Han Jonathan K, Hill Lucas G, Koenig Marianne E, Das Niladri
University of Pittsburgh Medical Center St Margaret Family Medicine Residency.
Fam Med. 2017 Oct;49(9):730-733.
The United States is experiencing an epidemic of opioid-related deaths. Naloxone, the drug of choice for reversing acute opioid overdose, is not routinely prescribed for outpatient use. The aims of this project were to improve naloxone awareness, increase naloxone prescribing, and prevent opioid overdoses.
A naloxone counseling intervention was implemented in three family health centers by an interprofessional team of providers including family medicine physicians, clinical pharmacists, and social workers. An outreach letter was designed with provider input, an electronic order set was developed to facilitate prescribing, and intranasal naloxone kits were assembled for free dispensing. Providers and staff received education about opioid overdose and naloxone prescribing. Faculty and resident physicians were surveyed before and after the intervention to assess their attitudes. Patients who received naloxone kits were surveyed to assess their attitudes and use of opioids and naloxone.
Over 16 months, 71 outreach letters were distributed and 97 naloxone kits were dispensed. The majority of kits were prescribed for illicit opioid use. Faculty and resident physician surveys indicated improved knowledge about naloxone prescribing, and increased professional satisfaction caring for patients requesting opioids. Surveyed patients endorsed high levels of comfort discussing opioid use with their primary care physician. Five successful opioid overdose reversals were reported.
An interprofessional naloxone counseling intervention engaged patients in opioid use discussions, increased provider satisfaction, and reversed overdoses. Improving naloxone access is an essential component of comprehensive overdose prevention programs that encourage responsible opioid prescribing and use.
美国正经历一场与阿片类药物相关的死亡流行。纳洛酮是逆转急性阿片类药物过量的首选药物，但门诊通常不常规开具。本项目的目的是提高对纳洛酮的认识、增加纳洛酮的处方开具并预防阿片类药物过量。
一个由包括家庭医学医生、临床药剂师和社会工作者在内的跨专业医疗团队在三个家庭健康中心实施了纳洛酮咨询干预。在医疗服务提供者的参与下设计了一封外展信，开发了一个电子医嘱集以方便处方开具，并组装了鼻内用纳洛酮试剂盒以供免费发放。医疗服务提供者和工作人员接受了关于阿片类药物过量和纳洛酮处方开具的教育。在干预前后对教员和住院医师进行了调查，以评估他们的态度。对收到纳洛酮试剂盒的患者进行了调查，以评估他们对阿片类药物和纳洛酮的态度及使用情况。
在16个月的时间里，发放了71封外展信，分发了97个纳洛酮试剂盒。大多数试剂盒是为非法使用阿片类药物而开具的。教员和住院医师的调查表明，他们对纳洛酮处方开具的知识有所提高，并且在照顾要求使用阿片类药物的患者方面的职业满意度有所增加。接受调查的患者表示，他们非常愿意与初级保健医生讨论阿片类药物的使用。报告了5次成功逆转阿片类药物过量的案例。
一项跨专业的纳洛酮咨询干预促使患者参与阿片类药物使用的讨论，提高了医疗服务提供者的满意度，并逆转了过量情况。改善纳洛酮的可及性是全面过量预防计划的重要组成部分，该计划鼓励负责任地开具和使用阿片类药物。
