J Am Pharm Assoc (2003). 2020 Jan-Feb;60(1):81-86. doi: 10.1016/j.japh.2019.09.007. Epub 2019 Oct 25.
Each U.S. state and the District of Columbia has passed legislation expanding access to naloxone, the opioid overdose antidote. Most naloxone access laws allow for standing orders, whereby prescribers may authorize pharmacists to dispense naloxone without an outside prescription. A recent study from our group assessing naloxone accessibility via standing order identified continued access barriers. The present study assessed whether brief, in-person, student-led academic detailing of community pharmacists improved naloxone accessibility.
A telephone audit of all 2317 CVS, Walgreens, H-E-B, and Walmart pharmacies in Texas was conducted to determine naloxone accessibility under standing orders. Within 2 months following the initial audit, student pharmacists visited the Austin and San Antonio, Texas area pharmacies that indicated they would not dispense naloxone without a prescription, to provide brief (< 5 minutes) academic detailing to the pharmacist on duty. Students followed a scripted outline designed to inform pharmacists about naloxone standing orders and naloxone use for opioid overdose response. Then they provided a flyer and requested that it be displayed in the pharmacy to inform patients about naloxone. An identical telephone audit was conducted 1-2 weeks following the education.
Of the 49 pharmacies receiving education, 37 (76%) responded that they would dispense naloxone without an outside prescription appropriately. When comparing each pharmacy before and after detailing, respectively, it was observed that 51% versus 71% (P = 0.008) stocked naloxone; 43% versus 71% (P = 0.002) would dispense naloxone to a third-party customer; and 12% versus 37% (P = 0.005) would submit a claim to the insurance of a third-party customer.
Student-led academic detailing was effective in improving pharmacists' willingness to dispense naloxone under standing orders and increasing naloxone accessibility from community pharmacies. Studies beyond Texas chain pharmacies are warranted to validate the effectiveness of this technique on a larger scale.
美国每个州和哥伦比亚特区都通过了扩大纳洛酮（阿片类药物过量解毒剂）获取途径的立法。大多数纳洛酮获取法允许医嘱，即医生可以授权药剂师在没有处方的情况下配给纳洛酮。我们小组最近的一项评估通过医嘱获取纳洛酮的便利性的研究发现了持续存在的获取障碍。本研究评估了由学生主导的对社区药剂师进行短暂的面对面学术培训是否能提高纳洛酮的可及性。
对德克萨斯州所有 2317 家 CVS、Walgreens、H-E-B 和 Walmart 药店进行电话审计，以确定在医嘱下纳洛酮的可及性。在初始审计后的 2 个月内，学生药剂师访问了奥斯汀和圣安东尼奥的德克萨斯州地区的药店，这些药店表示如果没有处方，他们将不会配给纳洛酮，然后向值班药剂师提供关于纳洛酮医嘱和纳洛酮用于阿片类药物过量反应的简短（<5 分钟）学术培训。学生们遵循了一个脚本大纲，旨在告知药剂师有关纳洛酮医嘱和纳洛酮用于阿片类药物过量反应的信息。然后，他们提供了一张传单，并要求将其在药店展示，以告知患者有关纳洛酮的信息。在教育后的 1-2 周内进行了相同的电话审计。
在接受教育的 49 家药店中，有 37 家（76%）表示他们将适当地在没有处方的情况下配给纳洛酮。分别比较每家药店在详细说明前后的情况，发现 51%对 71%（P=0.008）备有纳洛酮；43%对 71%（P=0.002）将向第三方客户配给纳洛酮；12%对 37%（P=0.005）将向第三方客户的保险提交索赔。
由学生主导的学术培训能够有效提高药剂师在医嘱下配给纳洛酮的意愿，并增加社区药店的纳洛酮可及性。需要在德克萨斯州连锁药店之外进行研究，以验证这种技术在更大规模上的有效性。
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