Departments of Internal Medicine, VA Connecticut Healthcare System West Haven, CT.
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
Pain Med. 2017 Dec 1;18(12):2325-2330. doi: 10.1093/pm/pnx243.
Opioid prescribing for chronic pain significantly contributes to opioid overdose deaths in the United States. Naloxone as a take-home antidote to opioid overdose is underutilized and has not been evaluated in the high-risk chronic pain population. The objective was to increase overdose education and naloxone distribution (OEND) to high-risk patients on long-term opioid therapy for pain by utilizing group visits in primary care.
Quality improvement intervention among two primary care clinics.
A large, academic facility within the Veterans Health Administration.
Patients prescribed ≥100 mg morphine-equivalent daily dose or coprescribed opioids and benzodiazepines.
One clinic provided usual care with respect to OEND; another clinic encouraged attendance at an OEND group visit to all of its high-risk patients.
We used attendance at group visits, prescriptions of naloxone issued, and patient satisfaction scores to evaluate this format of OEND.
Group OEND visits resulted in significantly more naloxone prescriptions than usual care. At these group visits, patients were engaged, valued the experience, and all requested a prescription for the naloxone kit.
This quality improvement pilot study suggests that OEND group visits are a promising model of care.
在美国，慢性疼痛的阿片类药物处方显著导致阿片类药物过量死亡。纳洛酮作为阿片类药物过量的家庭解毒剂未得到充分利用，并且尚未在高风险慢性疼痛人群中进行评估。本研究旨在通过在初级保健中利用小组就诊，增加对长期接受阿片类药物治疗疼痛的高风险患者的过量用药教育和纳洛酮分发（OEND）。
在两个初级保健诊所进行的质量改进干预。
退伍军人事务部内的一个大型学术机构。
开处≥100mg 吗啡等效日剂量或同时开处阿片类药物和苯二氮䓬类药物的患者。
一个诊所按照常规做法提供 OEND；另一个诊所鼓励所有高风险患者参加 OEND 小组就诊。
我们使用小组就诊的出席率、开出的纳洛酮处方和患者满意度评分来评估这种 OEND 模式。
小组 OEND 就诊导致开出的纳洛酮处方明显多于常规护理。在这些小组就诊中，患者参与度高，重视就诊体验，所有人都要求开纳洛酮套件的处方。
这项质量改进试点研究表明，OEND 小组就诊是一种有前途的护理模式。
