MUSC Health, Charleston, SC, and Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA.
MUSC Health, Charleston, SC, and Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Am J Health Syst Pharm. 2024 Nov 22;81(Supplement_5):S189-S196. doi: 10.1093/ajhp/zxae199.
To evaluate the impact of a best-practice advisory (BPA) and South Carolina legislation on naloxone prescribing patterns. The primary objective was to assess the change in naloxone prescription rates following BPA implementation. The secondary objective was to analyze the performance of the BPA.
Naloxone prescriptions generated before (July 28, 2020, through July 27, 2021) and after (July 28, 2021, through July 28, 2022) BPA implementation were analyzed via retrospective chart review. Lists of patients at risk for opioid overdose and patients for whom the BPA fired were generated for March 2022. The BPA's effectiveness was evaluated based on the proportion of at-risk patients missed by the alert, the frequency with which the BPA resulted in a naloxone prescription, and the reasons for not prescribing naloxone when the BPA fired.
Following BPA implementation, there was a significant increase in the average monthly naloxone prescribing rate from 66.1 to 625.5 prescriptions per month. Overall, 2,086 patients were considered at risk for opioid overdose and 1,101 had a BPA alert during March 2022, with 32.7% of BPA alerts resulting in naloxone prescribing. The most common reasons selected for not prescribing naloxone were "patient refusal" and "criteria not met." Only 354 patients (17.1%) at risk for opioid overdose also had a BPA alert.
State legislation and implementation of the BPA significantly increased naloxone prescribing rates. However, a significant proportion of patients identified as being at risk did not have a BPA alert and most BPA alerts did not result in naloxone prescribing, suggesting a need for improvement of the BPA.
评估最佳实践咨询（BPA）和南卡罗来纳州立法对纳洛酮处方模式的影响。主要目的是评估 BPA 实施后纳洛酮处方率的变化。次要目的是分析 BPA 的性能。
通过回顾性病历审查分析 BPA 实施前后（2020 年 7 月 28 日至 2021 年 7 月 27 日和 2021 年 7 月 28 日至 2022 年 7 月 28 日）生成的纳洛酮处方。为 2022 年 3 月生成了有阿片类药物过量风险的患者和 BPA 触发的患者名单。根据警报漏报的高危患者比例、BPA 导致纳洛酮处方的频率以及 BPA 触发时未开具纳洛酮的原因，评估 BPA 的有效性。
BPA 实施后，平均每月纳洛酮处方率从 66.1 份增加到 625.5 份。总体而言，2022 年 3 月有 2086 名患者被认为有阿片类药物过量的风险，1101 名患者有 BPA 警报，其中 32.7%的 BPA 警报导致开具纳洛酮处方。选择不开具纳洛酮的最常见原因是“患者拒绝”和“不符合标准”。只有 354 名（17.1%）有阿片类药物过量风险的患者也有 BPA 警报。
州立法和 BPA 的实施显著提高了纳洛酮的处方率。然而，很大一部分被确定为有风险的患者没有 BPA 警报，而且大多数 BPA 警报并没有导致纳洛酮处方，这表明需要改进 BPA。
