Trends in naloxone prescriptions prescribed after implementation of a National Academic Detailing Service in the Veterans Health Administration: A preliminary analysis
Trends in naloxone prescriptions prescribed after implementation of a National Academic Detailing Service in the Veterans Health Administration: A preliminary analysis
复制标题
DOI：
10.1016/j.japh.2016.11.003
复制
发表时间：
2017-03-01
影响因子：
2.1
通讯作者：
Christopher, Melissa L. D.
中科院分区：
文献类型：
--
作者：
Bounthavong, Mark;Harvey, Michael A.;Christopher, Melissa L. D.
目的：评估美国退伍军人健康管理局（VA）国家学术详细服务以及阿片类药物过量教育和纳洛酮分配（OEND）计划对2014年10月至2016年9月处方的纳洛酮处方的影响。方法：一个回顾性、重复测量队列研究进行了评估的有效性，在现实世界中的应用学术细化（AD）以及2014年10月至2016年9月提供者门诊纳洛酮处方的OEND。结果是每个提供者每月开具纳洛酮处方的数量。在研究期间，VA提供者知道OEND，但可能没有接触到学术细节。因此，在研究期间提供第一次OEND特定学术详细说明会议时，提供者被归类为暴露。广义估计方程用于估计暴露于学术细节和每月纳洛酮处方之间的关联，同时考虑到每个供应商内部的相关性。发病率比95%CIsreported.Results：七百五十（22.6%）的3313供应商收到至少一个OEND具体的学术详细访问。在1年时，与未暴露于AD的供应商相比，暴露于AD的供应商每月纳洛酮处方的平均数量是3倍（95%CI 2.0-5.3）;在2年时，纳洛酮处方的平均数量是7倍（95%CI 3.0-17.9）。此外，纳洛酮处方从基线到2年的平均差异为7.1%，更大的AD暴露的供应商相比，AD未暴露的供应商（95%CI 2.0%-12.5%）。结论：初步分析提供了第一个证据表明，学术详细影响纳洛酮处方率在一个大型的，综合性的医疗保健系统在1年和2年。此外，2年随访后，与未暴露于AD的提供者相比，暴露于AD的提供者在纳洛酮处方率方面的平均差异更高。爱思唯尔公司出版代表美国药剂师协会
Objectives: To evaluate the effects of the U.S. Veterans Health Administration (VA) National Academic Detailing Service alongside the Opioid Overdose Education and Naloxone Distribution (OEND) program on naloxone prescriptions prescribed from October 2014 to September 2016.Methods: A retrospective, repeated measures cohort study was conducted to evaluate the effectiveness of a real-world application of academic detailing (AD) alongside OEND on providers' outpatient naloxone prescribing from October 2014 to September 2016. Outcome was the number of naloxone prescriptions prescribed per month per provider. During the study period, VA providers were aware of OEND, but may not have been exposed to academic detailing. Therefore, providers were categorized as exposed when the first OEND-specific academic detailing session was provided during the study period. Generalized estimating equations were used to estimate the association between exposure to academic detailing and monthly naloxone prescriptions prescribed while taking into account the correlation within each provider. Incident rate ratios with 95% CIs were reported.Results: Seven hundred fifty (22.6%) of 3313 providers received at least 1 OEND-specific academic detailing visit. At 1 year, the average number of naloxone prescriptions per month was 3-times greater in AD-exposed providers compared with AD-unexposed providers (95% CI 2.0-5.3); and at 2 years, the average number of naloxone prescriptions was 7-times greater (95% CI 3.0-17.9). Moreover, the average difference in naloxone prescribing from baseline to 2 years was 7.1% greater in AD-exposed providers compared with AD-unexposed providers (95% CI 2.0%-12.5%).Conclusions: This preliminary analysis provides the first evidence that academic detailing influenced naloxone prescribing rates in a large, integrated health care system at 1 and 2 years. In addition, AD-exposed providers had a higher average difference in naloxone prescribing rate compared with AD-unexposed providers after 2 years of follow-up. Published by Elsevier Inc. on behalf of the American Pharmacists Association.