Overdose Risk Assessment, Counseling and Naloxone Prescription in Health Care

医疗保健中的过量风险评估、咨询和纳洛酮处方

基本信息

批准号：
8567153
负责人：
Ingrid A Binswanger
金额：
$ 25.5万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-06-15 至 2016-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8567153
关键词：
Academic Medical Centers Address Administrator Antidotes Attitude Belief Caring Cessation of life Chronic Client satisfaction Clinic Clinical Clinical Pharmacists Clinical Trials Communication Communities Counseling Country Data Dependence Development Dose Drug user Early treatment Education Emergency Situation Epidemic Event Focus Groups Future HIV Harm Reduction Health Benefit Health system Healthcare Healthcare Systems Heroin Home environment Hospitals Individual Information Technology Injury Intervention Interview Knowledge Lead Life Literature Managed Care Measures Medical Methods Naloxone Opioid Overdose Pain management Patients Pharmaceutical Preparations Pharmacologic Substance Pharmacy facility Physicians Poisoning Preparation Preventive Intervention Primary Health Care Provider Public Health Randomized Controlled Trials Risk Risk Assessment Site System Testing Training United States Food and Drug Administration Vehicle crash Ventilatory Depression base emergency service responder high risk improved interest intervention effect novel opioid misuse overdose death overdose prevention patient population prescription opioid prevent primary care setting programs public health relevance safety net success therapy development tool uptake

项目摘要

DESCRIPTION (provided by applicant): Fatal unintentional poisonings from pharmaceutical opioids have increased more than three-fold in the last decade, reaching epidemic proportions. Naloxone is an effective, Food and Drug Administration approved opioid antidote usually administered by first responders in emergency settings to reverse respiratory depression due to opioid poisoning. Community-based harm reduction organizations have developed effective overdose education and naloxone distribution programs for heroin and illicit pharmaceutical opioid users in a number of states. Widespread prescribing of naloxone for take-home use to patients on prescription opioids may prevent overdose deaths through earlier treatment. Primary care settings in large health care systems, offer the opportunity to reach many individuals at risk for opioid overdose, particularly individuals on high dose opioids. In the primary care setting, patients at risk can be identified and can be counseled on overdose risk, improving communication between clinicians and patients about the risks of opioids. Primary care providers can also prescribe naloxone. In this study we will examine the key barriers and facilitators to prescribing naloxone for take-home use and develop and pilot test an overdose risk assessment, counseling and naloxone prescription intervention for delivery in primary care settings. This study will develop a feasible, information-technology supported overdose prevention intervention for use in large health care systems. We will obtain key preliminary data to support a future large scale, multi-site randomized controlled trial of this intervention from patients and providers in three distinct health systems: an academic medical center, a managed care organization, and a safety net hospital system. The intervention will be targeted to medical clinicians who care for high-risk chronic prescription opioid users in primary care, including general medical and HIV clinics. Our Specific Aims are to: (1) Assess the knowledge, attitudes and beliefs about overdose prevention and naloxone prescription among patients, clinicians, pharmacists and clinical administrators in three health care systems. Through interviews and focus groups, we will determine the barriers and facilitators to overdose risk assessment, counseling and naloxone prescription for take-home use. (2) Develop an efficient overdose risk assessment, counseling and naloxone prescription intervention for delivery in diverse primary care practices. (3) Pilot test a randomized controlled trial of a naloxone prescription interventio that includes overdose risk assessment and counseling and determine its effects on the number of naloxone prescriptions delivered to patients This mixed methods study is responsive to federal calls for studies on widening access to naloxone and NIDA's interest in interventions to prevent drug-related injuries. Together, these aims will lead to the development of a novel intervention which has the potential to reduce fatalities from pharmaceutical opioid overdoses.

描述（由申请人提供）：在过去的十年中，药物阿片类药物的致命无意中毒增加了三倍以上，达到了流行比例。纳洛酮是一种有效的食品和药物管理局批准的阿片类药物解毒剂，通常由急救人员在紧急情况下施用，以逆转阿片类药物中毒引起的呼吸抑郁症。基于社区的减少危害组织已为许多州开发了有效的过量教育和纳洛酮分配计划，并为许多州的非法药物使用者使用。在处方阿片类药物上，纳洛酮为患者使用纳洛酮的广泛处方可能会防止通过早期治疗过量死亡。大型医疗保健系统中的初级保健环境，提供机会吸引许多有风险的人对于阿片类药物过量，尤其是高剂量阿片类药物的个体。在初级保健环境中，可以确定有风险的患者，并可以就过量的风险进行咨询，从而改善临床医生与患者有关阿片类药物风险的沟通。初级保健提供者也可以开处方纳洛酮。在这项研究中，我们将研究主要的障碍和促进者，以开处方纳洛酮，用于实地使用，开发和试点测试过量的风险评估，咨询和纳洛酮处方干预措施，以便在初级保健环境中提供。这项研究将开发出可行的，信息技术的支持，以预防过量干预措施用于大型医疗保健系统。我们将获得关键的初步数据，以支持未来的大规模，多站点的随机对照试验，对患者和提供者的三个不同卫生系统中的干预措施：学术医疗中心，托管护理组织和安全网医院系统。该干预措施将针对医疗临床医生，这些医学临床医生照顾高风险的慢性处方阿片类药物在初级保健中，包括一般医疗和艾滋病毒诊所。我们的具体目的是：（1）评估三个医疗保健系统中患者，临床医生，药剂师和临床管理员中预防过量和纳洛酮处方的知识，态度和信念。通过访谈和焦点小组，我们将确定过量用户的风险评估，咨询和纳洛酮处方的障碍和促进者。（2）开发有效的过量风险评估，咨询和纳洛酮处方干预措施，以在各种初级保健实践中提供。（3）试验测试纳洛酮处方介入的随机对照试验，其中包括过量风险评估和咨询，并确定其对纳洛酮处方数量的影响，这种混合方法的研究对联邦的呼吁做出了反应，该研究呼吁对扩大纳洛酮和NIDA访问的研究对预防药物受伤的兴趣进行研究，以应对。这些目标总之将导致一种新的干预措施的发展，该干预措施有可能减少阿片类药物过量的死亡人数。