Pharmacy Benefits Management (PBM), National Academic Detailing Service, U.S. Department of Veterans Affairs, Washington, DC.
The Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, Washington.
Health Serv Res. 2019 Oct;54(5):1055-1064. doi: 10.1111/1475-6773.13194. Epub 2019 Jul 17.
Academic detailing in partnership with the Opioid Overdose Education and Naloxone Distribution (OEND) program was implemented to increase naloxone access for the prevention of opioid overdose mortality in veterans at the U.S. Department of Veterans Affairs (VA). However, implementation was not uniform leading to varying levels of intervention exposure potentially impacting naloxone prescribing. We examined the impact of implementation strength (proportion of providers exposed to academic detailing) at each station on naloxone prescribing from September 2014 to December 2017.
Retrospective cohort design with fixed effects models at the VA.
DATA COLLECTION/EXTRACTION METHODS: We used VA Corporate Data Warehouse for data on pharmacy dispensing, station-, provider- and patient-level characteristics. OEND-specific academic detailing activities came from data recorded by academic detailers using Salesforce.com.
VA stations wherein 100 percent of providers exposed to an OEND-related academic detailing educational outreach visit experienced an increased incident rate of naloxone prescribing that was 5.52 times the incident rate of stations where no providers were exposed; alternatively, this is equivalent to an average monthly increase of 2.60 naloxone prescriptions per 1000 population at risk for opioid overdose.
Our findings highlight the importance of academic detailing's implementation strength on naloxone prescribing. Decision makers must carefully consider the implementation process to achieve the greatest effectiveness from the intervention.
学术细节与阿片类药物过量教育和纳洛酮分发（OEND）计划合作实施，旨在增加退伍军人事务部（VA）退伍军人的纳洛酮获取量，以预防阿片类药物过量死亡。然而，实施并不统一，导致干预暴露程度不同，可能会影响纳洛酮的处方。我们研究了每个站点的实施力度（接触学术细节的提供者比例）对 2014 年 9 月至 2017 年 12 月期间纳洛酮处方的影响。
VA 的回顾性队列设计和固定效应模型。
数据收集/提取方法：我们使用 VA 公司数据仓库获取有关药房配药、站点、提供者和患者特征的数据。OEND 特定的学术细节活动来自学术详细信息员使用 Salesforce.com 记录的数据。
VA 站点中，100%的提供者接触到与 OEND 相关的学术细节教育外展访问，经历了纳洛酮处方的发生率增加了 5.52 倍，而没有提供者接触的站点的发生率增加了 5.52 倍；或者，这相当于每 1000 名有阿片类药物过量风险的人群中，每月平均增加 2.60 剂纳洛酮处方。
我们的研究结果强调了学术细节实施力度对纳洛酮处方的重要性。决策者必须仔细考虑实施过程，以从干预措施中获得最大效果。
