Overdose Education and Naloxone for Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff
Overdose Education and Naloxone for Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff
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DOI：
10.1007/s11606-015-3394-3
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发表时间：
2015-12-01
影响因子：
5.7
通讯作者：
Glanz, Jason M.
中科院分区：
文献类型：
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作者：
Binswanger, Ingrid A.;Koester, Stephen;Glanz, Jason M.
自1990年代末以来，致命的非故意阿片类药物中毒的比率大幅上升。纳洛酮是一种有效的阿片解毒剂，可以在过量使用时开给患者供旁观者使用。初级保健诊所代表了可以接触到大量患者处方阿片类药物的环境，以获得过量教育和纳洛酮处方。我们的目标是调查初级保健临床工作人员对过量教育和纳洛酮处方的知识、态度和信念。这是一项定性研究，使用焦点小组阐明临床水平和提供者水平的障碍和促进者。科罗拉多州三大卫生系统的十个初级保健内科医学、家庭医学和传染病/艾滋病毒实践。基于行为理论制定了焦点小组指南。焦点组的成绩单被编码为显性意义和潜在意义，并使用包括归纳和演绎分析的递归方法分析主题。主题出现在与过量教育和纳洛酮处方相关的四个内容领域：知识、障碍、好处和促进者。临床工作人员(N=56)证实了关于纳洛酮及其在门诊环境中的使用的实质性知识差距。他们对给谁开纳洛酮表示不确定，并确定了在实践中使用纳洛酮的一系列后勤障碍。工作人员还描述了对冒犯患者的恐惧，以及对开纳洛酮的患者危险行为增加的担忧。在考虑纳洛酮时，一些供应商对自己开出的阿片类药物处方表示批评和不适。这些障碍被认为处方纳洛酮可以预防死亡并导致更安全的阿片类药物使用行为的信念所平衡。来自这些定性焦点小组的发现可能不能推广到其他环境。除了证据差距，后勤和态度障碍将需要解决，以提高对开出止痛阿片类药物的患者的过量教育和纳洛酮处方的接受。
The rate of fatal unintentional pharmaceutical opioid poisonings has increased substantially since the late 1990s. Naloxone is an effective opioid antidote that can be prescribed to patients for bystander use in the event of an overdose. Primary care clinics represent settings in which large populations of patients prescribed opioids could be reached for overdose education and naloxone prescription.Our aim was to investigate the knowledge, attitudes and beliefs about overdose education and naloxone prescription among clinical staff in primary care.This was a qualitative study using focus groups to elucidate both clinic-level and provider-level barriers and facilitators.Ten primary care internal medicine, family medicine and infectious disease/HIV practices in three large Colorado health systems.A focus group guide was developed based on behavioral theory. Focus group transcripts were coded for manifest and latent meaning, and analyzed for themes using a recursive approach that included inductive and deductive analysis.Themes emerged in four content areas related to overdose education and naloxone prescription: knowledge, barriers, benefits and facilitators. Clinical staff (N = 56) demonstrated substantial knowledge gaps about naloxone and its use in outpatient settings. They expressed uncertainty about who to prescribe naloxone to, and identified a range of logistical barriers to its use in practice. Staff also described fears about offending patients and concerns about increased risk behaviors in patients prescribed naloxone. When considering naloxone, some providers reflected critically and with discomfort on their own opioid prescribing. These barriers were balanced by beliefs that prescribing naloxone could prevent death and result in safer opioid use behaviors.Findings from these qualitative focus groups may not be generalizable to other settings.In addition to evidence gaps, logistical and attitudinal barriers will need to be addressed to enhance uptake of overdose education and naloxone prescription for patients prescribed opioids for pain.