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Crowther D, Curran J, Somerville M, Sinclair D, Wozney L, MacPhee S, Rose AE, Boulos L, Caudrella A. Harm reduction strategies in acute care for people who use alcohol and/or drugs: A scoping review. PLoS One 2023; 18:e0294804. [PMID: 38100469 PMCID: PMC10723714 DOI: 10.1371/journal.pone.0294804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND People who use alcohol and/or drugs (PWUAD) are at higher risk of infectious disease, experiencing stigma, and recurrent hospitalization. Further, they have a higher likelihood of death once hospitalized when compared to people who do not use drugs and/or alcohol. The use of harm reduction strategies within acute care settings has shown promise in alleviating some of the harms experienced by PWUAD. This review aimed to identify and synthesize evidence related to the implementation of harm reduction strategies in acute care settings. METHODS A scoping review investigating harm reduction strategies implemented in acute care settings for PWUAD was conducted. A search strategy developed by a JBI-trained specialist was used to search five databases (Medline, Embase, CINAHL, PsychInfo and Scopus). Screening of titles, abstracts and full texts, and data extraction was done in duplicate by two independent reviewers. Discrepancies were resolved by consensus or with a third reviewer. Results were reported narratively and in tables. Both patients and healthcare decision makers contributing to the development of the protocol, article screening, synthesis and feedback of results, and the identification of gaps in the literature. FINDINGS The database search identified 14,580 titles, with 59 studies included in this review. A variety of intervention modalities including pharmacological, decision support, safer consumption, early overdose detection and turning a blind eye were identified. Reported outcome measures related to safer use, managed use, and conditions of use. Reported barriers and enablers to implementation related to system and organizational factors, patient-provider communication, and patient and provider perspectives. CONCLUSION This review outlines the types of alcohol and/or drug harm reduction strategies, which have been evaluated and/or implemented in acute care settings, the type of outcome measures used in these evaluations and summarizes key barriers and enablers to implementation. This review has the potential to serve as a resource for future harm reduction evaluation and implementation efforts in the context of acute care settings.
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Affiliation(s)
- Daniel Crowther
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | - Mari Somerville
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | - Doug Sinclair
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Mental Health and Addictions Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Shannon MacPhee
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | | | - Leah Boulos
- The Maritime Strategy for Patient Oriented Research SUPPORT Unit, Halifax, NS, Canada
| | - Alexander Caudrella
- Mental Health and Addictions Service, St Michael’s Hospital, Toronto, Ontario, Canada
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2
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Sze J, Chan T, Dalpoas S, Kiruthi C, Harris CM, Gundareddy V, Parker MS, Jacob E. Implementation of a Pharmacist-Led, Multidisciplinary Naloxone Patient Education Program at an Academic Medical Center. J Pharm Pract 2023; 36:1201-1210. [PMID: 35484711 DOI: 10.1177/08971900221094268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Opioid related overdoses are a leading cause of death in the United States (U.S). National, state and local initiatives have been implemented to combat the opioid crisis. However, there is a paucity of initiatives that examine the role of comprehensive naloxone education interventions for hospitalized patients. Objective: The aim of this study was to design a multidisciplinary, pharmacist-driven, standardized, patient and product tailored, inpatient naloxone education program (NEP) at a U.S. academic medical center, targeting patients at high risk of opioid overdose, and to examine patients' retention of education. Methods: This prospective pilot study targeted hospitalized patients who were considered at high-risk for opioid overdose once discharged. Using daily screening methods and established inclusion criteria, we evaluated the impact of implementing a patient-tailored NEP. The primary outcome measures were patient knowledge and awareness of naloxone use. A paired t-test analysis was conducted to assess for improvement in patient naloxone awareness and knowledge. Results: Of ninety-five patients screened, forty-four patients met inclusion criteria and nineteen patients completed naloxone education along with pre- and post-assessments. Patients more accurately completed the assessment, indicating enhanced knowledge about naloxone use and administration, following the naloxone education (4.68 ± .13 vs 3.42 ± .31 out of 5 questions, mean ± SEM; P = .0016). Conclusion: This study found a positive impact on patient knowledge of naloxone use and administration following implementation of a robust and comprehensive NEP.
