提供者对在实施国家学术细化项目后为有阿片类药物过量风险的患者开纳洛酮处方的障碍和促进因素的看法：定性评估。
Providers' perceptions on barriers and facilitators to prescribing naloxone for patients at risk for opioid overdose after implementation of a national academic detailing program: A qualitative assessment.
机构信息
The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA; National Academic Detailing Service, Pharmacy Benefits Management, U.S. Department of Veterans Affairs, Washington, D.C, USA; Veterans Affairs (VA) Health Economics Resource Center (HERC), Menlo Park, CA, USA; Veterans Affairs (VA) Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA.
The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA.
出版信息
Res Social Adm Pharm. 2020 Aug;16(8):1033-1040. doi: 10.1016/j.sapharm.2019.10.015. Epub 2019 Oct 31.
BACKGROUND
Academic detailing is an educational outreach program that aligns providers' prescribing with evidence-based practice. The U.S. Department of Veterans Affairs (VA) Opioid Overdose Education and Naloxone Distribution (OEND) Program partnered with the VA Pharmacy Benefits Management National Academic Detailing Service to deliver naloxone education to providers who cared for patients at risk of opioid overdose. In this pilot study, we interviewed providers' who received academic detailing to capture their perceptions of facilitators and barriers to prescribing naloxone.
OBJECTIVE
To identify providers' perceptions of facilitators and barriers to prescribing naloxone for patients at risk for opioid overdose after implementation of a national academic detailing program.
METHODS
This was a hybrid inductive-deductive qualitative pilot using semi-structured interviews with VA providers to explore constructs associated with facilitators and barriers to prescribing take-home naloxone to patients at risk for opioid overdose from August 2017 to April 2018.
RESULTS
Eleven participants were interviewed, six physicians, three clinical psychiatric pharmacists, and two nurse practitioners. Participants identified patient-level barriers (social stigma and lack of homeless patient support), poor data integration, and burden of data validation as barriers to prescribing naloxone. However, they also identified patient lists, repeat visits, and face-to-face/one-on-one video conferencing visits as important facilitators for naloxone prescribing.
CONCLUSIONS/IMPORTANCE: Academic detailing will need to address issues of social stigma regarding naloxone, educate providers about existing support systems for homeless veterans, and develop tools for data integration to improve naloxone access for veterans at risk for an opioid overdose.
背景
学术详述是一种教育外展计划，旨在使提供者的处方与循证实践保持一致。美国退伍军人事务部（VA）阿片类药物过量教育和纳洛酮分发（OEND）计划与 VA 药房福利管理国家学术详述服务合作，向为有阿片类药物过量风险的患者提供护理的提供者提供纳洛酮教育。在这项试点研究中，我们采访了接受学术详述的提供者，以了解他们对开具纳洛酮处方的促进因素和障碍的看法。
目的
确定提供者对在全国学术详述计划实施后为有阿片类药物过量风险的患者开具纳洛酮处方的促进因素和障碍的看法。
方法
这是一项混合归纳演绎定性试点研究，使用半结构化访谈与 VA 提供者进行，以探讨与为有阿片类药物过量风险的患者开具纳洛酮处方的促进因素和障碍相关的结构。从 2017 年 8 月到 2018 年 4 月。
结果
共采访了 11 名参与者，其中 6 名是医生，3 名是临床精神药理学药剂师，2 名是执业护士。参与者确定了患者层面的障碍（社会耻辱和缺乏无家可归患者的支持）、数据集成不良以及数据验证负担是开具纳洛酮处方的障碍。然而，他们还确定了患者名单、复诊和面对面/一对一视频会议访问是开具纳洛酮的重要促进因素。
结论/重要性：学术详述将需要解决纳洛酮的社会耻辱问题，教育提供者有关无家可归退伍军人现有支持系统的信息，并开发数据集成工具，以改善有阿片类药物过量风险的退伍军人获得纳洛酮的机会。
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