina N. Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY
| | - Sarah Gutkind
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Emily Winkelstein
- Bureau of Alcohol and Drug Use Prevention, Care and Treatment, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Monique Wright
- Bureau of Alcohol and Drug Use Prevention, Care and Treatment, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Jennifer Dolatshahi
- Bureau of Alcohol and Drug Use Prevention, Care and Treatment, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Alice Welch
- Bureau of Alcohol and Drug Use Prevention, Care and Treatment, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Denise Paone
- Bureau of Alcohol and Drug Use Prevention, Care and Treatment, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Hillary V. Kunins
- Bureau of Alcohol and Drug Use Prevention, Care and Treatment, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY
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Skelton JB, Dharbhamalla V. The role of managed care pharmacy in coprescribing naloxone for patients with specific risk: recommendations from the AMCP Addiction Advisory Group. J Manag Care Spec Pharm 2021; 28:100-106. [PMID: 34949114 PMCID: PMC10372947 DOI: 10.18553/jmcp.2022.28.1.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Prescription opioid misuse remains a significant cause of morbidity and mortality associated with drug overdose. Researchers, government agencies, public health interests, and professional organizations support the benefits of naloxone coprescribing for patients on chronic opioid therapy to prevent deaths from opioid overdose. However, gaps remain in the provision of naloxone to patients at risk. Currently, less than 1% of patients who should be prescribed naloxone with their opioid medications obtain a prescription for naloxone, illustrating an opportunity for health care providers to conduct thorough risk assessments for patients taking opioids and coprescribing naloxone to those at risk. There are documented barriers to the provision of naloxone for primary care providers, pharmacists, and patients. Managed care organizations have also created barriers. To better understand and evaluate trends in treatment, coverage, policies, and needs associated with providing health services to patients with substance use disorders, the Academy of Managed Care Pharmacy (AMCP) Addiction Advisory Group conducted a survey in 2019. Eighty percent of the managed behavioral health organizations and 47% of AMCP payer members who responded to the survey encouraged naloxone coprescribing in patients at high risk of overdose; however, no organizations require coprescribing. Health plans, managed care organizations, prescribers, pharmacists, patients, and others have important roles in decreasing the morbidity and mortality associated with opioid overdose. In particular, managed care organizations can take specific and meaningful actions to implement payment policies that improve naloxone coprescribing for patients at risk. In this article, opportunities have been outlined for managed care leadership that actively support public health policies for naloxone coprescribing, and 7 recommendations are presented. DISCLOSURES: The AMCP Addiction Advisory Group and the development of this article were supported by Alkermes and Precision Toxicology. Sponsors participated in the advisory group, which provided guidance in the development of the manuscript. Dharbhamalla is employed by AMCP. Skelton is a paid consultant working with AMCP.
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Cruz TH, Bachyrycz A, Rodriguez DE, Ma X, Roberts MH, Chambers S, Rafi J, Sanchez A, Bakhireva L. CONSIDER New Mexico: Effects of naloxone training among pharmacists and pharmacy technicians. J Am Pharm Assoc (2003) 2021; 62:757-765. [PMID: 35016857 DOI: 10.1016/j.japh.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pharmacists serve a critical role in providing health care, especially in medically underserved areas. Despite the opioid crisis and legislation in most states allowing pharmacists to dispense naloxone without a prescription from another provider, pharmacists face multiple barriers to dispensing naloxone. OBJECTIVE This study tested the effectiveness of CONSIDER New Mexico, an innovative educational initiative designed to increase naloxone dispensing by pharmacies. METHODS A quasi-experimental study was conducted in New Mexico in 2019-2020. Community pharmacists and pharmacy technicians were recruited from a purposive sample of pharmacies. Data were collected through pre- and postintervention surveys with 65 pharmacists and 44 technicians from 49 pharmacies. Data analysis included hybrid fixed-effects regression models of variables associated with pre-post intervention change in intent to dispense naloxone and generalized least squares with maximum likelihood estimation for pre-post intervention change in naloxone dispensing. RESULTS Positive intervention effects were observed for measures of normative beliefs, self-efficacy, and intent to dispense naloxone (P < 0.05). Changes in normative beliefs and self-efficacy were associated with greater intent to offer naloxone to patients (P < 0.05). In addition, the median number of naloxone prescriptions dispensed per month increased 3.5 times after intervention. A statistically significant positive association was observed between the intervention and naloxone dispensing after adjusting for other factors (P < 0.001). Pharmacies providing more than 4 additional health services were more likely to increase naloxone dispensing postintervention than pharmacies offering not more than 2 services (P < 0.01). This difference averaged 19 naloxone prescriptions per month. Estimated change in dispensing postintervention was statistically significantly lower at independent, clinic-based, and other pharmacies where an average of 36 fewer naloxone prescriptions were dispensed per month compared with chain drug stores (P = 0.03). CONCLUSION The CONSIDER New Mexico intervention effectively increased self-efficacy, intent to dispense, and naloxone dispensing. Findings will inform future research examining widespread dissemination and implementation of the intervention and the sustainability of intervention effects.
