Group Visits for Overdose Education and Naloxone Distribution in Primary Care: A Pilot Quality Improvement Initiative
Group Visits for Overdose Education and Naloxone Distribution in Primary Care: A Pilot Quality Improvement Initiative
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DOI：
10.1093/pm/pnx243
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发表时间：
2017-12-01
期刊：
影响因子：
3.1
通讯作者：
Becker, William C.
中科院分区：
文献类型：
--
作者：
Spelman, Juliette F.;Peglow, Stephanie;Becker, William C.
客观的。在美国，用于治疗慢性疼痛的阿片类药物是导致阿片类药物过量死亡的重要原因。纳洛酮作为阿片类药物过量的带回家解毒剂尚未得到充分利用，并且尚未在高危慢性疼痛人群中进行评估。目的是通过初级保健中的小组访视，加强对长期接受阿片类药物治疗疼痛的高危患者的过量用药教育和纳洛酮分配 (OEND)。设计。两个初级保健诊所的质量改进干预。设置。退伍军人健康管理局内的一个大型学术机构。主题。患者每日服用≥100毫克吗啡当量的处方，或同时服用阿片类药物和苯二氮卓类药物。方法。一间诊所提供有关 OEND 的常规护理；另一家诊所鼓励其所有高危患者参加 OEND 小组访视。结果。我们使用小组访问的出席率、纳洛酮处方以及患者满意度评分来评估这种形式的 OEND.Key Results。团体 OEND 就诊导致纳洛酮处方数量明显多于常规护理。在这些小组访问中，患者很投入，重视这次经历，并且所有人都要求纳洛酮套件的处方。结论。这项质量改进试点研究表明，OEND 团体访视是一种有前途的护理模式。
Objective. Opioid prescribing for chronic pain significantly contributes to opioid overdose deaths in the United States. Naloxone as a take-home antidote to opioid overdose is underutilized and has not been evaluated in the high-risk chronic pain population. The objective was to increase overdose education and naloxone distribution (OEND) to high-risk patients on long-term opioid therapy for pain by utilizing group visits in primary care.Design. Quality improvement intervention among two primary care clinics.Setting. A large, academic facility within the Veterans Health Administration.Subjects. Patients prescribed >= 100 mg morphine-equivalent daily dose or coprescribed opioids and benzodiazepines.Methods. One clinic provided usual care with respect to OEND; another clinic encouraged attendance at an OEND group visit to all of its high-risk patients.Results. We used attendance at group visits, prescriptions of naloxone issued, and patient satisfaction scores to evaluate this format of OEND.Key Results. Group OEND visits resulted in significantly more naloxone prescriptions than usual care. At these group visits, patients were engaged, valued the experience, and all requested a prescription for the naloxone kit.Conclusion. This quality improvement pilot study suggests that OEND group visits are a promising model of care.