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Affiliation(s)
- Jennifer Sze
- OptumRx, Customer Service, United Health Group, Overland Park, KS, USA
| | - Tsz Chan
- OptumRx, Customer Service, United Health Group, Overland Park, KS, USA
| | - Stacy Dalpoas
- Department of Pharmacy, Novant Health, Winston-Salem, NC
| | - Catherine Kiruthi
- Department of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Che Matthew Harris
- Department of General Internal Medicine, Division of Hospital Medicine, Johns Hopkins School of Medicine, and Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Venkat Gundareddy
- Department of General Internal Medicine, Division of Hospital Medicine, Johns Hopkins School of Medicine, and Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Marlena S Parker
- Department of Pharmacy, University of Pittsburgh Medical Center, Harrisburg, PA, USA
| | - Elsen Jacob
- College of Pharmacy & Health Sciences, St. John's University, Queens, NY, USA
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3
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Sugarman OK, Breithaupt J, Wang X, Bachhuber MA. Characteristics and health service use of Medicaid-insured individuals filling naloxone under a standing order in Louisiana. J Am Pharm Assoc (2003) 2023; 63:904-908.e1. [PMID: 36653275 PMCID: PMC11059200 DOI: 10.1016/j.japh.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Naloxone distribution is a key intervention to reduce opioid overdose deaths. On January 23, 2017, Louisiana implemented a standing order that permits pharmacies to dispense naloxone to patients without a patient-specific prescription. OBJECTIVES To examine the characteristics and health service use of Louisiana Medicaid members filling naloxone under the standing order. METHODS We conducted a retrospective cohort study of Louisiana Medicaid members from January 23, 2017 to December 31, 2019. We extracted fee-for-service claims and managed care encounters for naloxone dispensed under the standing order. RESULTS Overall, there were 2053 naloxone fills by 1912 unique individuals. The total number of naloxone fills increased from 22 in 2017 to 1218 in 2019. Most members (n = 1,586, 83.0%) received any type of health service and 20.4% (n = 391) received an opioid-related health service in the 30 days prior to filling naloxone. Additionally, 12.7% (n = 242) of members had received medication for opioid use disorder (MOUD), and 42.6% (n = 815) filled a prescription opioid analgesic within the 60 days prior to filling naloxone. Nineteen members (1.0%) had an emergency department visit for overdose within 90 days after filling naloxone. CONCLUSION Standing orders play an important role in providing access to naloxone, even among Medicaid members who had recent encounters with health care providers. We identified multiple opportunities to improve naloxone prescribing among providers caring for Medicaid-insured people who use opioids, including prescribers of opioid analgesics or MOUD.