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Kelsch JR, Bailey AM, Baum RA, Metts EL, Weant KA. Guidance for emergency medicine pharmacists to improve care for people with opioid use disorder. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jordan R. Kelsch
- Department of Pharmacy University of Kentucky HealthCare Lexington Kentucky USA
| | - Abby M. Bailey
- Department of Pharmacy University of Kentucky HealthCare Lexington Kentucky USA
| | - Regan A. Baum
- Department of Pharmacy University of Kentucky HealthCare Lexington Kentucky USA
| | - Elise L. Metts
- Department of Pharmacy University of Kentucky HealthCare Lexington Kentucky USA
| | - Kyle A. Weant
- Department of Clinical Pharmacy and Outcome Sciences University of South Carolina College of Pharmacy Columbia South Carolina USA
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McQuillan A. Clinical pharmacist involvement in expanding naloxone distribution in a veteran population. Am J Health Syst Pharm 2021; 79:472-476. [PMID: 34755851 DOI: 10.1093/ajhp/zxab424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To describe the process used in a clinical pharmacist specialist (CPS)-led Opioid Overdose Education and Naloxone Distribution (OEND) program initiative to increase naloxone distribution to veterans at high risk for overdose via provider education and identification of barriers to naloxone distribution. SUMMARY Drug overdose is the leading cause of accidental death in the United States. One step toward counteracting the epidemic includes expanding access to and use of naloxone. The Veterans Health Administration has developed initiatives to target veterans at risk for opioid overdose, such as the Veterans Affairs (VA) OEND program. Pharmacists can play a unique role in OEND by both prescribing naloxone and educating patients and providers on risk mitigation strategies. Through provider education, patient education, and facility-wide initiatives, naloxone prescribing was increased by 9-fold from August 2016 to August 2018. In addition, the number of new naloxone prescribers increased by almost 7-fold during the intervention period. Naloxone distribution to high-risk groups drastically increased across all target groups. CONCLUSION CPS involvement in promoting OEND at VAPHS drastically increased rates of prescribing of naloxone kits to veterans at risk for opioid overdose. This initiative showed that a CPS can play multiple roles in supporting OEND outreach at a large healthcare setting.
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Irwin MN, Walkerly A. Role of the pharmacist in acute care interventions for opioid use disorder: A scoping review. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Madison N. Irwin
- Department of Pharmacy Services Michigan Medicine Ann Arbor Michigan USA
- University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | - Autumn Walkerly
- Department of Pharmacy Services Michigan Medicine Ann Arbor Michigan USA
- University of Michigan College of Pharmacy Ann Arbor Michigan USA
- Department of Clinical Pharmacy University of Southern California School of Pharmacy, Los Angeles County + USC Medical Center Los Angeles California USA
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State laws that authorize pharmacists to prescribe naloxone are associated with increased naloxone dispensing in retail pharmacies. Drug Alcohol Depend 2021; 227:109012. [PMID: 34482035 DOI: 10.1016/j.drugalcdep.2021.109012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The opioid crisis in the United States continues to worsen. Several states have passed laws granting pharmacists the authority to independently prescribe (not just dispense) naloxone. Since pharmacists are accessible healthcare providers, enhancing their ability to prescribe naloxone, an effective opioid overdose reversal agent, may help combat the ongoing opioid overdose epidemic. METHOD Using a nationally representative database on drug dispensing in 2010 to 2018 from Symphony Health, we conducted a cross-sectional study to assess whether state laws authorizing pharmacists to prescribe naloxone were associated with increased naloxone dispensing from retail pharmacies. RESULTS The number of naloxone prescriptions dispensed from retail pharmacies increased from 2010 to 2018 and doubled from 2017 to 2018. The presence of state laws authorizing pharmacists to prescribe naloxone is associated with an average increase of 331(95% CI = 43.56, 618.49) prescription dispensed per state per quarter. This represents an approximately 53% increase in naloxone dispensed compared to pharmacies in states where there were no such laws. CONCLUSIONS Our study suggests that state laws that allow pharmacists to prescribe and not just dispense naloxone at retail pharmacies can increase the availability and accessibility of naloxone. Adopting and implementing such laws may help reduce serious and life-threatening opioid overdoses.
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Opioid Overdose Prevention Training for Health Care Teams in Underserved Communities. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Coons LM, Gardea Hart J, White A, Summers S. Naloxone Prescribing and Education in Outpatient Pain Management and Palliative Care. J Pain Palliat Care Pharmacother 2021; 35:100-105. [PMID: 33844624 DOI: 10.1080/15360288.2020.1843587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Over the past two decades, opioid use and overdose have increased substantially. Naloxone, an opioid overdose reversal agent, has been one of many risk mitigation strategies for preventing mortality due to overdose. Most literature describing naloxone utilization has been about populations of illicit drug users and patients in hospitals, primary care, and pharmacies. There is limited information regarding naloxone prescribing and training for opioid users in specialty pain management clinics. Furthermore, there are no known publications concerning patients receiving palliative care services and overdose prevention. Pain and palliative care patients are commonly at risk of opioid overdose. In an interdisciplinary outpatient pain and palliative care clinic, pharmacists implemented naloxone prescribing and education. Eleven patients at increased risk for overdose were prescribed naloxone and educated on overdose risk factors, recognition, and management. Seven patients reported picking up their naloxone prescription from the pharmacy, and none reported using it within two weeks of the initial education. This intervention was deemed successful within the clinic, but small sample size and the pharmacist role may not be replicable within other pain and palliative care settings. It encourages further research of overdose risk and prevention in pain management and palliative care.
