Glanz Jason M, Mueller Shane R, Narwaney Komal J, Wagner Nicole, Xu Stan, Kraus Courtney, Wain Kris, Botts Sheila, Binswanger Ingrid A
Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO.
Department of Epidemiology, Colorado School of Public Health, Aurora, CO.
BMJ Public Health. 2024 Jul;2(1). doi: 10.1136/bmjph-2023-000725. Epub 2024 Jul 8.
Public health efforts to reduce opioid overdose fatalities include educating people at risk and expanding access to naloxone, a medication that reverses opioid-induced respiratory depression. People receiving long-term opioid therapy (LTOT) are at increased risk for overdose, yet naloxone uptake in this population remains low. The objective of this study was to determine if a targeted, digital health intervention changed patient risk behavior, increased naloxone uptake, and increased knowledge about opioid overdose prevention and naloxone.
We conducted a pragmatic randomized clinical trial among patients prescribed LTOT in a health care delivery system in Colorado. Participants were randomly assigned to receive an animated overdose prevention and naloxone educational video (intervention arm) or usual care (control arm). The 6-minute video was designed to educate patients about opioid overdose and naloxone, increase overdose risk perception, and prompt them to purchase naloxone from the pharmacy. Over an 8-month follow-up, opioid risk behavior was assessed with the Opioid-Related Behaviors in Treatment survey instrument, and overdose and naloxone knowledge was measured with the Prescription Opioid Overdose Knowledge Scale after viewing the video at baseline. Naloxone dispensations were evaluated using pharmacy data over a 12-month period. Data were analyzed with generalized linear mixed effects and log-binomial regression models.
There were 519 participants in the intervention arm and 485 participants in the usual care arm. Opioid risk behavior did not differ between the study arms over time (study arm by time interaction P=0.93). There was no difference in naloxone uptake between the arms (RR = 1.13, 95% CI: 0.77-1.66). Knowledge was significantly greater in the intervention arm compared to usual care (P<0.001).
A targeted, digital health intervention video effectively increased opioid overdose and naloxone knowledge, without increasing opioid risk behavior. Naloxone uptake did not differ between the intervention and usual care arms.
ClinicalTrials.gov number NCT03337009.
减少阿片类药物过量致死的公共卫生措施包括对有风险的人群进行教育，并扩大纳洛酮的可及性，纳洛酮是一种可逆转阿片类药物所致呼吸抑制的药物。接受长期阿片类药物治疗（LTOT）的人群过量用药风险增加，但该人群中纳洛酮的使用率仍然较低。本研究的目的是确定一种有针对性的数字健康干预措施是否能改变患者的风险行为、提高纳洛酮的使用率，并增加有关阿片类药物过量预防和纳洛酮的知识。
我们在科罗拉多州一个医疗保健系统中对接受LTOT治疗的患者进行了一项实用随机临床试验。参与者被随机分配接受一部关于过量用药预防和纳洛酮的动画教育视频（干预组）或常规护理（对照组）。这部6分钟的视频旨在教育患者有关阿片类药物过量和纳洛酮的知识，提高对过量用药风险的认知，并促使他们从药房购买纳洛酮。在8个月的随访期间，使用治疗中与阿片类药物相关行为调查工具评估阿片类药物风险行为，并在基线观看视频后使用处方阿片类药物过量知识量表测量过量用药和纳洛酮知识。使用药房12个月期间的数据评估纳洛酮的配药情况。数据采用广义线性混合效应模型和对数二项回归模型进行分析。
干预组有519名参与者，常规护理组有485名参与者。随着时间的推移，各研究组之间的阿片类药物风险行为没有差异（研究组与时间的交互作用P = 0.93）。两组之间纳洛酮的使用率没有差异（RR = 1.13，95%CI：0.77 - 1.66）。与常规护理相比，干预组的知识水平显著更高（P < 0.001）。
一项有针对性的数字健康干预视频有效地增加了阿片类药物过量和纳洛酮的知识，而没有增加阿片类药物风险行为。干预组和常规护理组之间纳洛酮的使用率没有差异。
ClinicalTrials.gov编号NCT03337009。
