J Am Pharm Assoc (2003). 2019 Nov-Dec;59(6):867-871. doi: 10.1016/j.japh.2019.07.012. Epub 2019 Aug 26.
To determine the impact of a pharmacist-led coprescribing initiative on patient access to naloxone in a primary care setting.
Family medicine residency practice with embedded pharmacists in western North Carolina.
In June 2016, clinical pharmacists embedded in a primary care clinic initiated a naloxone coprescribing initiative with the aim of increasing access to naloxone for patients on chronic opioid therapy who were on 50 mg or greater morphine-equivalents daily (MED), on a concomitant benzodiazepine, had a history of an overdose, or had a diagnosis of a substance use disorder. Pharmacists' roles included educating providers and clinical staff regarding naloxone, creating quick links within the electronic health record to more easily prescribe naloxone, identifying patients who met criteria for naloxone, and counseling patients about naloxone.
This study was a single-cohort pre- and postintervention study. One year after initiation of the program, data were manually collected to assess the rates of naloxone prescribing and the reason for requiring naloxone. In addition, pharmacy students called pharmacies to determine fill rates and obtain reasons given by patients for not filling naloxone.
A total of 234 patients remained candidates for naloxone at the end of 1 year. Naloxone coprescribing increased from 3.4% at baseline to 37.2% at follow-up (P = 0.0001). Seventy-one percent of patients required naloxone because of chronic opioid therapy doses of 50 mg or more MED, 55% were on a benzodiazepine, 6% had a diagnosis of a substance use disorder, and 1% had a history of overdose. Of the patients who received a naloxone prescription, 31.4% filled it.
Embedded clinical pharmacists in primary care have the potential to increase naloxone coprescribing for high-risk patients treated with chronic opioid therapy for pain.
确定药剂师主导的共同处方倡议对初级保健环境中纳洛酮可及性的影响。
北卡罗来纳州西部的家庭医学住院医师实习基地，药剂师嵌入其中。
2016 年 6 月，临床药剂师在一家初级保健诊所启动了一项纳洛酮共同处方倡议，旨在增加每天接受 50 毫克或以上吗啡等效剂量（MED）的慢性阿片类药物治疗、同时使用苯二氮䓬类药物、有药物过量史或有物质使用障碍诊断的患者获得纳洛酮的机会。药剂师的作用包括向医务人员和临床工作人员提供纳洛酮方面的教育、在电子健康记录中创建快速链接，以便更轻松地开具纳洛酮处方、确定符合纳洛酮条件的患者、并向患者提供纳洛酮咨询。
这是一项单队列前后干预研究。在计划启动一年后，手动收集数据以评估纳洛酮的开具率和需要纳洛酮的原因。此外，药学专业学生致电药店，以确定纳洛酮的配药率，并了解患者未配药的原因。
在 1 年结束时，共有 234 名患者仍有资格接受纳洛酮。共同处方纳洛酮的比例从基线时的 3.4%增加到随访时的 37.2%（P=0.0001）。71%的患者需要纳洛酮是因为接受了 50 毫克或以上 MED 的慢性阿片类药物治疗剂量，55%同时使用苯二氮䓬类药物，6%有物质使用障碍诊断，1%有药物过量史。接受纳洛酮处方的患者中，31.4%的人配药。
在治疗疼痛的慢性阿片类药物治疗患者中，初级保健中嵌入的临床药剂师有可能增加共同处方纳洛酮。