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Siff JE, Margolius D, Papp J, Boulanger B, Watts B. A Healthcare System-Level Intervention to Increase Naloxone Availability for Patients With Opioid Prescriptions. Am J Addict 2020; 30:179-182. [PMID: 33378097 DOI: 10.1111/ajad.13136] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES National guidelines recommend prescribing naloxone to patients receiving chronic opioids. However, provider adherence to naloxone co-prescribing best practices is poor and knowledge gaps for improvement efforts are large. As part of a system-wide quality improvement intervention to improve opioid safety, we sought to improve access to naloxone for patients with opioid prescriptions. METHODS A prompt for naloxone co-prescribing was implemented in the electronic health record. Baseline data and data after implementation were collected for naloxone co-prescribing and fill rates on naloxone prescriptions s (n = 9122 pre, 8368 post). RESULTS In the 9 months following the implementation of the electronic prompt, the total number of naloxone prescriptions increased more than 15-fold. Patients prescribed naloxone filled their naloxone prescriptions similarly (42%) before and after the prompt implementation, resulting in a marked increase in the absolute number of patients with access to naloxone. Patient fill rates varied by clinical area (33% emergency medicine to 47% general medicine). CONCLUSION AND SCIENTIFIC SIGNIFICANCE An electronic prompt, encouraging providers to prescribe naloxone to at-risk patients led to a marked increase in the percentage of patients with an active naloxone prescription. The availability of naloxone in communities saves lives and this study is the first to demonstrate an intervention, which led to increased naloxone prescribing and reported on actual pharmacy fills of naloxone when co-prescribed with opioids. (Am J Addict 2020;00:00-00).
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Affiliation(s)
- Jonathan E Siff
- The MetroHealth System, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David Margolius
- The MetroHealth System, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joan Papp
- The MetroHealth System, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Bernard Boulanger
- The MetroHealth System, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Brook Watts
- The MetroHealth System, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
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Naloxone provision to emergency department patients recognized as high-risk for opioid use disorder. Am J Emerg Med 2020; 40:173-176. [PMID: 33243535 DOI: 10.1016/j.ajem.2020.10.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Patients with opioid use disorder (OUD) are at increased risk for overdose and death. Clinical practice guidelines and professional organization policy statements recommend providing naloxone to patients at risk for overdose. We sought to characterize fidelity to naloxone practice recommendations in a cohort of Emergency Department (ED) patients in whom opioid use disorder was suspected by the treating physician. METHODS This single-center cross-sectional study evaluated electronic health records from an urban academic ED with 73,000 annual encounters in a region with a high prevalence of OUD. Patients ≥18 years old with encounters from January 1, 2018 to November 30, 2019 were included if discharged from the ED and either administered buprenorphine in the ED or referred to outpatient substance use treatment. The primary outcome measure was the percentage of included patients provided naloxone (take-home or prescription). We used random effects multivariable logistic regression (accounting for multiple patient encounters) to estimate the odds ratio (OR) for receiving naloxone. RESULTS Of 1036 eligible patient encounters, 320 resulted in naloxone provision (30.9%, 95% CI: 28.1-33.8). Naloxone provision occurred for 33.6% (95% CI 30.5-36.7) of 900 patients referred to outpatient substance use treatment without ED buprenorphine administration, 10.6% (95% CI 5.0-19.2) of 85 patients administered buprenorphine and not referred to outpatient substance use treatment, and 17.6% (95% CI 8.4-30.9) of 51 patients administered buprenorphine and referred to outpatient treatment. After controlling for age, sex, race, and prior provision of naloxone, the administration of buprenorphine was associated with a 94% lower odds (aOR = 0.06 [95% CI 0.011-0.33]) for naloxone provision compared to those only referred to outpatient treatment. CONCLUSION A majority of ED patients who received an intervention targeted at OUD, in an ED where take-home naloxone is freely available, did not receive either take-home naloxone or a prescription for naloxone at discharge. Patients receiving buprenorphine were less likely to receive naloxone than patients only referred to outpatient treatment. These data suggest barriers other than recognition of potential OUD and naloxone availability impact provision of naloxone and argue for a treatment "bundle" as a conceptual model for care of ED patients with suspected OUD.
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Coon SA, Hill LG, Hutchison RW, Arnold LM, Jarrett JB, Ottney AR, Oung AB, Painter NA, Smith MA, Stranges PM, Tran TH, McFee Winans AR, Bratberg JP. Mobilizing pharmacists to address the opioid crisis: A joint opinion of the ambulatory care and adult medicine practice and research networks of the American College of Clinical Pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1331] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Scott A. Coon
- Department of Pharmacotherapeutics & Clinical Research University of South Florida, Taneja College of Pharmacy, Morsani College of Medicine Tampa Florida USA
| | - Lucas G. Hill
- Division of Pharmacy Practice The University of Texas at Austin College of Pharmacy Austin Texas USA
| | - Robert W. Hutchison
- Department of Pharmacy Practice Texas A&M Irma Lerma Rangel College of Pharmacy Round Rock Texas USA
| | - Lindsay M. Arnold
- Department of Pharmacy Services St. Elizabeth's Medical Center Brighton Massachusetts USA
| | - Jennie B. Jarrett
- Department of Pharmacy Practice University of Illinois at Chicago, College of Pharmacy Chicago Illinois USA
| | - Anne R. Ottney
- Department of Pharmacy Practice Ferris State University, College of Pharmacy Big Rapids Michigan USA
| | - Alvin B. Oung
- Department of Pharmacy Practice University of Wyoming School of Pharmacy Laramie Wyoming USA
| | - Nathan A. Painter
- Division of Clinical Pharmacy University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences San Diego California USA
| | - Michael A. Smith
- Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | - Paul M. Stranges
- Department of Pharmacy Practice University of Illinois at Chicago, College of Pharmacy Chicago Illinois USA
| | - Tran H. Tran
- Department of Pharmacy Practice Midwestern University Chicago College of Pharmacy Downers Grove Illinois USA
