Behar Emily, Rowe Christopher, Santos Glenn-Milo, Santos Nina, Coffin Phillip O
San Francisco Department of Public Health.
Fam Med. 2017 Feb;49(2):122-126.
Improving the safety of prescribed opioids in clinical settings is a national priority. While co-prescribing naloxone is increasingly recommended, there is little understanding of the optimal way to implement this practice.
We developed and delivered an academic detailing intervention to 40 randomly selected opioid-prescribing primary care providers in San Francisco from February to May 2015. Process outcomes were tracked and included provider demographics, number and type of contact attempts, reason for refusal (if applicable), name of detailer, duration of intervention, topics covered, provider concerns, and follow-up plan. Outcome evaluation included changes in the rate of naloxone prescriptions 4 months before and after academic detailing by provider based on de-identified Medi-Cal claims data. Using a difference-in-differences approach, we developed a negative binomial regression model to compare changes in naloxone prescribing to Medi-Cal patients between providers that did and did not receive the intervention.
Eighty-three percent of 48 providers contacted accepted the intervention after a mean of 2.6 contacts. Detailing lasted a mean of 28 minutes (range 5-60 minutes) and most frequently covered indications for naloxone, examples of naloxone prescriptions, language to use with patients, and pharmacy outreach. Those who received the academic detailing had a significantly greater increase in naloxone prescriptions compared to those who did not receive the intervention (IRR=11.0, 95%CI=1.8-67.8, P=.010).
Academic detailing addressing opioid safety and naloxone prescribing was well-received by primary care providers and associated with an increase in naloxone prescriptions filled by Medi-Cal patients.
提高临床环境中开具阿片类药物的安全性是一项国家优先事项。虽然越来越多地建议同时开具纳洛酮，但对于实施这种做法的最佳方式却知之甚少。
2015年2月至5月，我们为旧金山40名随机挑选的开具阿片类药物的初级保健提供者开展并实施了一项学术推广干预措施。跟踪过程结果，包括提供者的人口统计学信息、联系尝试的次数和类型、拒绝原因（如适用）、推广人员姓名、干预持续时间、涵盖的主题、提供者的担忧以及后续计划。结果评估包括根据去识别化的医疗补助索赔数据，比较提供者在学术推广前后4个月内纳洛酮处方率的变化。我们采用差异中的差异方法，开发了一个负二项回归模型，以比较接受和未接受干预的提供者之间为医疗补助患者开具纳洛酮的变化情况。
在联系的48名提供者中，83%在平均2.6次联系后接受了干预。推广平均持续28分钟（范围为5 - 60分钟），最常涵盖纳洛酮的适应症、纳洛酮处方示例、与患者沟通的语言以及药房推广。与未接受干预的提供者相比，接受学术推广的提供者纳洛酮处方量显著增加（发病率比=11.0，95%置信区间=1.8 - 67.8，P = 0.010）。
针对阿片类药物安全性和纳洛酮处方的学术推广受到初级保健提供者的好评，并与医疗补助患者填写的纳洛酮处方量增加相关。
