Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2022 Mar 1;5(3):e223986. doi: 10.1001/jamanetworkopen.2022.3986.
A central tenet of harm reduction and prevention of opioid overdose deaths is the distribution and use of naloxone. Patient-centered methods that investigate naloxone acquisition and carrying can guide opioid overdose education and naloxone distribution efforts.
To assess patients' self-reported naloxone acquisition and carrying after an emergency department (ED) encounter using automated text messaging.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study investigated self-reported patient behaviors involving naloxone after ED discharge in a large, urban academic health system in Philadelphia, Pennsylvania. Adult patients who were prescribed or dispensed naloxone and who had a mobile phone number listed in the electronic health record provided informed consent after ED discharge, and data were collected prospectively using text messaging from October 10, 2020, to March 19, 2021. Patients who did not respond to the survey or who opted out were excluded.
Automated text message-based survey after ED discharge for patients who were prescribed or dispensed naloxone.
The primary outcome was patient-reported naloxone acquisition, carrying, and use. Descriptive statistics were used to summarize patient demographic characteristics.
Of 205 eligible patients, 41 (20.0%) completed the survey; of those patients, the mean (SD) age was 39.5 (13.7) years, and 21 (51.2%) were women. Fifteen (36.6%) had a personal history of being given naloxone after an overdose. As indicated by the ED record, 27 participants (65.9%) had naloxone dispensed in the ED, and 36 (87.8%) self-reported acquiring naloxone during or after their ED visit. Twenty-four participants (58.5%) were not carrying naloxone in the week before their ED visit. Twenty participants (48.8%) were carrying naloxone after the ED visit, and 27 (65.9%) reported planning to continue carrying naloxone in the future. Of the 24 individuals (58.5%) not carrying naloxone before their ED encounter, 13 (54.2%) reported planning to continue carrying naloxone in the future.
In this cohort study of adult patients dispensed or prescribed naloxone from the ED, most reported acquiring naloxone on or after discharge. The ED remains a key point of access to naloxone for individuals at high risk of opioid use and overdose, and text messaging could be a method to engage and motivate patient-reported behaviors in enhancing naloxone acquisition and carrying.
减少伤害和预防阿片类药物过量死亡的核心原则之一是纳洛酮的分发和使用。以患者为中心的方法，调查纳洛酮的获取和携带情况，可以指导阿片类药物过量教育和纳洛酮分发工作。
使用自动短信评估急诊部 (ED) 就诊后患者自我报告的纳洛酮获取和携带情况。
设计、地点和参与者：这项队列研究调查了宾夕法尼亚州费城一家大型城市学术健康系统中 ED 出院后患者自我报告的与纳洛酮有关的行为。在 ED 出院后，在电子健康记录中列出手机号码的成年患者在获得知情同意后，使用短信进行前瞻性数据收集，从 2020 年 10 月 10 日至 2021 年 3 月 19 日。未回复调查或选择退出的患者被排除在外。
ED 出院后给开了纳洛酮或配了纳洛酮的患者的自动短信调查。
主要结果是患者报告的纳洛酮获取、携带和使用情况。使用描述性统计来总结患者的人口统计学特征。
在 205 名符合条件的患者中，有 41 名（20.0%）完成了调查；这些患者的平均（SD）年龄为 39.5（13.7）岁，21 名（51.2%）为女性。15 名（36.6%）有个人经历表明在过量服用后接受过纳洛酮。根据 ED 记录，27 名参与者（65.9%）在 ED 中接受了纳洛酮，36 名（87.8%）自我报告在 ED 就诊期间或之后获得了纳洛酮。在 ED 就诊前一周，24 名参与者（58.5%）未携带纳洛酮。20 名参与者（48.8%）在 ED 就诊后携带纳洛酮，27 名（65.9%）报告计划在未来继续携带纳洛酮。在 24 名（58.5%）在 ED 就诊前未携带纳洛酮的患者中，13 名（54.2%）报告计划在未来继续携带纳洛酮。
在这项对从 ED 开出或开出纳洛酮的成年患者的队列研究中，大多数患者报告在出院后获得了纳洛酮。ED 仍然是个人获得纳洛酮的一个关键途径，这些个人有阿片类药物使用和过量的高风险，短信可以是一种方法，以吸引和激励患者报告的行为，增强纳洛酮的获取和携带。