| | - Amanda R. McFee Winans
- Section of Clinical Pharmacy, Department of Pharmaceutical Care Services Bassett Medical Center Cooperstown New York USA
| | - Jeffrey P. Bratberg
- Department of Pharmacy Practice University of Rhode Island College of Pharmacy Kingston Rhode Island USA
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Predictors of receiving an emergency department naloxone prescription following an opioid overdose. Am J Emerg Med 2020; 46:763-764. [PMID: 32972794 DOI: 10.1016/j.ajem.2020.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 11/21/2022] Open
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Opioid Prescribing with Take-Home Naloxone: Rationale and Recommendations. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00419-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Emergency Nurse Perceptions of Naloxone Distribution in the Emergency Department. J Emerg Nurs 2020; 46:675-681.e1. [DOI: 10.1016/j.jen.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022]
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Abstract
BACKGROUND In 2017, approximately 11.4 million Americans used opioids inappropriately. Nearly 47,600 deaths in 2017 were attributable to overdose on opioids. Intranasal naloxone was approved by the Food and Drug Administration in 2015 as a rescue medication for opioid overdose. New York State launched a prescription drug monitoring program in 2012, the Internet System for Tracking Over-Prescribing (I-STOP), that required completion before dispensing any controlled substance. Currently, prescribing naloxone at our institution requires 10 clicks and 2 free text boxes. The goal of this project was to increase the prescribing of intranasal naloxone by utilizing EMR automation and visualization tools. METHODS Our intervention embedded a section within the required I-STOP note, displaying the last date naloxone was prescribed and an option to "prescribe intranasal naloxone." If checked, a prepopulated order dialog box was generated. RESULTS Intranasal naloxone orders for the institution totaled 65 for 2 months before the intervention and 203 for 2 months after the intervention, with 112 (55%) coming directly from the I-STOP note modification. Ease of prescribing improved as total clicks were reduced from 10 to 2, and free text boxes from 2 to 0. CONCLUSIONS Our findings suggest that a clinical decision support system can be an effective way to increase hospital-wide naloxone prescribing rates. We were able to increase prescribing rates by more than three-fold, significantly increasing the availability of a rescue medication to individuals at high-risk for overdose. Intranasal naloxone prescribing increased with the implementation of a visual reminder and a more intuitive ordering experience while preserving provider autonomy.
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Gruver BR, Jiroutek MR, Kelly KE. Naloxone coprescription in U.S. ambulatory care centers and emergency departments. J Am Pharm Assoc (2003) 2020; 60:e44-e49. [PMID: 32278514 DOI: 10.1016/j.japh.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The rise in both drug overdoses and deaths owing to opioids has been increasing for at least 2 decades in the United States. Naloxone-prescribing programs have been in use since the mid-2000s with a guideline to manage their use being published in 2012. This study seeks to determine the national prevalence of naloxone coprescribing within U.S. ambulatory care centers and emergency departments (EDs). METHODS This study was a retrospective, cross-sectional, observational analysis of data collected by the Centers for Disease Control and Prevention (CDC) in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey: Emergency Department Summary during the years 2012-2016. All survey participants aged 18 years or older with documented opioid use-with the exception of codeine, dihydrocodeine, and opioid-containing cough syrups-were included. Variables of interest that were available in the data were summarized. RESULTS Naloxone was coprescribed with opioids in less than 0.1% of visits. Despite 5 years of data combined across 2 national surveys including 48,158 adults with documented opioid use, further analyses of naloxone coprescription could not be performed owing to the limited number of such coprescriptions. Among the factors previously documented to increase the risk of opioid overdose, concurrent benzodiazepine use (18.7%) was the most reported, followed by history of substance use disorder (1.6%) and history of overdose (< 0.1%). CONCLUSION Using nationally representative data collected by the CDC from ambulatory care centers and EDs, we found that naloxone was coprescribed with opioids in only less than 0.1% of visits. Future research is warranted to determine whether current practices have adapted to meet the standards set by the 2016 CDC guidelines.
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Naloxone perspectives from people who use opioids: Findings from an ethnographic study in three states. J Am Assoc Nurse Pract 2020; 33:294-303. [PMID: 32251033 DOI: 10.1097/jxx.0000000000000371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Naloxone is an opioid antagonist that can reverse an opioid overdose. Increased opioid-related mortality rates led to greater distribution of naloxone without a prescription and administration of naloxone by laypersons. This study fills a gap in knowledge of naloxone experiences among active users of opioids living in suburban communities. PURPOSE The purpose of this article is to provide nurse practitioners with an in-depth understanding of current naloxone use practices among people who experience overdose events. The specific aims are to compare access to naloxone in diverse suburban towns, to examine administration differences across settings, and to understand perspectives on naloxone experiences from people who are actively using opioids. METHODOLOGICAL ORIENTATION The data for this analysis were drawn from an ethnographic study in the suburban towns around Atlanta, Georgia; Boston, Massachusetts; and New Haven, Connecticut. Short surveys and in-depth interviews were collected. Inductive methods were used to compare data across settings. SAMPLE The sample of 106 included 48% female, 62% White, 24% African American/Black, 13% more than one race, and 21% Hispanic/Latinx. The mean age was 41.35 years. CONCLUSIONS Differences between study settings in access to naloxone, administration frequency, and delivery systems were found. Findings suggest more education and training is needed in overdose prevention and harm reduction intervention. Studies on delivery systems need to address the increase in fentanyl-related overdoses. IMPLICATIONS FOR PRACTICE Nurse practitioners can help to target distribution of naloxone in local communities, facilitate collaboration with harm reduction services, and provide evidence-based education and training to laypersons.