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Affiliation(s)
- Olivia K. Sugarman
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD; Program Manager, Louisiana State University Health Sciences Center - New Orleans, School of Medicine, Section of Community and Population Medicine, New Orleans, LA
| | - Jarrod Breithaupt
- University of Louisiana, Monroe, College of Pharmacy, Office of Outcomes Research and Evaluation, Monroe, LA
| | - Xiaojun Wang
- University of Louisiana, Monroe, College of Pharmacy, Office of Outcomes Research and Evaluation, Monroe, LA
| | - Marcus A. Bachhuber
- Louisiana State University Health Sciences Center - New Orleans, School of Medicine, Section of Community and Population Medicine, New Orleans, LA
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4
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Heiman E, Lanh S, Moran TP, Steck A, Carpenter J. Electronic Advisories Increase Naloxone Prescribing Across Health Care Settings. J Gen Intern Med 2022; 38:1402-1409. [PMID: 36376626 PMCID: PMC9663180 DOI: 10.1007/s11606-022-07876-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Naloxone is a life-saving, yet underprescribed, medication that is recommended to be provided to patients at high risk of opioid overdose. OBJECTIVE We set out to evaluate the changes in prescriber practices due to the use of an electronic health record (EHR) advisory that prompted opioid prescribers to co-prescribe naloxone when prescribing a high-dose opioid. It also provided prescribers with guidance on decreasing opioid doses for safety. DESIGN This was a retrospective chart abstraction study looking at all opioid prescriptions and all naloxone prescriptions written as emergency department (ED) discharge, inpatient hospital discharge, or outpatient medications, between July 1, 2018, and February 1, 2020. The EHR advisory went live on June 1, 2019. SUBJECTS Included in the analysis were all adult patients seen in the abovementioned settings at a large county hospital and associated outpatient clinics. MAIN MEASURES We performed an interrupted time series analysis looking at naloxone prescriptions and daily opioid dosing in morphine milligram equivalents (MMEs), before and after initiation of the EHR advisory. KEY RESULTS The EHR advisory was associated with changes in prescribers' behavior, leading to increased naloxone prescriptions and decreased prescribed opioid doses. CONCLUSIONS EHR advisories are an effective systems-level intervention to enhance the safety of prescribed opioids and increase rates of naloxone prescribing.
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Affiliation(s)
- Erica Heiman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Sothivin Lanh
- Department of Emergency Medicine, Summa Health System, Akron, OH, USA
| | - Tim P Moran
- Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Alaina Steck
- Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Joseph Carpenter
- Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA, USA
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5
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Nguyen T, Applewhite D, Cheung F, Jacob S, Mitchell E. Implementation of a multidisciplinary inpatient opioid overdose education and naloxone distribution program at a large academic medical center. Am J Health Syst Pharm 2022; 79:2253-2260. [PMID: 36075057 DOI: 10.1093/ajhp/zxac252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting 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 Opioid overdose-related deaths continue to rise. Despite public health efforts, there is still variability in obtainment of naloxone, a lifesaving antidote. We share our experience in the implementation of a novel opioid overdose education and naloxone distribution (OEND) program at a large academic medical center. METHODS Collaborative efforts by pharmacists, pharmacy students, physicians, nurses, and recovery coaches were employed in the design of the program. The service was available Monday through Friday, 9 AM to 6 PM, and primarily carried out by pharmacy students on a rotating basis. Services offered included bedside delivery of naloxone and education prior to the day of discharge. In preparation for their role, the pharmacy students were required to complete a series of trainings and competency assessments. RESULTS A total of 40 patients were included in the program evaluation. Of the completed consults 96.7% (n = 30) of patients received both counseling and naloxone delivery. Eighty percent of patients had a history of nonfatal opioid overdose, but only 37.5% had naloxone listed as a home medication. Fifteen percent of patients had patient-directed discharges but still received OEND services. CONCLUSION Implementation of an inpatient OEND program by mobilizing trained student pharmacists is feasible and expands naloxone access to patients during transitions of care. A similar model could be considered in the future for the delivery of harm reduction supplies to this patient population.
