Wilson Courtenay Gilmore, Rodriguez Franklin, Carrington Anne C, Fagan E Blake
J Am Pharm Assoc (2003). 2017 Mar-Apr;57(2S):S130-S134. doi: 10.1016/j.japh.2016.12.076. Epub 2017 Feb 9.
To develop a targeted naloxone coprescribing program in a primary care practice.
Large academic family medicine practice in western North Carolina.
A robust pain management program was developed at this institution in 2012 which incorporated many of the recommendations later outlined in the 2016 Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain. The only guideline-recommended initiative that was not addressed involves providing naloxone to patients on chronic opioid therapy at high risk for opioid overdose.
Pharmacists embedded in this practice developed a targeted naloxone coprescribing program for patients who are on chronic opioid therapy and have doses of 50 mg or more morphine equivalents daily (MED), are taking benzodiazepines, have a history of substance use disorder, or have a history of overdose.
A retrospective chart review was conducted to determine the number of patients on chronic opioid therapy who meet the CDC guidelines for offering naloxone.
A total of 1297 patients were identified, and 709 met the criteria for chronic opioid use. Nearly one-half (n = 350; 49.4%) of these patients met the criteria for naloxone, although only 3.4% had naloxone on their medication list. Doses of 50 mg or more MED was the primary reason for needing naloxone (n = 216; 61%) with concomitant benzodiazepine use as the second most likely reason (n = 130; 37.1%). For patients taking 50 mg or more MED, 37.5% were also on a benzodiazepine and 4.1% also had a history of substance use disorder.
Pharmacists embedded in a primary care practice are well poised to develop a targeted naloxone coprescribing program to increase patients' access to naloxone.
在基层医疗实践中制定有针对性的纳洛酮联合处方计划。
北卡罗来纳州西部的大型学术性家庭医学诊所。
该机构于2012年制定了一项完善的疼痛管理计划，其中纳入了许多后来在2016年疾病控制与预防中心（CDC）慢性疼痛阿片类药物处方指南中概述的建议。唯一未涉及的指南推荐举措是为接受慢性阿片类药物治疗且有阿片类药物过量高风险的患者提供纳洛酮。
该诊所的药剂师为接受慢性阿片类药物治疗且每日吗啡当量剂量为50毫克或更多（MED）、正在服用苯二氮䓬类药物、有物质使用障碍病史或有过量用药史的患者制定了有针对性的纳洛酮联合处方计划。
进行了一项回顾性病历审查，以确定符合CDC提供纳洛酮指南的慢性阿片类药物治疗患者数量。
共识别出1297名患者，其中709名符合慢性阿片类药物使用标准。这些患者中近一半（n = 350；49.4%）符合纳洛酮使用标准，尽管其药物清单上仅有3.4%的患者使用了纳洛酮。MED剂量为50毫克或更多是需要纳洛酮的主要原因（n = 216；61%），同时使用苯二氮䓬类药物是第二大可能原因（n = 130；37.1%）。对于服用50毫克或更多MED的患者，37.5%的患者同时也在服用苯二氮䓬类药物，4.1%的患者有物质使用障碍病史。
基层医疗实践中的药剂师有充分的条件制定有针对性的纳洛酮联合处方计划，以增加患者获得纳洛酮的机会。