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Otachi JK, Vundi N, Surratt HL. Examining Factors Associated with Non-Fatal Overdose among People Who Inject Drugs in Rural Appalachia. Subst Use Misuse 2020; 55:1935-1942. [PMID: 32552243 PMCID: PMC9121392 DOI: 10.1080/10826084.2020.1781179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Overdose (OD) deaths have continued to rise in the United States posing a critical public health challenge. Various factors have been associated with increased likelihood of OD, including history of injection drug use. Purpose: This study examined multi-level factors associated with non-fatal OD among current people who inject drugs (PWID) in Appalachian Kentucky. Methods: This cross-sectional study utilized data from 324 PWID recruited via Respondent-Driven Sampling techniques in three Appalachian counties. The analysis focused on correlates of overdose history among people who inject drugs (PWID). Findings: Approximately 36.7% of our sample reported having overdosed in their lifetime, with only 21.4% currently having access to a naloxone kit for OD reversal. Respondents who had injected fentanyl alone or in combination with another drug (OR = 4.26, 95% CI= 2.31,7.86) had 4 times higher odds of an OD than those who did not. Our study found those who injected buprenorphine as primary drug (OR = 0.29, 95% CI = 0.10,0.81) had lower odds of OD compared to those who injected heroin. Conclusions/Importance: Given an increase in OD prevalence among PWID in the U.S, and especially among people living in the Appalachian region of Kentucky, assessing factors associated with OD is critical in development of tailored public health interventions to address the disparate rates of non-fatal OD in this vulnerable population.
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Affiliation(s)
- Janet K Otachi
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Nikita Vundi
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Hilary L Surratt
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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Evoy KE, Groff L, Hill LG, Godinez W, Gandhi R, Reveles KR. Impact of student pharmacist–led naloxone academic detailing at community pharmacies in Texas. J Am Pharm Assoc (2003) 2020; 60:81-86. [DOI: 10.1016/j.japh.2019.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/15/2022]
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Thakur T, Frey M, Chewning B. Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review. J Am Pharm Assoc (2003) 2020; 60:178-194. [DOI: 10.1016/j.japh.2019.06.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/07/2019] [Accepted: 06/18/2019] [Indexed: 01/21/2023]
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Martino JG, Smith SR, Rafie S, Rafie S, Marienfeld C. Physician and Pharmacist: Attitudes, Facilitators, and Barriers to Prescribing Naloxone for Home Rescue. Am J Addict 2019; 29:65-72. [DOI: 10.1111/ajad.12982] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/18/2019] [Accepted: 11/09/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Janine G. Martino
- Department of PharmacyUniversity of California San Diego HealthSan Diego California
| | - Shawn R. Smith
- Department of Pharmacy Practice and AdministrationWestern University of Health Sciences College of PharmacyPomona California
| | - Sally Rafie
- Department of PharmacyUniversity of California San Diego HealthSan Diego California
| | - Samantha Rafie
- Department of PsychiatryUniversity of California San Diego HealthSan Diego California
- Department of Mental HealthVA San Diego Healthcare SystemSan Diego California
| | - Carla Marienfeld
- Department of PsychiatryUniversity of California San Diego HealthSan Diego California
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Hargraves D, White CC, Mauger MR, Puthota A, Pallerla H, Wigle P, Brubaker SL, Schlaudecker JD. Evaluation of an interprofessional naloxone didactic and skills session with medical residents and physician assistant learners. Pharm Pract (Granada) 2019; 17:1591. [PMID: 31592036 PMCID: PMC6763304 DOI: 10.18549/pharmpract.2019.3.1591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/01/2019] [Indexed: 11/14/2022] Open
Abstract
Background The CDC has reported 399,230 opioid-related deaths from 1999-2017. In 2018, the US surgeon general issued a public health advisory, advising all Americans to carry naloxone. Studies show that enhanced naloxone access directly reduces death from opioid overdose. Despite this, health care professional learners report low knowledge and confidence surrounding naloxone. Therefore, it becomes critical that medical education programs incorporate didactic and experiential sessions improving knowledge, skills and attitudes regarding harm reduction through naloxone. Objectives 1. Describe the components and evaluation of a replicable and adaptable naloxone didactic and skills session model for medical providers; 2. Report the results of the evaluation from a pilot session with family medicine residents and physician assistant students; and 3. Share the session toolkit, including evaluation surveys and list of materials used. Methods In July 2017, a literature search was completed for naloxone skill training examining best practices on instruction and evaluation. A training session for family medicine residents and physician assistant learners was designed and led by University of Cincinnati College of Medicine and College of Pharmacy faculty. The same faculty designed a pre and post session evaluation form through internal review on elements targeting naloxone knowledge, attitude, and self-efficacy. Results The training session included one hour for a didactic and one hour for small group live skills demonstration in four methods of naloxone administration (syringe and ampule, nasal atomizer, branded nasal spray and auto injector). Forty-eight participants showed statistically significant (p<0.05) improvement in knowledge (67.5% to 95.9%), attitudes (71.2% to 91.2%), and self-efficacy (62.1% to 97.8%) from pre to post assessment. Forty-four of 48 participants agreed that the pace of the training was appropriate and that the information will be of use in their respective primary care practices. Supply costs for the session were USD 1,200, with the majority being reusable on subsequent trainings. Conclusions Our study of a naloxone didactic and skills session for primary care trainees demonstrated significant improvements in knowledge, self-efficacy, and attitudes. It provides an adaptable and efficient model for delivery of knowledge and skills in naloxone administration training. The pilot data suggest that the training was efficacious.
