农村社区药房的阿片类药物过量咨询及纳洛酮处方：一项试点研究。
Opioid overdose counseling and prescribing of naloxone in rural community pharmacies: A pilot study.
作者信息
Teeter Benjamin S, Thannisch Mary M, Martin Bradley C, Zaller Nickolas D, Jones Duane, Mosley Cynthia L, Curran Geoffrey M
机构信息
Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America.
University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America.
出版信息
Explor Res Clin Soc Pharm. 2021 Jun;2. doi: 10.1016/j.rcsop.2021.100019. Epub 2021 May 8.
INTRODUCTION
Fatal overdoses from opioids increased four-fold from 1999 to 2009, and they are now the leading cause of death among Americans under 50. Legislation has been passed by every state to increase access to naloxone but dispensing by community pharmacies remains low.
OBJECTIVES
The objective of this study was to pilot test a proactive opioid overdose counseling intervention and a passive naloxone intervention, and the implementation strategies developed to support their delivery, in rural community pharmacies on relevant implementation outcomes.
METHODS
The interventions, implementation strategies, and the overall pilot study approach were developed in a collaborative partnership with a regional supermarket pharmacy chain. They selected 2 rural pharmacies to participate in the pilot study and 2 non-intervention pharmacies to serve as comparison sites. Two interventions were pilot tested in the 2 intervention pharmacies: 1)a proactive opioid overdose counseling intervention and 2) a passive naloxone intervention. An explanatory sequential mixed-methods design was utilized to evaluate adoption, feasibility, acceptability, and appropriateness outcomes after the 3-month observation period.
RESULTS
Between the 2 intervention pharmacies, 130 patients received the opioid overdose counseling intervention. 44 (33.8%) were prescribed and dispensed naloxone. Zero naloxone prescriptions were written or dispensed at the comparison pharmacies. Interviews with pharmacy staff found the interventions to be feasible, acceptable, and appropriate in their settings.
CONCLUSION
This small scale pilot study in partnership with a regional supermarket pharmacy chain had positive results with a third of patients who received the opioid overdose counseling intervention being dispensed naloxone. However, the majority of patients did not receive naloxone indicating additional revisions to the intervention components and/or implementation strategies are needed to improve the overall impact of the interventions.
引言
1999年至2009年期间，阿片类药物致死的过量用药事件增加了四倍，目前已成为50岁以下美国人的首要死因。每个州都已通过立法，以增加纳洛酮的可及性，但社区药房的配药率仍然很低。
目的
本研究的目的是在农村社区药房对一种主动式阿片类药物过量用药咨询干预措施和一种被动式纳洛酮干预措施，以及为支持其实施而制定的实施策略，就相关实施结果进行试点测试。
方法
干预措施、实施策略以及整个试点研究方法是与一家地区连锁超市药房合作制定的。他们选择了2家农村药房参与试点研究，并选择2家非干预药房作为对照点。在2家干预药房对两种干预措施进行了试点测试：1）主动式阿片类药物过量用药咨询干预措施和2）被动式纳洛酮干预措施。采用解释性序列混合方法设计，在3个月的观察期后评估采用情况、可行性、可接受性和适宜性结果。
结果
在2家干预药房中，130名患者接受了阿片类药物过量用药咨询干预措施。44名（占33.8%）患者被开具并配到了纳洛酮。对照药房未开出或配出任何纳洛酮处方。对药房工作人员的访谈发现，这些干预措施在其环境中是可行的、可接受的和适宜的。
结论
这项与地区连锁超市药房合作开展的小规模试点研究取得了积极成果，接受阿片类药物过量用药咨询干预措施的患者中有三分之一配到了纳洛酮。然而，大多数患者没有配到纳洛酮，这表明需要对干预措施的组成部分和/或实施策略进行进一步修订，以提高干预措施的总体效果。
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