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Affiliation(s)
- TuTran Nguyen
- Department of Pharmacy, The Massachusetts General Hospital, Boston, MA.,Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Dinah Applewhite
- Division of General Internal Medicine, The Massachusetts General Hospital, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Fiona Cheung
- Department of Pharmacy, The Massachusetts General Hospital, Boston, MA.,Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Susan Jacob
- Department of Pharmacy, The Massachusetts General Hospital, Boston, MA.,Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Elisabeth Mitchell
- Department of Pharmacy, The Massachusetts General Hospital, Boston, MA.,Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
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6
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Dora‐Laskey A, Kellenberg J, Dahlem CH, English E, Gonzalez Walker M, Brummett CM, Kocher KE. Piloting a statewide emergency department take-home naloxone program: Improving the quality of care for patients at risk of opioid overdose. Acad Emerg Med 2022; 29:442-455. [PMID: 34962682 DOI: 10.1111/acem.14435] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Emergency department (ED) patients with nonfatal opioid overdose are at high risk for subsequent fatal overdose, yet ED programs aimed at reducing harm from opioid use remain underdeveloped. OBJECTIVES The objective was to pilot a statewide ED take-home naloxone program and improve the care of patients with opioid use disorder (OUD) and risky drug use through training and interprofessional network building. METHODS Nine hospital EDs with pharmacy, nurse, and physician champions were recruited, surveyed, and trained. Take-home naloxone rescue kits were developed, disseminated, and tracked. Two overdose prevention summits were convened prior to the COVID pandemic, and two X-waiver training courses aimed at emergency physicians and advanced practice providers were arranged, both in person and virtual. RESULTS A total of 872 naloxone rescue kits were distributed to ED patients at risk of opioid overdose during the first phase of this project, and more than 140 providers were trained in the use of medications for OUD in acute care settings. CONCLUSIONS A statewide ED take-home naloxone program was shown to be feasible across a range of different hospitals with varying maturity in preexisting OUD resources and capabilities. Future work will be aimed at both expanding and measuring the effectiveness of this work.
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Affiliation(s)
- Aaron Dora‐Laskey
- Department of Emergency Medicine Michigan State University College of Human Medicine East Lansing Michigan USA
| | - Joan Kellenberg
- Department of Anesthesiology University of Michigan Ann Arbor Michigan USA
| | - Chin Hwa Dahlem
- Department of Health Behavior and Biological Sciences School of Nursing University of Michigan Ann Arbor Michigan USA
| | - Elizabeth English
- Department of Anesthesiology University of Michigan Ann Arbor Michigan USA
| | | | - Chad M. Brummett
- Department of Anesthesiology University of Michigan Ann Arbor Michigan USA
| | - Keith E. Kocher
- Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA
- Department of Learning Health Sciences University of Michigan Ann Arbor Michigan USA
- Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor Michigan USA
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7
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Lennox R, Martin L, Brimner C, O'Shea T. Hospital policy as a harm reduction intervention for people who use drugs. Int J Drug Policy 2021; 97:103324. [PMID: 34153628 DOI: 10.1016/j.drugpo.2021.103324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 01/19/2023]
Abstract
Hospitals are a critical touchpoint for people who use drugs (PWUD). However, hospital policies, both formal and informal, can have a detrimental impact on PWUD in acute care settings. Introducing new policies, or revising existing policies that inadvertently harm or stigmatize PWUD while hospitalized, could be an effective harm reduction intervention for this high-risk population. This paper explores seven areas where institutional policy change could improve the hospital experience of PWUD: (1) use of nonprescribed substances in hospital, (2) supporting inpatient addiction consultation services (3) in-hospital supervised consumption spaces (4) supply and distribution of safe drug use equipment and naloxone, (5) role of security services and personal searches, (6) use of hospital restrictions, and (7) involvement of PWUD in policy development.
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Affiliation(s)
- Robin Lennox
- Department of Family Medicine, McMaster University, Hamilton, Canada; St. Joseph's Healthcare, Hamilton, Canada.
