J Am Pharm Assoc (2003). 2020 Sep-Oct;60(5):694-701.e1. doi: 10.1016/j.japh.2020.01.030. Epub 2020 Mar 4.
Tennessee has one of the highest rates of opioid prescribing in the United States; therefore, the objectives of this study were to examine availability, pricing, and pharmacist-initiated recommendations of naloxone in retail community pharmacies in Eastern and Western Tennessee; to identify the most common barriers to naloxone dispensing and strategies to improve access; and to determine regional differences in access to naloxone.
A cross-sectional survey conducted via telephone.
All retail community pharmacies located in the most populous counties in the eastern and western regions of Tennessee were eligible for inclusion, as were all retail community pharmacies in the 5 counties in each region that had the highest rates of opioid prescriptions (316 pharmacies identified in 12 counties).
Outcome measures included availability, price, and pharmacist-initiated recommendations of naloxone products, barriers to dispensing, and suggestions to improve naloxone access. Survey responses were summarized as descriptive statistics. Chi-square, independent samples t test, and inductive content analysis were conducted.
Response rate was 56.3%. Most participants (92.7%) reported that naloxone (Narcan) was available from their pharmacies at a mean cash price of $132.49, with no statistically significant differences between regions. The most commonly reported barrier was cost (70.2%). When queried about recommendations to various groups at a high risk of overdose, as advised by the U.S. Department of Health and Human Services, 42.1% to 69.1% of pharmacies reported recommending naloxone to at least 50% of high-risk patients. Suggestions to increase naloxone access included lowering the cost and improving naloxone-related education for patients, pharmacists, and other providers.
Although Narcan was widely available, cost was a frequently cited barrier to dispensing. Pharmacist-initiated recommendations for coprescribing and dispensing naloxone to patients at a high risk of overdose were limited. Addressing cost issues in addition to increasing patient and pharmacist education concerning the use and benefit of naloxone were suggested to improve naloxone access.
田纳西州是美国阿片类药物处方率最高的州之一；因此，本研究的目的是检查田纳西州东部和西部零售社区药店中纳洛酮的供应、定价和药剂师建议情况；确定纳洛酮配药的最常见障碍以及改善获取途径的策略；并确定纳洛酮获取途径的地区差异。
通过电话进行的横断面调查。
符合条件的是田纳西州东部和西部人口最多的县的所有零售社区药店，以及每个地区阿片类药物处方率最高的 5 个县的所有零售社区药店（共 12 个县中的 316 家药店）。
结局测量包括纳洛酮产品的供应、价格和药剂师建议、配药障碍以及改善纳洛酮获取途径的建议。汇总调查结果作为描述性统计数据。进行了卡方检验、独立样本 t 检验和归纳内容分析。
回复率为 56.3%。大多数参与者（92.7%）报告说，他们的药店可以提供纳洛酮（Narcan），平均现金价格为 132.49 美元，地区之间没有统计学上的显著差异。报告的最常见障碍是成本（70.2%）。当被问及根据美国卫生与公众服务部的建议，向各种有过量用药风险的群体推荐纳洛酮时，42.1%至 69.1%的药店报告向至少 50%的高风险患者推荐了纳洛酮。增加纳洛酮获取途径的建议包括降低成本和改善患者、药剂师和其他提供者的纳洛酮相关教育。
尽管纳洛酮广泛可用，但成本是配药的常见障碍。药剂师主动建议将纳洛酮与高风险过量用药患者共同处方和配药的情况有限。建议解决成本问题，同时增加患者和药剂师对纳洛酮使用和益处的教育，以改善纳洛酮的获取途径。
