Providers' perceptions on barriers and facilitators to prescribing naloxone for patients at risk for opioid overdose after implementation of a national academic detailing program: A qualitative assessment

2020 ◽  
Vol 16 (8) ◽  
pp. 1033-1040 ◽  
Author(s):  
Mark Bounthavong ◽  
Kangho Suh ◽  
Melissa L.D. Christopher ◽  
David L. Veenstra ◽  
Anirban Basu ◽  
...  
Keyword(s):  
At Risk ◽  
Barriers And Facilitators ◽  
Qualitative Assessment ◽  
Opioid Overdose ◽  
Academic Detailing ◽  
Patients At Risk

Performance of a Predictive Model versus Prescription-Based Thresholds in Identifying Patients at Risk of Fatal Opioid Overdose

2021 ◽  
Vol 56 (3) ◽  
pp. 396-403
Author(s):  
Lindsey M. Ferris ◽  
Brendan Saloner ◽  
Kate Jackson ◽  
B. Casey Lyons ◽  
Vijay Murthy ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Model ◽  
Opioid Overdose ◽  
Patients At Risk ◽  
Model Versus

Piloting a Statewide Emergency Department Take‐Home Naloxone Program: Improving the Quality of Care for Patients at Risk of Opioid Overdose

2021 ◽  
Author(s):  
Aaron Dora‐Laskey ◽  
Joan Kellenberg ◽  
Chin Hwa Dahlem ◽  
Elizabeth English ◽  
Monica Gonzalez Walker ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Quality Of Care ◽  
Opioid Overdose ◽  
Patients At Risk

Implementing routine emergency department naloxone rescue kits for patients at risk of opioid overdose

2015 ◽  
Vol 156 ◽  
pp. e60
Author(s):  
Mari-Lynn Drainoni ◽  
Jacqueline Ellison ◽  
Elisa Koppelman ◽  
Patricia Mitchell ◽  
James Feldman ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Opioid Overdose ◽  
Patients At Risk

scholarly journals Protocol for Take home naloxone In Multicentre Emergency setting (TIME): Feasibility Study

2020 ◽  
Author(s):  
Matthew Jones ◽  
Fiona Bell ◽  
Jonathan Benger ◽  
Sarah Black ◽  
Penny Buykx ◽  
...  
Keyword(s):  
At Risk ◽  
Feasibility Study ◽  
Adverse Event Rate ◽  
Opioid Overdose ◽  
Emergency Setting ◽  
Risk Of Death ◽  
Emergency Ambulance ◽  
Patients At Risk ◽  
One Year

Abstract Background Opioids, such as heroin, kill more people worldwide by overdose than any other type of drug, and death rates associated with opioid poisoning in the UK are at record levels (1, 2). Naloxone is an opioid antagonist which can be distributed in ‘kits’ for administration by witnesses in an overdose emergency. This intervention is known as Take Home Naloxone (THN). We know that THN can save lives on an individual level, but there is currently limited evidence about the effectiveness of THN distribution on an aggregate level, in specialist drug service settings or in emergency service settings. Notably, we do not know whether THN kits reduce deaths from opioid overdose in at-risk populations, if there are unforeseen harms associated with THN distribution or if THN is cost-effective. In order to address this research gap, we aim to determine the feasibility of a fully-powered cluster Randomised Controlled Trial (RCT) of THN distribution in emergency settings. Methods We will carry out a feasibility study for a RCT of THN distributed in emergency settings at four sites, clustered by Emergency Department (ED) and catchment area within its associated ambulance service. THN is a peer-administered intervention. At two intervention sites, emergency ambulance paramedics and ED clinical staff will distribute THN to adult patients who are at risk of opioid overdose. At two control sites, practice will carry on as usual. We will develop a method of identifying a population to include in an evaluation, comprising people at risk of fatal opioid overdose, who may potentially receive naloxone included in a THN kit. We will gather anonymised outcomes up to one year following a 12 month ‘live’ trial period for patients at risk of death from opioid poisoning. We expect approximately 100 patients at risk of opioid overdose to be in contact with each service during the one year recruitment period. Our outcomes will include: deaths; emergency admissions; intensive care admissions; and ED attendances. We will collect numbers of eligible patients attended by participating emergency ambulance paramedics and attending ED; THN kits issued; and NHS resource usage. We will determine whether to progress to a fully-powered trial based on pre-specified progression criteria: sign-up of sites (n = 4); staff trained (>= 50%); eligible participants identified (>= 50%); THN provided to eligible participants (>= 50%); people at risk of death from opioid overdose identified for inclusion in follow up (>= 75% of overdose deaths); outcomes retrieved for high risk individuals (>= 75%); and adverse event rate (<10% difference between study arms).Discussion This feasibility study is the first randomised, methodologically robust investigation of THN distribution in emergency settings. The study addresses an evidence gap related to the effectiveness of THN distribution in emergency settings. As this study is being carried out in emergency settings, obtaining informed consent on behalf of participants is not feasible. We therefore employ novel methods for identifying participants and capturing follow up data, with effectiveness dependent on the quality of the available routine data.Trial registration ISRCTN13232859 (Registered 16/02/2018)

