Optimizing naloxone distribution to prevent opioid overdose fatalities: results from piloting the Systems Analysis and Improvement Approach within syringe service programs.
Optimizing naloxone distribution to prevent opioid overdose fatalities: results from piloting the Systems Analysis and Improvement Approach within syringe service programs.
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DOI：
10.1186/s12913-023-09289-8
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发表时间：
2023-03-22
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
--
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在阿片类药物过量事件期间，及时给予纳洛酮（一种阿片类药物拮抗剂）可预防阿片类药物过量死亡。注射器服务计划开创了纳洛酮分配给阿片类药物过量的潜在旁观者。本研究的目的是试点测试的多组件的实施策略-纳洛酮（SAIA-纳洛酮）的系统分析和改进方法-以改善纳洛酮分配注射器服务计划的目标。两个注射器服务项目参与了为期6个月的SAIA-纳洛酮试点，其中包括（1）分析项目数据，以确定纳洛酮给药级联中的差距，（2）流程图，以确定流失的原因和集思广益的方案变更，以进行改进，以及（3）进行持续质量改进，以测试和评估修改是否改善级联。我们使用开始SAIA-纳洛酮治疗前52周和治疗后26周的数据进行了中断时间序列分析。Poisson回归用于评估SAIA-纳洛酮与每周接受纳洛酮的参与者数量和分配的纳洛酮剂量数量之间的相关性。在研究过程中，11，107剂纳洛酮被分发给6，071名参与者。通过SAIA-Naloxone，注射器服务计划优先考虑测试程序修改，以改善数据收集程序，主动筛选和识别纳洛酮初治参与者，简化纳洛酮再填充系统，并允许二次纳洛酮分配。SAIA-纳洛酮与每周接受纳洛酮的平均人数（SPP参与者增加37%; 95%CI，12%至67%）和每周分配的纳洛酮剂量平均数（纳洛酮剂量增加105%; 95%CI，79%至136%）超过基础的SAIA-纳洛酮前水平的统计学显著增加相关。随着时间的推移，这些最初的增加随着持续的积极变化而扩大（与SAIA前纳洛酮时期的每周趋势相比，随后每周接受纳洛酮的SSP参与者增加了1.6%，分配的纳洛酮剂量增加了0.3%）。SAIA-纳洛酮具有很强的潜力，可以改善注射器服务项目中纳洛酮的分布。这些发现在美国面临阿片类药物过量危机恶化的情况下是令人鼓舞的，并支持在注射器服务项目中进行大规模随机试验来测试SAIA-纳洛酮。
Opioid overdose fatalities are preventable with timely administration of naloxone, an opioid antagonist, during an opioid overdose event. Syringe service programs have pioneered naloxone distribution for potential bystanders of opioid overdose. The objective of this study was to pilot test a multi-component implementation strategy—the systems analysis and improvement approach for naloxone (SAIA-Naloxone)—with the goal of improving naloxone distribution by syringe service programs. Two syringe service programs participated in a 6-month pilot of SAIA-Naloxone, which included (1) analyzing program data to identify gaps in the naloxone delivery cascade, (2) flow mapping to identify causes of attrition and brainstorm programmatic changes for improvement, and (3) conducting continuous quality improvement to test and assess whether modifications improve the cascade. We conducted an interrupted time series analysis using 52 weeks of data before and 26 weeks of data after initiating SAIA-Naloxone. Poisson regression was used to evaluate the association between SAIA-Naloxone and the weekly number of participants receiving naloxone and number of naloxone doses distributed. Over the course of the study, 11,107 doses of naloxone were distributed to 6,071 participants. Through SAIA-Naloxone, syringe service programs prioritized testing programmatic modifications to improve data collection procedures, proactively screen and identify naloxone-naïve participants, streamline naloxone refill systems, and allow for secondary naloxone distribution. SAIA-Naloxone was associated with statistically significant increases in the average number of people receiving naloxone per week (37% more SPP participants; 95% CI, 12% to 67%) and average number of naloxone doses distributed per week (105% more naloxone doses; 95% CI, 79% to 136%) beyond the underlying pre-SAIA-Naloxone levels. These initial increases were extended by ongoing positive changes over time (1.6% more SSP participants received naloxone and 0.3% more naloxone doses were distributed in each subsequent week compared to the weekly trend in the pre-SAIA Naloxone period). SAIA-Naloxone has strong potential for improving naloxone distribution from syringe service programs. These findings are encouraging in the face of the worsening opioid overdose crisis in the United States and support testing SAIA-Naloxone in a large-scale randomized trial within syringe service programs.
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影响因子：
4.4
作者：
Davis, Corey S.;Southwell, Jessica K.;Dailey, Michael W.
通讯作者：
Dailey, Michael W.
影响因子：
12.7
作者：
Davis, Corey S.;Ruiz, Sarah;Walley, Alexander Y.
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影响因子：
1.9
作者：
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Zong, X
影响因子：
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作者：
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Scholl, Lawrence
DOI：
10.1097/qai.0000000000001023
发表时间：
2016-07-01
影响因子：
3.6
作者：
Rustagi, Alison Silvis;Gimbel, Sarah;Sherr, Kenneth
通讯作者：
Sherr, Kenneth