| | - Leslie Martin
- Department of Medicine, Division of General Internal Medicine, McMaster University, Hamilton, Canada; St. Joseph's Healthcare, Hamilton, Canada
| | | | - Tim O'Shea
- St. Joseph's Healthcare, Hamilton, Canada; Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Canada
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8
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Riazi F, Toribio W, Irani E, Hughes TM, Huxley-Reicher Z, McBratney E, Vu T, Sigel K, Weiss JJ. Community Case Study of Naloxone Distribution by Hospital-Based Harm Reduction Program for People Who Use Drugs in New York City. Front Sociol 2021; 6:619683. [PMID: 34307540 PMCID: PMC8292929 DOI: 10.3389/fsoc.2021.619683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/03/2021] [Indexed: 05/04/2023]
Abstract
Background: In 2017, The Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program at Mount Sinai Hospital became a registered Opioid Overdose Prevention Program (OOPP) and received funding from the New York City Department of Health and Mental Hygiene to develop a program to provide overdose education and naloxone distribution (OEND) training to at risk population and bystanders. We report on the programmatic quality improvement initiatives conducted. Methods: From April 2017 to December 2020, the REACH OOPP conducted 290 opioid overdose reversal trainings, throughout the Mount Sinai Health System and in multiple other community settings. OEND training was at times offered alone and in other settings alongside Hepatitis C Virus point of care testing. Additionally, a "train the trainer" model was implemented whereby medical students and nurses at outpatient clinics were trained to train others. Results: There were 4235 naloxone kits distributed to 3,906 participants. The training venues included hospital settings (patients and medical staff), public events, substance use programs, educational facilities, homeless prevention programs, faith-based organizations, alternative to incarceration programs, and community-based organizations. We implemented two types of training. During outreach sessions, we utilized one-on-one personalized sessions to train bystanders. When training clinic staff in the "train the trainer" model we utilized a standardized didactic presentation with slides. The two top reasons participants reported for being trained were "Just in case I see someone overdose" (59.3%) and "I'm worried that someone I know will overdose OR that I will overdose" (20.2%). Conclusion: The REACH program at Mount Sinai Hospital developed an effective model to train community bystanders and health care staff by leveraging administrative support and building on broader programmatic initiatives to promote drug user health and stigma-free care for people who use drugs. Hospitals do not currently mandate staff training or keeping naloxone stocked at inpatient units or outpatients clinics posing a challenge when implementing an OEND program in this setting. A recommended policy change needed to decrease overdose deaths is for hospitals to be required to implement systematic naloxone education and access for all health care personal and at risk patients.
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Affiliation(s)
- Farah Riazi
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- *Correspondence: Farah Riazi,
| | - Wilma Toribio
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emaun Irani
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Terence M. Hughes
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Elisa McBratney
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Trang Vu
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jeffrey J. Weiss
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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9
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Siff JE, Margolius D, Papp J, Boulanger B, Watts B. A Healthcare System-Level Intervention to Increase Naloxone Availability for Patients With Opioid Prescriptions. Am J Addict 2020; 30:179-182. [PMID: 33378097 DOI: 10.1111/ajad.13136] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES National guidelines recommend prescribing naloxone to patients receiving chronic opioids. However, provider adherence to naloxone co-prescribing best practices is poor and knowledge gaps for improvement efforts are large. As part of a system-wide quality improvement intervention to improve opioid safety, we sought to improve access to naloxone for patients with opioid prescriptions. METHODS A prompt for naloxone co-prescribing was implemented in the electronic health record. Baseline data and data after implementation were collected for naloxone co-prescribing and fill rates on naloxone prescriptions s (n = 9122 pre, 8368 post). RESULTS In the 9 months following the implementation of the electronic prompt, the total number of naloxone prescriptions increased more than 15-fold. Patients prescribed naloxone filled their naloxone prescriptions similarly (42%) before and after the prompt implementation, resulting in a marked increase in the absolute number of patients with access to naloxone. Patient fill rates varied by clinical area (33% emergency medicine to 47% general medicine). CONCLUSION AND SCIENTIFIC SIGNIFICANCE An electronic prompt, encouraging providers to prescribe naloxone to at-risk patients led to a marked increase in the percentage of patients with an active naloxone prescription. The availability of naloxone in communities saves lives and this study is the first to demonstrate an intervention, which led to increased naloxone prescribing and reported on actual pharmacy fills of naloxone when co-prescribed with opioids. (Am J Addict 2020;00:00-00).
