J Am Pharm Assoc (2003). 2024 May-Jun;64(3):102026. doi: 10.1016/j.japh.2024.01.022. Epub 2024 Feb 4.
Risk of fatal drug overdose is higher in pregnant and postpartum people with substance use disorder (SUD) than for nonpregnant women of reproductive age. It is recommended that naloxone is prescribed for pregnancies complicated by opioid or stimulant use disorder.
The purpose of this study was to assess the rates of naloxone coprescribing with buprenorphine in a perinatal SUD (PSUD) specialty clinic and identify opportunities for pharmacist-led interventions to improve communication and documentation surrounding naloxone access to achieve a rate of 100% coprescribing of naloxone with buprenorphine.
A clinical pharmacist practitioner is embedded on the Project CARA (Care that Advocates Respect/Resilience/Recovery for All) team, which provides outpatient SUD care integrated with perinatal care in Western North Carolina.
The clinical pharmacist practitioner assessed baseline rates of naloxone coprescribing with medications for opioid use disorder. Interventions to improve rates of coprescribing include provider education, electronic health record (EHR) documentation templates, and direct patient outreach.
Baseline rates of naloxone coprescribing were assessed and then re-evaluated after different interventions to measure pharmacist impact.
Each intervention improved rates of naloxone coprescribing in a PSUD clinic. EHR documentation templates had the largest impact on baseline efforts, although the long-term benefits derived from these efforts have not yet been demonstrated. Substantial time investment from the pharmacist was required to address patients' barriers to obtaining naloxone after their visits.
Further process improvement should address barriers to naloxone access for both patients and providers. This may include proactive identification of patients in need of naloxone and a "meds-to-beds" pilot to assist patients in navigating logistical challenges.
与非妊娠育龄妇女相比，患有物质使用障碍（SUD）的孕妇和产后人群发生致命药物过量的风险更高。建议对合并阿片类或兴奋剂使用障碍的妊娠开具纳洛酮处方。
本研究旨在评估围产期 SUD（PSUD）专科诊所中与丁丙诺啡同时开具纳洛酮的比率，并确定药剂师主导的干预措施的机会，以改善与纳洛酮获取相关的沟通和记录，从而实现丁丙诺啡与纳洛酮同时开具的比率达到 100%。
一名临床药师从业者被嵌入 Project CARA（为所有人提供关爱、尊重、韧性和康复的护理）团队，该团队在北卡罗来纳州西部提供与围产期护理相结合的门诊 SUD 护理。
临床药师从业者评估了与阿片类药物使用障碍药物同时开具纳洛酮的初始比率。为提高同时开具比率而采取的干预措施包括提供教育、电子健康记录（EHR）记录模板以及直接对患者进行宣传。
评估了纳洛酮同时开具的初始比率，然后在不同干预措施后重新评估，以衡量药剂师的影响。
在 PSUD 诊所中，每项干预措施都提高了纳洛酮同时开具的比率。EHR 记录模板对基线工作的影响最大，尽管这些工作的长期效益尚未得到证明。药剂师需要投入大量时间来解决患者在就诊后获得纳洛酮的障碍。
应进一步改进流程，以解决患者和提供者获得纳洛酮的障碍。这可能包括主动识别需要纳洛酮的患者，并试行“药物到病床”，以帮助患者解决后勤挑战。