scholarly journals Development, implementation, and evaluation of a clinical decision support tool to improve naloxone coprescription within military health system pharmacies

2021 ◽  
Author(s):  
Alexander Rittel ◽  
Krista Highland ◽  
Mark S Maneval ◽  
Archie Bockhorst ◽  
Agustin Moreno ◽  
...  
Keyword(s):  
At Risk ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Opioid Overdose ◽  
Military Health System ◽  
Military Health ◽  
Support Tool ◽  
Patients At Risk

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe the development, implementation, and evaluation of a pharmacy clinical decision support tool designed to increase naloxone coprescription among people at risk for opioid overdose in a large healthcare system. Summary The Military Health System Opioid Registry and underlying presentation layer were used to develop a clinical decision support capability to improve naloxone coprescription at the pharmacy point of care. Pharmacy personnel use a patient identification card barcode scanner or manually enter a patient’s identification number to quickly visualize information on a patient’s risk for opioid overdose and medical history related to pain and, when appropriate, receive a recommendation to coprescribe naloxone. The tool was made available to military treatment facility pharmacy locations. An interactive dashboard was developed to support monitoring, utilization, and impact on naloxone coprescription to patients at risk for opioid overdose. Conclusion Initial implementation of the naloxone tool was slow from a lack of end-user awareness. Efforts to increase utilization were, in part, successful owing to a number of enterprise-wide educational initiatives. In early 2020, the naloxone tool was used in 15% of all opioid prescriptions dispensed at a military pharmacy. Data indicate that the frequency of naloxone coprescription to patients at risk for opioid overdose was significantly higher when the naloxone tool was used than when the tool was not used.

scholarly journals Addressing the Opioid Crisis: Community Partnerships in Primary Care

PRiMER ◽  
2019 ◽  
Vol 3 ◽  
Author(s):  
Jamie Weinand ◽  
Athena Huckaby ◽  
Olivia Chavez ◽  
Ramona Sharma ◽  
Jeanette Lara ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Family Medicine ◽  
Control Period ◽  
The United States ◽  
Opioid Overdose ◽  
Family Medicine Residency ◽  
Standardized Protocol ◽  
Number Of Patients ◽  
Patients At Risk

Introduction: New Mexico is currently ranked 17th in the United States for drug overdose death rates. Our project seeks to decrease opioid overdose deaths in a community by increasing the number of patients with naloxone in a local family medicine residency clinic. Methods: We developed a protocol wherein providers asked patients at risk of opioid overdose about naloxone access. Free naloxone was distributed in partner with the county health department, accompanied by teaching of use. We reviewed patient encounters during a 45-day control and study period to measure naloxone possession among patients at risk. Results: Nearly two-thirds of patients at risk of opioid overdose had no naloxone. A standardized protocol implemented to distribute an opioid reversal agent doubled naloxone prescribed by providers at visits (10.3%) compared to a control period (4.3%), but lacked statistical significance. Conclusion: Patients in a family medicine residency clinic who were at risk of opioid overdose overwhelmingly did not have naloxone, and a standardized protocol with a community-based partnership increased access to naloxone. Further project data will have implications for ongoing naloxone distribution programs in primary care.

