Katie E Raffel1, Leila Y Beach2, John Lin3, Jacob E Berchuck4, Shelly Abram5, Elizabeth Markle6, Shalini Patel7. 1. Assistant Professor of Clinical Medicine at the University of California, San Francisco. katie.raffel@ucsf.edu. 2. Clinical Instructor at the University of California, San Francisco Medical Center. leila.beach@ucsf.edu. 3. Center for Innovation and Implementation Fellow at the Veterans Administration Palo Alto Health Care System and Center for Primary Care Outcomes Research Fellow at Stanford University in Palo Alto, CA. johnklin@stanford.edu. 4. Clinical Fellow in Hematology and Oncology at the Dana-Farber Cancer Institute in Boston, MA. jberchuck@partners.org. 5. Licensed Vocational Nurse at the San Francisco Veterans Administration Medical Center in CA. shelly.abram@va.gov. 6. Chair and a Professor of Community Mental Health at the California Institute of Integral Studies in San Francisco. liz@opensourcewellness.org. 7. Associate Professor of Clinical Medical at the University of California, San Francisco Medical Center and at the San Francisco Veterans Administration Medical Center in CA. shalini.patel@ucsf.edu.
Abstract
CONTEXT: Naloxone distribution has historically been implemented in a community-based, expanded public health model; however, there is now a need to further explore primary care clinic-based naloxone delivery to effectively address the nationwide opioid epidemic. OBJECTIVE: To create a general medicine infrastructure to identify patients with high-risk opioid use and provide 25% of this population with naloxone autoinjector prescription and training within a 6-month period. DESIGN: The quality improvement study was conducted at an outpatient clinic serving 1238 marginally housed veterans with high rates of comorbid substance use and mental health disorders. Patients at high risk of opioid-related adverse events were identified using the Stratification Tool for Opioid Risk Management and were contacted to participate in a one-on-one, 15-minute, hands-on naloxone training led by nursing staff. MAIN OUTCOME MEASURES: The number of patients identified at high risk and rates of naloxone training/distribution. RESULTS: There were 67 patients identified as having high-risk opioid use. None of these patients had been prescribed naloxone at baseline. At the end of the intervention, 61 patients (91%) had been trained in the use of naloxone. Naloxone was primarily distributed by licensed vocational nurses (42/61, 69%). CONCLUSION: This study demonstrates the feasibility of high-risk patient identification and of a primary care-based and nursing-championed naloxone distribution model. This delivery model has the potential to provide access to naloxone to a population of patients with opioid use who may not be engaged in mental health or specialty care.
CONTEXT: Naloxone distribution has historically been implemented in a community-based, expanded public health model; however, there is now a need to further explore primary care clinic-based naloxone delivery to effectively address the nationwide opioid epidemic. OBJECTIVE: To create a general medicine infrastructure to identify patients with high-risk opioid use and provide 25% of this population with naloxone autoinjector prescription and training within a 6-month period. DESIGN: The quality improvement study was conducted at an outpatient clinic serving 1238 marginally housed veterans with high rates of comorbid substance use and mental health disorders. Patients at high risk of opioid-related adverse events were identified using the Stratification Tool for Opioid Risk Management and were contacted to participate in a one-on-one, 15-minute, hands-on naloxone training led by nursing staff. MAIN OUTCOME MEASURES: The number of patients identified at high risk and rates of naloxone training/distribution. RESULTS: There were 67 patients identified as having high-risk opioid use. None of these patients had been prescribed naloxone at baseline. At the end of the intervention, 61 patients (91%) had been trained in the use of naloxone. Naloxone was primarily distributed by licensed vocational nurses (42/61, 69%). CONCLUSION: This study demonstrates the feasibility of high-risk patient identification and of a primary care-based and nursing-championed naloxone distribution model. This delivery model has the potential to provide access to naloxone to a population of patients with opioid use who may not be engaged in mental health or specialty care.
Authors: Sandro Galea; Nancy Worthington; Tinka Markham Piper; Vijay V Nandi; Matt Curtis; David M Rosenthal Journal: Addict Behav Date: 2005-09-01 Impact factor: 3.913
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