Rife Tessa, Tat Christina, Jones Jennifer, Pennington David L
San Francisco Veterans Affairs Health Care System, San Francisco, California.
School of Pharmacy, University of California, San Francisco, San Francisco, California.
J Am Assoc Nurse Pract. 2021 Mar 12;34(1):188-195. doi: 10.1097/JXX.0000000000000577.
Up to 35% of veterans with opioid use disorder (OUD) are homeless, and veterans with OUD are nearly 29 times higher risk for homelessness; however, few are prescribed naloxone, an evidence-based intervention to reverse life-threatening opioid overdose.
Many housing facilities for homeless veterans contracted with the San Francisco Veterans Affairs Health Care System are located in neighborhoods with high rates of opioid overdose. No systematic interventions have been implemented to provide opioid overdose education and naloxone kits to veterans and staff at these facilities. This quality improvement (QI) initiative aimed to increase provision of opioid overdose education and naloxone for veterans and staff at contracted housing facilities.
This was a prospective single-arm cohort QI intervention. All contracted veteran housing programs were included. Descriptive statistics evaluated results.
A total of 18 contracted veteran housing programs were contacted from July 2019 through January 2020 to schedule training.
Of those, 13 programs responded to outreach and 10 visits were completed at 8 housing facilities. Training was provided by pharmacist and nurse practitioner trainers to 26 staff members and 59 veterans. Naloxone was prescribed to 37 veterans.
A pharmacist-led and nurse practitioner-led initiative was effective in increasing veteran and staff access to opioid overdose education and naloxone at >44% contracted veteran housing facilities. Challenges included lack of response from housing programs, low veteran turn out, and inability to provide naloxone to veterans not enrolled/ineligible for health care. Future initiatives should examine strategies to standardize access in homeless veterans' programs.
高达35%的患有阿片类药物使用障碍（OUD）的退伍军人无家可归，患有OUD的退伍军人无家可归的风险几乎高出29倍；然而，很少有人被开给纳洛酮，这是一种用于逆转危及生命的阿片类药物过量的循证干预措施。
许多与旧金山退伍军人事务医疗保健系统签约的无家可归退伍军人住房设施位于阿片类药物过量发生率高的社区。尚未实施系统干预措施，为这些设施的退伍军人和工作人员提供阿片类药物过量教育和纳洛酮试剂盒。这项质量改进（QI）倡议旨在增加为签约住房设施的退伍军人和工作人员提供阿片类药物过量教育和纳洛酮。
这是一项前瞻性单臂队列QI干预。纳入了所有签约的退伍军人住房项目。描述性统计评估结果。
从2019年7月到2020年1月，共联系了18个签约的退伍军人住房项目以安排培训。
其中，13个项目回应了外展活动，在8个住房设施完成了10次访问。药剂师和执业护士培训师为26名工作人员和59名退伍军人提供了培训。为37名退伍军人开了纳洛酮。
由药剂师主导和执业护士主导的倡议有效地增加了超过44%的签约退伍军人住房设施中退伍军人和工作人员获得阿片类药物过量教育和纳洛酮的机会。挑战包括住房项目没有回应、退伍军人参与率低以及无法为未登记/无资格获得医疗保健的退伍军人提供纳洛酮。未来的倡议应研究使无家可归退伍军人项目的获取标准化的策略。