scholarly journals Protocol for Take home naloxone In Multicentre Emergency setting (TIME): Feasibility Study

2020 ◽  
Author(s):  
Matthew Jones ◽  
Fiona Bell ◽  
Jonathan Benger ◽  
Sarah Black ◽  
Penny Buykx ◽  
...  
Keyword(s):  
At Risk ◽  
Feasibility Study ◽  
Adverse Event Rate ◽  
Opioid Overdose ◽  
Emergency Setting ◽  
Risk Of Death ◽  
Emergency Ambulance ◽  
Patients At Risk ◽  
One Year

Abstract Background Opioids, such as heroin, kill more people worldwide by overdose than any other type of drug, and death rates associated with opioid poisoning in the UK are at record levels. Naloxone is an opioid antagonist which can be distributed in ‘kits’ for administration by witnesses in an overdose emergency. This intervention is known as Take Home Naloxone (THN). There is a lack of rigorous experimental research into the effectiveness of THN distribution, with fundamental questions remaining unanswered: do THN kits reduce deaths? are there unforeseen harms associated with THN distribution? and is THN distribution cost-effective? We seek to establish the feasibility of a fully-powered cluster Randomised Controlled Trial (RCT) of THN distribution in emergency settings to answer these questions.Methods We will carry out a feasibility study for a RCT of THN distributed in emergency settings at four sites, clustered by Emergency Department (ED) and catchment area within its associated ambulance service. At two intervention sites, emergency ambulance paramedics and ED clinical staff will distribute THN to adult patients who are at risk of opioid overdose. At two control sites practice will carry on as usual. THN is a peer-administered intervention. We will develop a method of identifying a population to include in an evaluation, comprising people at risk of opioid overdose, who may potentially receive THN. We will gather anonymised outcomes up to one year following a 12 month ‘live’ trial period for patients at risk of death from opioid poisoning. We expect approximately 100 patients at risk of opioid overdose to be in contact with each service during the one year recruitment period. Our outcomes will include: deaths; emergency admissions; intensive care admissions; and ED attendances. We will collect numbers of eligible patients attended by participating emergency ambulance paramedics and attending ED; THN kits issued; and NHS resource usage. We will determine whether to progress to a fully powered trial based on pre-specified progression criteria: sign-up of sites (n = 4); staff trained (>= 50%); eligible participants identified (>= 50%); THN provided to eligible participants (>= 50%); people at risk of death from opioid overdose identified for inclusion in follow up (>= 75% of overdose deaths); outcomes retrieved for high risk individuals (>= 75%); and adverse event rate (<10% difference between trial arms).Discussion This feasibility study is the first randomised, methodologically robust investigation of THN distribution in emergency settings. The study addresses an evidence gap related to the effectiveness of THN distribution in emergency settings. As this study is being carried out in emergency settings, obtaining informed consent on behalf of participants is not feasible. We therefore employ novel methods for identifying participants and capturing follow up data, the effectiveness of which are dependent on the quality of the available routine data.

scholarly journals Predictive Modelling of Susceptibility to Substance Abuse, Mortality and Drug-Drug Interactions in Opioid Patients

2021 ◽  
Vol 4 ◽  
Author(s):  
Ramya Vunikili ◽  
Benjamin S. Glicksberg ◽  
Kipp W. Johnson ◽  
Joel T. Dudley ◽  
Lakshminarayanan Subramanian ◽  
...  
Keyword(s):  
At Risk ◽  
Drug Interactions ◽  
Predictive Models ◽  
Causal Effect ◽  
Opioid Abuse ◽  
Gradient Boosting ◽  
Diabetic Patients ◽  
Opioid Overdose ◽  
Extreme Gradient Boosting ◽  
Patients At Risk