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Affiliation(s)
- Jonathan E Siff
- The MetroHealth System, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David Margolius
- The MetroHealth System, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joan Papp
- The MetroHealth System, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Bernard Boulanger
- The MetroHealth System, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Brook Watts
- The MetroHealth System, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
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10
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Ross JJ, Ard KL, Carlile N. Septic Arthritis and the Opioid Epidemic: 1465 Cases of Culture-Positive Native Joint Septic Arthritis From 1990-2018. Open Forum Infect Dis 2020; 7:ofaa089. [PMID: 32258206 PMCID: PMC7100530 DOI: 10.1093/ofid/ofaa089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/06/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The clinical spectrum of septic arthritis in the era of the opioid crisis is ill-defined. METHODS This is a retrospective chart review of 1465 cases of culture-positive native joint septic arthritis at Boston teaching hospitals between 1990 and 2018. RESULTS Between 1990-2008 and 2009-2018, the proportion of septic arthritis cases involving people who inject drugs (PWID) rose from 10.3% to 20% (P < .0000005). Overall, methicillin-sensitive Staphylococcus aureus (MSSA) caused 41.5% of cases, and methicillin-resistant Staphylococcus aureus (MRSA) caused 17.9%. Gram-negative rods caused only 6.2% of cases. Predictors of MRSA septic arthritis included injection drug use (P < .001), bacteremia (P < .001), health care exposure (P < .001), and advancing age (P = .01). Infections with MSSA were more common in PWID (56.3% vs 38.8%; P < .00001), as were infections with MRSA (24% vs 16.8%; P = .01) and Serratia sp. (4% vs 0.4%; P = .002). Septic arthritis in the setting of injection drug use was significantly more likely to involve the sacroiliac, acromioclavicular, and facet joints; 36.8% of patients had initial synovial fluid cell counts of <50 000 cells/mm3. CONCLUSIONS Injection drug use has become the most common risk factor for septic arthritis in our patient population. Septic arthritis in PWID is more often caused by MRSA, MSSA, and Serratia sp., and is more prone to involve the sacroiliac, acromioclavicular, sternoclavicular, and facet joints. Synovial fluid cell counts of <50 000 cells/mm3 are common in culture-positive septic arthritis.
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Affiliation(s)
- John J Ross
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Correspondence: J. Ross MD, FIDSA, 15 Francis St., PBB-420, Brigham and Women’s Hospital, Boston, MA 02115 ()
| | - Kevin L Ard
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Narath Carlile
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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11
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Patino MI, Kraus P, Bishop MA. Implementation of patient education software in an anticoagulation clinic to decrease visit times for new patient appointments. Patient Educ Couns 2019; 102:961-967. [PMID: 30665730 DOI: 10.1016/j.pec.2018.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Patient education on high-risk medications such as warfarin is important, and they require quick follow-up after initiation to maximize efficacy and safety. In our Anticoagulation Clinic, two 60-minute new patient appointments are available each day, contributing to prolonged lead-time. We instituted standardized warfarin video education to shorten in-clinic-room visit time, to potentially increase new patient appointments. METHODS Patients viewed the video in the waiting area with a goal to decrease visit times by 15 min (25%), before pharmacists completed their visit. Data collected included time spent in the clinic room, education comprehension, and patient feedback. RESULTS Ninety patient visits were evaluated in one pre-intervention and two post-intervention phases. Patients who received video education spent less time in the clinic room versus those who had not (52.4 vs 39.4 min, p = 0.001), and two-thirds of all post-intervention visits achieved 25% reduction in visit time. There were no significant differences in education comprehension and patient satisfaction. CONCLUSION Video education significantly decreased in-clinic-room visit time, and most patients achieved a goal of 25% reduction in time spent, without a change in comprehension or patient satisfaction. PRACTICE IMPLICATIONS Implementation of video education can reduce clinic times in many patients without significantly impacting patient satisfaction.
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