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Affiliation(s)
- Daniel Hargraves
- Department of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Christopher C White
- Associate Professor of Family & Community Medicine. College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Marcia R Mauger
- College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Aruna Puthota
- The Christ Hospital; & Family Medicine Residency Program, University of Cincinnati. Cincinnati, OH (United States).
| | - Harini Pallerla
- Department of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Patricia Wigle
- James L. Winkle College of Pharmacy, University of Cincinnati. Cincinnati, OH (United States).
| | - Sarah L Brubaker
- Program Coordinator, Department of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Jeffrey D Schlaudecker
- Associate Professor of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
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Lai Joyce Chun K, Olsen A, Taing MW, Clavarino A, Hollingworth S, Dwyer R, Middleton M, Nielsen S. How prepared are pharmacists to provide over-the-counter naloxone? The role of previous education and new training opportunities. Res Social Adm Pharm 2019; 15:1014-1020. [DOI: 10.1016/j.sapharm.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 02/05/2023]
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Thakur T, Frey M, Chewning B. Pharmacist Services in the Opioid Crisis: Current Practices and Scope in the United States. PHARMACY 2019; 7:pharmacy7020060. [PMID: 31200469 PMCID: PMC6632048 DOI: 10.3390/pharmacy7020060] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/01/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: Pharmacist roles promoting safe opioid use are recognized in literature and practice. Pharmacists can offer services such as counseling on opioid risks, naloxone dispensing, education on opioid storage and disposal, prescription drug monitoring program (PDMP) utilization, opioid deprescribing, and providing resources for addiction treatment to help mitigate the opioid crisis. Objective: This commentary seeks to describe current and potential roles for pharmacists to combat the United States opioid crisis and identify key factors affecting service provision. Methods: The paper summarizes evidence-based studies describing current pharmacist roles and services, factors affecting service implementation, and strategies to further improve pharmacist roles and services related to promoting safe opioid use for patients. Results: Pharmacists recognize their roles and responsibilities to counsel patients on opioid risks, dispense naloxone, educate on opioid storage and disposal, utilize prescription drug monitoring programs (PDMPs), offer opioid deprescribing, and provide resources for addiction treatment. However, pharmacists express low confidence, time, and training as barriers to service provision. This suggests a need for structured training, resources, and organizational support for pharmacists to improve confidence and participation in such services. Conclusions: Although pharmacists are aware of roles and responsibilities to help reduce the opioid crisis, more training, education, organizational support and resources are needed to increase their ability to embody these roles.
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Affiliation(s)
- Tanvee Thakur
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA.
| | - Meredith Frey
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA.
| | - Betty Chewning
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA.
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Olsen A, Lawton B, Dwyer R, Taing MW, Chun KLJ, Hollingworth S, Nielsen S. Why aren't Australian pharmacists supplying naloxone? Findings from a qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 69:46-52. [PMID: 31078908 DOI: 10.1016/j.drugpo.2019.03.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opioid overdose is a significant public health issue among people who use pharmaceutical opioids and/or heroin. One response to reducing overdose deaths is to expand public access to naloxone. The Australian Therapeutic Goods Administration down-scheduled naloxone from prescription only (S4) to pharmacist only over-the-counter (OTC, schedule 3) in February 2016. There is little research examining pharmacists' perspectives or experiences of this change. METHODS Thirty-seven semi-structured interviews with Australian community pharmacists were conducted in 2016-2017 to investigate pharmacists' attitudes to and experiences of OTC naloxone. Transcripts were thematically analysed, guided by a broad interest in facilitators and barriers to OTC supply. RESULTS Around half of the pharmacists were aware of the down-scheduling and only two had provided OTC naloxone. Core barriers to pharmacist provision of OTC naloxone included limited understanding of opioid overdose, confusion about the role and responsibilities of pharmacists in providing OTC naloxone, concerns about business, stigma related to people who inject drugs (PWID) and system-level challenges. CONCLUSION Pharmacy provision of OTC naloxone offers an important opportunity to reduce overdose mortality. Our study suggests this opportunity is yet to be realised and highlights several individual- and structural-level impediments hindering the expansion of public access to naloxone via community pharmacies. There is a need to develop strategies to improve pharmacists' knowledge of OTC naloxone and opioid overdose as well as to address other logistical and cultural barriers that limit naloxone provision in pharmacy settings. These need to be addressed at the individual level (training) as well as the system level (information, regulation and supply).
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Affiliation(s)
- Anna Olsen
- National Centre for Epidemiology and Population Health, Australian National University, Acton ACT, 0200, Australia.
| | - Belinda Lawton
- Crawford School of Public Policy, Australian National University, Acton ACT, 0200, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, LaTrobe University, Bundoora Vic, 3086, Australia
| | - Meng-Wong Taing
- School of Pharmacy, University of Queensland, Brisbane St Lucia, Queensland, 4072, Australia; Centre for Optimising Pharmacy Practice-based Excellence in Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Ka Lai Joyce Chun
- School of Pharmacy, University of Queensland, Brisbane St Lucia, Queensland, 4072, Australia
| | - Samantha Hollingworth
- School of Pharmacy, University of Queensland, Brisbane St Lucia, Queensland, 4072, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick New South Wales, 2031, Australia; Monash Addiction Research Centre, Monash University, Frankston, Victoria, 31699, Australia
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Devries J, Rafie S, Ajayi TA, Kreshak A, Edmonds KP. Results of a Naloxone Screening Quality-Improvement Project in an Academic Emergency Department. J Emerg Med 2019; 56:378-385. [PMID: 30770141 DOI: 10.1016/j.jemermed.2018.12.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/19/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Emergency Department (ED) is a medical setting increasingly utilized by opioid users. In January 2016, our health system initiated a take-home naloxone education and distribution program. From July to August 2016, screening was performed in the ED to identify patients for take-home naloxone. OBJECTIVE To evaluate the outcomes of routine screening for take-home naloxone in the ED setting and to determine key screening questions. Secondary analysis of Electronic Health Records for discrete elements that could help identify individuals for naloxone. METHODS This is a single-center, retrospective cohort study conducted at two EDs within an academic health system. A screening tool was verbally administered to a convenience sample of ED patients as part of a pilot project to identify patients for overdose education and naloxone. Patient charts were reviewed retrospectively for pre-determined historical elements, medications prescribed, and substance use history. Descriptive and comparative analysis using Fisher two-tailed tests were performed with regard to historical elements, naloxone recommendation and prescription. RESULTS A total of 182 patients were included. Following screening, 58 (31.9%) were identified as candidates for take-home naloxone. Of those, 36 (62.1%) accepted naloxone recommendation and 19 (32.8%) were prescribed naloxone. Individuals not prescribed naloxone despite recommendation either declined naloxone 22 (37.9%) or were not prescribed naloxone 17 (29.3%). Subanalysis of questions with binary yes/no answers (N = 171) demonstrated significant prediction of both naloxone recommendation (ROC = 0.944) and prescription (ROC = 0.897). CONCLUSIONS Routine screening for take-home naloxone can help identify patients at-risk for opioid overdose and increase naloxone access in the ED.
