在社区药房环境中分析纳洛酮的可及性和主要药物不依从性。

Analysis of naloxone access and primary medication nonadherence in a community pharmacy setting.

出版信息

J Am Pharm Assoc (2003). 2022 Jan-Feb;62(1):49-54. doi: 10.1016/j.japh.2021.10.011. Epub 2021 Oct 21.

DOI:10.1016/j.japh.2021.10.011

Abstract

BACKGROUND

Access to naloxone is a primary public health strategy to prevent opioid overdose death. Factors associated with primary medication nonadherence (PMN) to naloxone are underreported in the literature.

OBJECTIVE

The objective of this study was to evaluate naloxone dispensing trends and PMN in a community pharmacy setting.

METHODS

This retrospective analysis included patients of a community pharmacy chain in Maine and New Hampshire (57 and 29 pharmacy locations, respectively) for whom a claim for a naloxone prescription was billed between January 1, 2019, and July 31, 2020.

RESULTS

A total of 2152 patients associated with 2606 naloxone claims were identified for analysis. A majority of the subjects were women (52.7%) and the mean age of all the subjects was 46.4 ± 16.0 years. Of the 2606 naloxone claims, 565 prescriptions were returned to stock and never dispensed to the patient for a PMN rate of 21.7%. Gender and age were not associated with naloxone PMN. Factors associated with naloxone PMN were urban location [x(1) = 12.49, P = 0.0004], concomitant opioid analgesic [x(1) = 4.56, P = 0.0328], and payment method [x(4) = 251.07, P < 0.0001]. Regarding payment method, nonadherence was higher among cash (138 of 386, 35.8%) and private insurance (191 of 455, 42.0%) transactions whereas lower among Medicare (132 of 681, 19.4%) and Medicaid (89 of 899, 9.9%) transactions. Concomitant buprenorphine [x(1) = 44.57, P < 0.0001] and the use of a naloxone standing order [x(1) = 4.79, P = 0.0162] were associated with primary adherence to take-home naloxone.

CONCLUSION

A notable portion of naloxone prescribed and filled in the community pharmacy setting was never obtained by the patient. Factors associated with PMN in this study included geographic location, use of a standing order, concomitant prescriptions for buprenorphine or opioid analgesic medications, and payment method. Underlying causes of PMN must be addressed (e.g., removing financial barriers and optimizing the use of standing orders) to increase naloxone access for persons at risk of opioid overdose.

摘要

背景

纳洛酮的获取是预防阿片类药物过量死亡的主要公共卫生策略。文献中报告的与纳洛酮主要药物不依从（PMN）相关的因素很少。

目的

本研究旨在评估社区药房环境中纳洛酮的配药趋势和 PMN。

方法

本回顾性分析包括缅因州和新罕布什尔州一家连锁社区药房的患者（分别有 57 和 29 家药房），在 2019 年 1 月 1 日至 2020 年 7 月 31 日期间，对开出的纳洛酮处方进行了索赔。

结果

共确定了 2152 名与 2606 份纳洛酮索赔相关的患者进行分析。大多数受试者为女性（52.7%），所有受试者的平均年龄为 46.4±16.0 岁。在 2606 份纳洛酮索赔中，565 份处方退回到库存，从未配给给患者，PMN 率为 21.7%。性别和年龄与纳洛酮 PMN 无关。与纳洛酮 PMN 相关的因素包括城市位置[x(1) = 12.49，P = 0.0004]、同时使用阿片类镇痛药[x(1) = 4.56，P = 0.0328]和支付方式[x(4) = 251.07，P < 0.0001]。关于支付方式，现金（386 例中的 138 例，35.8%）和私人保险（455 例中的 191 例，42.0%）交易的不依从率较高，而医疗保险（681 例中的 132 例，19.4%）和医疗补助（899 例中的 89 例，9.9%）交易的不依从率较低。同时使用丁丙诺啡[x(1) = 44.57，P < 0.0001]和使用纳洛酮常备订单[x(1) = 4.79，P = 0.0162]与携带纳洛酮回家的主要依从性相关。

结论

在社区药房环境中开出和配给的纳洛酮处方中，相当一部分从未被患者获得。本研究中与 PMN 相关的因素包括地理位置、常备订单的使用、丁丙诺啡或阿片类镇痛药处方的同时使用以及支付方式。必须解决 PMN 的根本原因（例如，消除财务障碍和优化常备订单的使用），以增加处于阿片类药物过量风险中的人的纳洛酮获取机会。