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Daffron A, Koon K, Gruenke NP, Wettergreen S. Effects of pharmacist-driven protocol on naloxone prescribing rates in two primary care clinics. Prev Med Rep 2023; 36:102493. [PMID: 38116254 PMCID: PMC10728458 DOI: 10.1016/j.pmedr.2023.102493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023] Open
Abstract
The Centers for Disease Control and Prevention (CDC) Guidelines for Prescribing Opioids for Chronic Pain recommend co-prescribing naloxone as a harm reduction strategy when there is an increased risk of opioid overdose. Although naloxone co-prescribing is an important harm reduction strategy, many at risk patients are not prescribed naloxone. The objective was to assess the effectiveness of a pharmacist-driven protocol at increasing the number of patients co-prescribed naloxone according to CDC recommendations. The study design was a multi-center retrospective cohort to evaluate the outcomes of a quality improvement intervention at two primary care clinics which aimed to increase naloxone co-prescribing. The intervention used a two-pronged approach consisting of telephonic outreach to eligible patients by pharmacists and pharmacy interns related to naloxone education and recommendations for naloxone co-prescribing. Additionally, recommendations were sent to the primary care provider in the electronic medical record (EMR) for consideration and implementation. After the 3 month intervention, 57 of the 86 patients contacted were co-prescribed naloxone (66.3%). Most naloxone initiation occurred at the time of telephonic outreach as a new medication order (n = 36), however an additional 12 patients were co-prescribed naloxone at a subsequent primary care provider visit. The proportion of patients at each clinic with MME ≥ 50 co-prescribed naloxone significantly increased after implementation of the intervention (pre 25/64 vs. post 43/76, p = 0.043). Overall, telephonic outreach to patients with recommendations to primary care providers in the EMR were effective methods to increase the rate of naloxone co-prescribing in primary care based on this study.
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Affiliation(s)
- Ashley Daffron
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 E. Montview Blvd, C238 Aurora, CO 80045, United States
| | - Kelly Koon
- PGY-2 Ambulatory Care Pharmacy Resident, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 E. Montview Blvd, C238 Aurora, CO 80045, United States
| | - Nathan P Gruenke
- Pharmacy Student, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 E. Montview Blvd, C238 Aurora, CO 80045, United States
| | - Sara Wettergreen
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 E. Montview Blvd, C238 Aurora, CO 80045, United States
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Macke EL, Henningsen E, Jessen E, Zumwalde NA, Landowski M, Western DE, Lee WH, Liu C, Gruenke NP, Doebley AL, Miller S, Pattnaik B, Ikeda S, Gumperz JE, Ikeda A. Loss of Chondroitin Sulfate Modification Causes Inflammation and Neurodegeneration in skt Mice. Genetics 2020; 214:121-134. [PMID: 31754016 PMCID: PMC6944401 DOI: 10.1534/genetics.119.302834] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/17/2019] [Indexed: 12/17/2022] Open
Abstract
One major aspect of the aging process is the onset of chronic, low-grade inflammation that is highly associated with age-related diseases. The molecular mechanisms that regulate these processes have not been fully elucidated. We have identified a spontaneous mutant mouse line, small with kinky tail (skt), that exhibits accelerated aging and age-related disease phenotypes including increased inflammation in the brain and retina, enhanced age-dependent retinal abnormalities including photoreceptor cell degeneration, neurodegeneration in the hippocampus, and reduced lifespan. By positional cloning, we identified a deletion in chondroitin sulfate synthase 1 (Chsy1) that is responsible for these phenotypes in skt mice. CHSY1 is a member of the chondroitin N-acetylgalactosaminyltransferase family that plays critical roles in the biosynthesis of chondroitin sulfate, a glycosaminoglycan (GAG) that is attached to the core protein to form the chondroitin sulfate proteoglycan (CSPG). Consistent with this function, the Chsy1 mutation dramatically decreases chondroitin sulfate GAGs in the retina and hippocampus. In addition, macrophage and neutrophil populations appear significantly altered in the bone marrow and spleen of skt mice, suggesting an important role for CHSY1 in the functioning of these immune cell types. Thus, our study reveals a previously unidentified impact of CHSY1 in the retina and hippocampus. Specifically, chondroitin sulfate (CS) modification of proteins by CHSY1 appears critical for proper regulation of immune cells of the myeloid lineage and for maintaining the integrity of neuronal tissues, since a defect in this gene results in increased inflammation and abnormal phenotypes associated with age-related diseases.
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Affiliation(s)
- Erica L Macke
- Department of Medical Genetics, University of Wisconsin-Madison, Wisconsin 53706
| | - Erika Henningsen
- Department of Medical Genetics, University of Wisconsin-Madison, Wisconsin 53706
| | - Erik Jessen
- Department of Medical Genetics, University of Wisconsin-Madison, Wisconsin 53706
- Department of Biochemistry, University of Wisconsin-Madison, Wisconsin 53706
| | - Nicholas A Zumwalde
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Wisconsin 53706
| | - Michael Landowski
- Department of Medical Genetics, University of Wisconsin-Madison, Wisconsin 53706
| | - Daniel E Western
- Department of Medical Genetics, University of Wisconsin-Madison, Wisconsin 53706
| | - Wei-Hua Lee
- Department of Medical Genetics, University of Wisconsin-Madison, Wisconsin 53706
| | - Che Liu
- Institute for Molecular Virology, University of Wisconsin-Madison, Wisconsin 53706
- McArdle Laboratory for Cancer Research, University of Wisconsin-Madison, Wisconsin 53706
| | - Nathan P Gruenke
- Department of Medical Genetics, University of Wisconsin-Madison, Wisconsin 53706
| | - Anna-Lisa Doebley
- Department of Medical Genetics, University of Wisconsin-Madison, Wisconsin 53706
| | - Samuel Miller
- Department of Medical Genetics, University of Wisconsin-Madison, Wisconsin 53706
| | - Bikash Pattnaik
- Department of Pediatrics, University of Wisconsin-Madison, Wisconsin 53706
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Wisconsin 53706
- McPherson Eye Research Institute, University of Wisconsin-Madison, Wisconsin 53706
| | - Sakae Ikeda
- Department of Medical Genetics, University of Wisconsin-Madison, Wisconsin 53706
- McPherson Eye Research Institute, University of Wisconsin-Madison, Wisconsin 53706
| | - Jenny E Gumperz
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Wisconsin 53706
| | - Akihiro Ikeda
- Department of Medical Genetics, University of Wisconsin-Madison, Wisconsin 53706
- McPherson Eye Research Institute, University of Wisconsin-Madison, Wisconsin 53706
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