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Affiliation(s)
- Jennifer Devries
- School of Medicine, University of California San Diego, La Jolla, California
| | - Sally Rafie
- Department of Pharmacy, University of California San Diego Health, San Diego, California
| | - Toluwalase A Ajayi
- Scripps Translational Science Institute, La Jolla, California; Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Allyson Kreshak
- Department of Emergency Medicine, University of California San Diego Health, La Jolla, California
| | - Kyle P Edmonds
- Department of Pharmacy, University of California San Diego Health, San Diego, California; Doris A. Howell Palliative Teams, University of California San Diego, La Jolla, California
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Dalal S, Bruera E. Pain Management for Patients With Advanced Cancer in the Opioid Epidemic Era. Am Soc Clin Oncol Educ Book 2019; 39:24-35. [PMID: 31099619 DOI: 10.1200/edbk_100020] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Use of opioids for the treatment of pain is necessary for the majority of patients with advanced cancer, however its use has become challenging in the face of the opioid epidemic and the emerging evidence that patients with cancer are also at risk for nonmedical opioid use. This article proposes an assessment and treatment plan that incorporates universal screening with monitoring for all patients with cancer who are considered for opioid treatment to assess their risk for opioid misuse and harm. Timely identification with appropriate management, including referral of at-risk patients, will allow oncology professionals to optimize the risk-to-benefit and support the safe use of opioids for patients with cancer.
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Affiliation(s)
- Shalini Dalal
- 1 From the Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- 1 From the Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Jakubowski A, Pappas A, Isaacsohn L, Castillo F, Masyukova M, Silvera R, Holaday L, Rausch E, Farooq S, Veltri KT, Cunningham CO, Bachhuber MA. Development and evaluation of a pilot overdose education and naloxone distribution program for hospitalized general medical patients. Subst Abus 2018; 40:61-65. [PMID: 30475162 DOI: 10.1080/08897077.2018.1518836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Overdose education and naloxone distribution (OEND) to people at risk of witnessing or experiencing an opioid overdose has traditionally been provided through harm reduction agencies. Expanding OEND to inpatient general medical settings may reach at-risk individuals who do not access harm reduction services and have not been trained. An OEND program targeting inpatients was developed, piloted, and evaluated on 2 general medicine floors at Montefiore Medical Center, a large urban academic medical center in Bronx, New York. Methods: The planning committee consisted of 10 resident physicians and 2 faculty mentors. A consult service model was piloted, whereby the primary inpatient care team paged the consult team (consisting of rotating members from the planning committee) for any newly admitted patient who had used any opioid in the year prior to admission. Consult team members assessed patients for eligibility and provided OEND to eligible patients through a short video training. Upon completion, patients received a take-home naloxone kit. To evaluate the program, a retrospective chart review over the first year (April 2016 to March 2017) of the pilot was conducted. Results: Overall, consults on 80 patients were received. Of these, 74 were eligible and the consult team successfully trained 50 (68%). Current opioid analgesic use of ≥50 morphine milligram equivalents daily was the most common eligibility criterion met (38%). Twenty-four percent of patients were admitted for an opioid-related adverse event, the most common being opioid overdose (9%), then opioid withdrawal (8%), skin complication related to injecting (5%), and opioid intoxication (2%). Twenty-five percent had experienced an overdose, 35% had witnessed an overdose in their lifetime, and 83% had never received OEND previously. Conclusions: Integrating OEND into general inpatient medical care is possible and can reach high-risk patients who have not received OEND previously. Future research should identify the optimal way of implementing this service.
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Affiliation(s)
- Andrea Jakubowski
- a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA.,b Department of Family and Social Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA
| | - Alexander Pappas
- b Department of Family and Social Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA
| | - Lee Isaacsohn
- b Department of Family and Social Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA
| | - Felipe Castillo
- c Department of Psychiatry , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA
| | - Mariya Masyukova
- b Department of Family and Social Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA
| | - Richard Silvera
- a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA.,b Department of Family and Social Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA
| | - Louisa Holaday
- a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA.,b Department of Family and Social Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA
| | - Evan Rausch
- a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA.,b Department of Family and Social Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA
| | - Sameen Farooq
- a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA.,b Department of Family and Social Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA
| | - Keith T Veltri
- d Department of Pharmacy , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA.,e Department of Pharmacy Practice , Touro College of Pharmacy , New York , New York , USA
| | - Chinazo O Cunningham
- a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA
| | - Marcus A Bachhuber
- a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA
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Cipriano LE, Zaric GS. Cost-effectiveness of naloxone kits in secondary schools. Drug Alcohol Depend 2018; 192:352-361. [PMID: 30321745 DOI: 10.1016/j.drugalcdep.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND We seek to identify conditions under which a plan by the Toronto District School Board (TDSB) to equip high schools with naloxone kits would be cost-effective. METHODS We developed a decision-analytic model to evaluate the costs, benefits, and cost-effectiveness of a school-based naloxone program. We estimated model inputs from the medical literature and used Toronto-specific sources whenever available. We present our results varying both the expected total number of opioid overdoses per year across all 112 TDSB high schools and the effectiveness of a school-based naloxone program in reducing mortality. RESULTS A school naloxone program likely costs less than CAD$50,000 per quality-adjusted life-year gained if the overdose frequency is at least once each year and it reduces opioid poisoning mortality by at least 40% (from 10% to <6.0%) or if the overdose frequency is at least two per year and the program reduces mortality by at least 20% (from 10% to <8.0%). The results are sensitive to the intensity and cost of staff training, the lifetime costs and life-expectancy of overdose survivors, and the probability of an overdose being fatal in the absence of a school naloxone program. CONCLUSIONS School naloxone programs are relatively inexpensive, but that does not ensure that they are a cost-effective use of resources. While potentially cost-effective, if the risk of an overdose in a Toronto high school is low, then other programs aimed at improving the health and wellbeing of students may be better use of limited resources.
