Santa Heather M, Amirova Samira G, Ventricelli Daniel J, Downs George E, Nowalk Alexandra A, Pringle Janice L, Aruru Meghana
Program Evaluation and Research Unit (PERU), University of Pittsburgh School of Pharmacy, Pittsburgh, PA.
Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA.
Am J Health Syst Pharm. 2021 Feb 8;78(4):327-335. doi: 10.1093/ajhp/zxaa387.
Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County's being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high.
To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site-specific naloxone dispensing protocols.
Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists' understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists' self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation.
Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists' knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.
阿片类药物滥用和过量致死在美国仍然是一个公共卫生问题。宾夕法尼亚州是美国阿片类药物过量致死率最高的州之一，费城县的这一比率比全国平均水平高出3倍。尽管采取了多种多模式干预措施，包括使用SBIRT（筛查、简短干预和转介治疗）方法以及分发纳洛酮，但过量致死率仍然很高。
为了深入了解改善费城县药剂师获取纳洛酮及纳洛酮分发策略，在费城的11家社区药房（连锁和独立药房）开展了一项研究。招募了24名药剂师并完成了SBIRT和纳洛酮培训。每家药房选出至少1名药房负责人，其接受了关于制定药房特定纳洛酮配药方案的额外培训并协助制定该方案。
前后调查结果显示，对纳洛酮配药的歧视态度有所减少，药剂师对长期处方和纳洛酮正确使用的理解有所增加。药剂师自我报告的向患者正确识别、讨论和分发纳洛酮能力的信心有所增强。所有药房在实施方案后平均每月分发率都有所提高。
接受两项培训的药剂师更有可能改变纳洛酮配药做法，导致社区药剂师分发纳洛酮的总体增加。该研究解决了药剂师知识方面的总体差距，减少了歧视，并使药剂师做好准备与患者讨论阿片类药物使用和过量预防问题。所描述的由药剂师主导的过量预防患者咨询和干预服务可作为其他社区药房采用的模式，以改善纳洛酮分发及类似干预措施以减少过量致死。
