Dieujuste Nathalie, Johnson-Koenke Rachel, Celedon Manuel, Basrai Zahir, Christopher Melissa, Smith Jason, Sasson Comilla
is a Research and Project Coordinator, is a Social Work Researcher, and is an Emergency Medicine Physician and Health Service Researcher, all at the Rocky Mountain Regional Veterans Affairs (VA) Medical Center in Aurora, Colorado. is an Assistant Chief of Emergency Medicine, and is an Emergency Medicine Physician, both at the Greater Los Angeles VA Health Care System in California. is an Associate Chief Consultant for VA Pharmacy Benefits Management and the National Director for VA PBM Academic Detailing Service in San Diego, California. is a Pharmacy Benefit Manager for VISN 19 Academic Detailing Service in Denver, Colorado. Rachel Johnson-Koenke is an Assistant Professor at the University of Colorado College of Nursing in Aurora.
Fed Pract. 2021 Sep;38(9):412-419. doi: 10.12788/fp.0179. Epub 2021 Sep 13.
A priority for Veterans Health Administration (VHA) leadership is increasing access to lifesaving treatment, particularly naloxone distribution and medication-assisted treatment (MAT) for opioid use disorder (OUD) for veterans. To date, these practices are not widely done in the VHA emergency departments (ED) and urgent care centers (UCC).
The goal of this research was to understand advanced care provider perceptions of barriers and facilitators to naloxone distribution or MAT initiation in VHA ED/UCCs. We developed and disseminated a survey to VHA ED and UCC advanced care providers, including medical doctors (MD/DO), physician assistants (PAs), and nurse practitioners (NPs). Descriptive statistical analysis was conducted.
There was 16.7% response rate (372 out of 2228 providers) from 103 of 132 sites across all VA regions. The top barrier for ED/UCCs providers to both naloxone and MAT initiation was the feeling that it was beyond their scope of practice (35.2% and 53.2%, respectively). Other reported barriers to MAT initiation included unclear follow-up plan and system for referral of care (50.1%) and feeling uncomfortable using MAT medications (28.8%). Top facilitators for prescribing naloxone included pharmacist who could help prescribe/educate the patient on the medication (44.6%) and patient knowledge of medication options to help overdose (31.7%). The top facilitator for MAT initiation from the ED/UCC was additional VA-based same day treatment options (34.9%).
Present findings offer a look into possible challenges to address or opportunities to leverage when considering or developing an ED/UCC-based naloxone distribution or MAT-initiation implementation program in VHA facilities.
退伍军人健康管理局（VHA）领导层的一项首要任务是增加获得救生治疗的机会，特别是为退伍军人提供纳洛酮分发和药物辅助治疗（MAT）以治疗阿片类药物使用障碍（OUD）。迄今为止，这些做法在VHA急诊科（ED）和紧急护理中心（UCC）中并未广泛开展。
本研究的目的是了解高级护理人员对VHA急诊部/紧急护理中心分发纳洛酮或启动MAT的障碍和促进因素的看法。我们开发并向VHA急诊部和紧急护理中心的高级护理人员进行了一项调查，这些人员包括医生（MD/DO）、医师助理（PA）和执业护士（NP）。进行了描述性统计分析。
所有VA地区132个站点中的103个站点的回复率为16.7%（2228名提供者中的372名）。急诊部/紧急护理中心的提供者在启动纳洛酮和MAT方面的首要障碍是感觉这超出了他们的执业范围（分别为35.2%和53.2%）。报告的启动MAT的其他障碍包括后续计划不明确和护理转诊系统（50.1%）以及对使用MAT药物感到不舒服（28.8%）。开具纳洛酮的首要促进因素包括可以帮助为患者开具/讲解药物的药剂师（44.6%）以及患者对有助于过量用药的药物选择的了解（31.7%）。急诊部/紧急护理中心启动MAT的首要促进因素是基于VA的额外同日治疗选择（34.9%）。
目前的研究结果揭示了在VHA设施中考虑或制定基于急诊部/紧急护理中心的纳洛酮分发或MAT启动实施计划时可能需要应对的挑战或可利用的机会。