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Affiliation(s)
- Lauren E Cipriano
- Ivey Business School, Western University, London, ON, N6G 0N1, Canada; Department of Biostatistics and Epidemiology, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A 5C1, Canada.
| | - Gregory S Zaric
- Ivey Business School, Western University, London, ON, N6G 0N1, Canada; Department of Biostatistics and Epidemiology, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A 5C1, Canada
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Gunn AH, Smothers ZPW, Schramm-Sapyta N, Freiermuth CE, MacEachern M, Muzyk AJ. The Emergency Department as an Opportunity for Naloxone Distribution. West J Emerg Med 2018; 19:1036-1042. [PMID: 30429939 PMCID: PMC6225944 DOI: 10.5811/westjem.2018.8.38829] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/26/2018] [Accepted: 08/16/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Substance use disorders, including opioid use disorders, are a major public health concern in the United States. Between 2005 and 2014, the rate of opioid-related emergency department (ED) visits nearly doubled, from 89.1 per 100,000 persons in 2005 to 177.7 per 100,000 persons in 2014. Thus, the ED presents a distinctive opportunity for harm-reduction strategies such as distribution of naloxone to patients who are at risk for an opioid overdose. Methods We conducted a systematic review of all existing literature related to naloxone distribution from the ED. We included only those articles published in peer-reviewed journals that described results relating to naloxone distribution from the ED. Results Of the 2,286 articles we identified from the search, five met the inclusion criteria and had direct relevance to naloxone distribution from the ED setting. Across the studies, we found variation in the methods of implementation and evaluation of take-home naloxone programs in the ED. In the three studies that attempted patient follow-up, success was low, limiting the evidence for the programs’ effectiveness. Overall, in the included studies there is evidence that distributing take-home naloxone from the ED has the potential for harm reduction; however, the uptake of the practice remained low. Barriers to implementation included time allocated for training hospital staff and the burden on workflow. Conclusion This systematic review of the best evidence available supports the ED as a potential setting for naloxone distribution for overdose reversal in the community. The variability of the implementation methods across the studies highlights the need for future research to determine the most effective practices.
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Affiliation(s)
- Alexander H Gunn
- Duke University, Duke-Margolis Center for Health Policy, Durham, North Carolina
| | | | - Nicole Schramm-Sapyta
- Duke Institute for Brain Sciences, Department of Psychiatry, Duke University, Durham, North Carolina
| | - Caroline E Freiermuth
- Duke University School of Medicine, Division of Emergency Medicine, Durham, North Carolina
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Andrew J Muzyk
- Duke University Hospital, Department of Pharmacy, Durham, North Carolina.,Campbell University College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Buies Creek, North Carolina
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Behar E, Bagnulo R, Coffin PO. Acceptability and feasibility of naloxone prescribing in primary care settings: A systematic review. Prev Med 2018; 114:79-87. [PMID: 29908763 PMCID: PMC6082708 DOI: 10.1016/j.ypmed.2018.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/10/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
Naloxone access through established healthcare settings is critical to responding to the opioid crisis. We conducted a systematic review to assess the acceptability and feasibility of prescribing naloxone to patients in primary care. We queried PubMed, EmBase and CINAHL for US-based, peer-reviewed, full-length, original articles relating to acceptability or feasibility of prescribing naloxone in primary care. Searches yielded 270 unduplicated articles; one analyst reviewed all titles and abstracts. Two analysts independently reviewed eligible articles for study design, study outcome, and acceptability and/or feasibility. Analyses were compared and a third reviewer consulted if discrepancies emerged. Seventeen articles were included. Providers' willingness to prescribe naloxone appeared to increase over time. Most studies provided prescribers in-person naloxone trainings, including how to write a prescription and indications for prescribing. Most studies implemented universal prescribing, whereby anyone prescribed long-term opioids or otherwise at risk for overdose was eligible for naloxone. Patient education was largely provided by prescribers and most studies provided take-home educational materials. Providers reported concerns around naloxone prescribing including lack of knowledge around prescribing and educating patients. Providers also reported benefits such as improving difficult conversations around opioids and resetting the culture around opioids and overdose. Current literature supports the acceptability and feasibility of naloxone prescribing in primary care. Provision of naloxone through primary care may help normalize such medication safety interventions, support larger opioid stewardship efforts, and expand access to patients not served by a community distribution program.
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Affiliation(s)
- Emily Behar
- San Francisco Department of Public Health, United States of America; The University of California, San Francisco, United States of America.
| | - Rita Bagnulo
- San Francisco Department of Public Health, United States of America
| | - Phillip O Coffin
- San Francisco Department of Public Health, United States of America; The University of California, San Francisco, United States of America
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