采用并利用急诊纳洛酮分发和同伴康复教练咨询计划。
Adoption and Utilization of an Emergency Department Naloxone Distribution and Peer Recovery Coach Consultation Program.
机构信息
Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.
Geisinger Commonwealth School of Medicine, Scranton, PA.
出版信息
Acad Emerg Med. 2019 Feb;26(2):160-173. doi: 10.1111/acem.13545. Epub 2018 Oct 3.
OBJECTIVE
Rising rates of opioid overdose deaths require innovative programs to prevent and reduce opioid-related morbidity and mortality. This study evaluates adoption, utilization, and maintenance of an emergency department (ED) take-home naloxone and peer recovery coach consultation program for ED patients at risk of opioid overdose.
METHODS
Using a Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework, we conducted a retrospective provider survey and electronic medical record (EMR) review to evaluate implementation of a naloxone distribution and peer recovery coach consultation program at two EDs. Provider adoption was measured by self-report using a novel survey instrument. EMRs of discharged ED patients at risk for opioid overdose were reviewed in three time periods: preimplementation, postimplementation, and maintenance. Primary study outcomes were take-home naloxone provision and recovery coach consultation. Secondary study outcome was referral to treatment. Chi-square analysis was used for study period comparisons. Logistic regression was conducted to examine utilization moderators. Poisson regression modeled utilization changes over time.
RESULTS
Most providers reported utilization (72.8%, 83/114): 95.2% (79/83) provided take-home naloxone and 85.5% (71/83) consulted a recovery coach. There were 555 unique patients treated and discharged during the study periods: 131 preimplementation, 376 postimplementation, and 48 maintenance. Postimplementation provision of take-home naloxone increased from none to more than one-third (35.4%, p < 0.001), one-third received consultation with a recovery coach (33.1%, 45/136), and discharge with referral to treatment increased from 9.16% to 20.74% (p = 0.003). Take-home naloxone provision and recovery coach consultation did not depreciate over time.
CONCLUSIONS
ED naloxone distribution and consultation of a community-based peer recovery coach are feasible and acceptable and can be maintained over time.
目的
阿片类药物过量致死率不断上升，这要求我们采取创新方案，预防和减少阿片类药物相关的发病率和死亡率。本研究评估了在有阿片类药物过量风险的急诊科（ED）患者中实施 ED 纳洛酮携带计划和同伴康复教练咨询项目的采用、使用和维持情况。
方法
本研究使用了“实施有效性可及性扩散维持性（RE-AIM）”框架，通过回顾性调查医务人员并查阅电子病历（EMR），评估了在两家 ED 实施纳洛酮分发和同伴康复教练咨询项目的情况。医务人员的采用情况通过使用新型调查工具进行自我报告来衡量。对有阿片类药物过量风险的出院 ED 患者的 EMR 进行了三个时间段的回顾：实施前、实施后和维持阶段。主要研究结果是携带纳洛酮出院和接受康复教练咨询。次要研究结果是转介至治疗。采用卡方检验进行研究期间比较。Logistic 回归分析用于检查利用度的调节因素。泊松回归模型用于随时间变化的利用度变化建模。
结果
大多数医务人员报告了利用率（72.8%，83/114）：95.2%（79/83）提供了携带纳洛酮出院，85.5%（71/83）咨询了康复教练。在研究期间共治疗和出院了 555 名患者：131 名在实施前，376 名在实施后，48 名在维持阶段。实施后携带纳洛酮出院的比例从无到超过三分之一（35.4%，p<0.001），三分之一的人接受了康复教练咨询（33.1%，45/136），出院时转介至治疗的比例从 9.16%增加到 20.74%（p=0.003）。携带纳洛酮出院和康复教练咨询没有随时间减少。
结论
ED 纳洛酮分发和社区基础同伴康复教练咨询是可行且可接受的，可以随着时间的推移而维持。
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