Objective: Opioids are a class of drugs that are known for their use as pain relievers. They bind to opioid receptors on nerve cells in the brain and the nervous system to mitigate pain. Addiction is one of the chronic and primary adverse events of prolonged usage of opioids. They may also cause psychological disorders, muscle pain, depression, anxiety attacks etc. In this study, we present a collection of predictive models to identify patients at risk of opioid abuse and mortality by using their prescription histories. Also, we discover particularly threatening drug-drug interactions in the context of opioid usage.Methods and Materials: Using a publicly available dataset from MIMIC-III, two models were trained, Logistic Regression with L2 regularization (baseline) and Extreme Gradient Boosting (enhanced model), to classify the patients of interest into two categories based on their susceptibility to opioid abuse. We’ve also used K-Means clustering, an unsupervised algorithm, to explore drug-drug interactions that might be of concern.Results: The baseline model for classifying patients susceptible to opioid abuse has an F1 score of 76.64% (accuracy 77.16%) while the enhanced model has an F1 score of 94.45% (accuracy 94.35%). These models can be used as a preliminary step towards inferring the causal effect of opioid usage and can help monitor the prescription practices to minimize the opioid abuse.Discussion and Conclusion: Results suggest that the enhanced model provides a promising approach in preemptive identification of patients at risk for opioid abuse. By discovering and correlating the patterns contributing to opioid overdose or abuse among a variety of patients, machine learning models can be used as an efficient tool to help uncover the existing gaps and/or fraudulent practices in prescription writing. To quote an example of one such incidental finding, our study discovered that insulin might possibly be interacting with opioids in an unfavourable way leading to complications in diabetic patients. This indicates that diabetic patients under long term opioid usage might need to take increased amounts of insulin to make it more effective. This observation backs up prior research studies done on a similar aspect. To increase the translational value of our work, the predictive models and the associated software code are made available under the MIT License.

Increasing Naloxone Knowledge and Use Through Direct-to-Patient Education

2020 ◽  
Vol 36 (6) ◽  
pp. 237-242
Author(s):  
Kathryn Litten ◽  
Lucas G. Hill ◽  
Aida Garza ◽  
Maaya Srinivasa
Keyword(s):  
At Risk ◽  
Knowledge Score ◽  
The United States ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Education Access ◽  
Patients At Risk ◽  
Change In Mean

Background: In the United States, opioid overdoses account for 130 deaths daily. Barriers to obtaining naloxone, the drug-of-choice for opioid overdose reversal, include limited education, access, and perceptions of provider judgement. Objectives: This study aimed to assess the efficacy of mailed education about naloxone, with or without a live teaching seminar, to patients at risk for opioid overdose. Methods: This observational study was conducted in a federally qualified health system. A phone presurvey was administered to patients on long-term opioid therapy or with a diagnosis of opioid use disorder to assess opioid overdose-related knowledge. Subjects were mailed a handout about naloxone and an invitation to receive naloxone at no cost at a seminar. Three-month phone postsurveys were conducted. The primary outcome was change in mean knowledge score from presurvey to postsurvey. Secondary outcomes included scores on individual survey items, naloxone prescriptions provided, and overdose reversals reported. Results: Ninety-four patients received mailed education. Sixty-two subjects took presurveys and 23 took 3-month follow-up surveys. Five subjects attended the live seminar. The mean cumulative knowledge score improved by 8.7% from the presurvey to the postsurvey. During the study period, one new naloxone prescription was written and one overdose reversal was reported. Conclusion: Direct-to-patient mailed education slightly improved knowledge regarding naloxone and opioid overdose response, and it may have led to one successful overdose reversal. Mailing education to a larger population of patients at risk for opioid overdose may be necessary to observe a substantial clinical impact.

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