Tees, Esk and Wear Valleys NHS Foundation Trust, UK.
Int J Drug Policy. 2011 Jan;22(1):9-15. doi: 10.1016/j.drugpo.2010.09.008. Epub 2010 Nov 1.
Opioid overdose has a high mortality, but is often reversible with appropriate overdose management and naloxone (opioid antagonist). Training in these skills has been successfully trialled internationally with opioid users themselves. Healthcare professionals working in substance misuse are in a prime position to deliver overdose prevention training to drug users and may themselves witness opioid overdoses. The best method of training dissemination has not been identified. The study assessed post-training change in clinician knowledge for managing an opioid overdose and administering naloxone, evaluated the 'cascade method' for disseminating training, and identified barriers to implementation.
A repeated-measures design evaluated knowledge pre-and-post training. A sub-set of clinicians were interviewed to identify barriers to implementation. Clinicians from addiction services across England received training. Participants self-completed a structured questionnaire recording overdose knowledge, confidence and barriers to implementation.
One hundred clinicians were trained initially, who trained a further 119 clinicians (n=219) and thereafter trained 239 drug users. The mean composite score for opioid overdose risk signs and actions to be taken was 18.3/26 (±3.8) which increased to 21.2/26 (±4.1) after training, demonstrating a significant improvement in knowledge (Z=9.2, p<0.001). The proportion of clinicians willing to use naloxone in an opioid overdose rose from 77% to 99% after training. Barriers to implementing training were clinician time and confidence, service resources, client willingness and naloxone formulation.
Training clinicians how to manage an opioid overdose and administer naloxone was effective. However the 'cascade method' was only modestly successful for disseminating training to a large clinician workforce, with a range of clinician and service perceived obstacles. Drug policy changes and improvements to educational programmes for drug services would be important to ensure successful implementation of overdose training internationally.
阿片类药物过量有很高的死亡率，但通过适当的过量管理和纳洛酮（阿片类拮抗剂）通常可以逆转。这些技能的培训已在国际上成功地在阿片类药物使用者中进行了试验。在物质滥用方面工作的医疗保健专业人员处于向药物使用者提供过量预防培训的最佳位置，并且可能自己目睹阿片类药物过量。尚未确定最佳培训传播方法。该研究评估了管理阿片类药物过量和给予纳洛酮的临床医生知识的培训后变化，评估了培训传播的“级联方法”，并确定了实施的障碍。
采用重复测量设计评估培训前后的知识变化。对临床医生进行了访谈，以确定实施的障碍。来自英格兰各地成瘾服务机构的临床医生接受了培训。参与者自行填写了一份结构化问卷，记录了过量的知识，信心和实施障碍。
最初有 100 名临床医生接受了培训，他们又培训了 119 名临床医生（n=219），然后培训了 239 名吸毒者。阿片类药物过量风险迹象和应采取的行动的平均综合得分为 18.3/26（±3.8），培训后增加到 21.2/26（±4.1），知识显著提高（Z=9.2，p<0.001）。培训后，愿意在阿片类药物过量中使用纳洛酮的临床医生比例从 77％上升到 99％。实施培训的障碍是临床医生的时间和信心，服务资源，客户意愿和纳洛酮配方。
培训临床医生如何管理阿片类药物过量和给予纳洛酮是有效的。但是，“级联方法”对于将培训传播给大量的临床医生劳动力而言，效果只是中等，因为存在一系列临床医生和服务方面的障碍。药物政策的改变和对毒品服务教育计划的改进对于确保国际上成功实施过量培训将非常重要。
