Factors Associated with Take Home Naloxone Refusal among Emergency Department Patients Participating in an Opioid Overdose Prevention Program

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Clare O'Brien-Lambert MPH , Keri Althoff PhD , Jennifer Barvincak MPH , Halle Cirbus MS , Safia Singer-Pomerantz , Ethan Cowan MD, MS
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引用次数: 0

Abstract

Background

Increasing the equitable distribution of take home naloxone (THN) may result in reduced deaths from opioid overdose (OD).

Objectives

The primary study objective is to describe the demographic and clinical characteristics of emergency department (ED) patients who decline THN. The findings of this descriptive study may generate new hypotheses for successful THN distribution.

Methods

Retrospective chart review using prospectively collected program evaluation data from a single urban EDs Health Education THN database and electronic health record. Characteristics of participants who refused versus accepted THN were compared using Chi-square testing for categorical variables and t-tests for continuous variables. A multivariate model was built to assess associations of statistical and clinically relevant characteristics with THN refusal.

Results

A total of 711 ED patients were offered THN of which 334 (46%) declined. In unadjusted analysis, with the independent variable being refusal of the THN offer, being currently on medication for opioid use disorder (MOUD) was associated with a greater odds of refusal (OR 1.9, 95%CI 1.3-2.6) while any drug related overdose (OR 0.6, 95%CI 0.4-0.8) or being given a prescription for buprenorphine in the ED (OR 0.2, 95%CI 0.1-0.9) were both associated with a lower odds of refusal.

Conclusions

Demographic characteristics did not differ between those who accept versus refuse THN. Patients already receiving MOUD were more likely to refuse THN while those starting MOUD in the ED were less likely to refuse THN. Further studies are needed to determine the root causes of patients’ declination of THN and develop targeted interventions to address these causes.
参与阿片类药物过量预防计划的急诊科患者拒绝将纳洛酮带回家的相关因素
增加纳洛酮(THN)的公平分配可能导致阿片类药物过量(OD)死亡的减少。目的本研究的主要目的是描述急诊科(ED)患者THN下降的人口学和临床特征。这一描述性研究的发现可能为成功的THN分布提供新的假设。方法采用前瞻性收集的城市ed健康教育THN数据库和电子病历的项目评价数据进行回顾性图表分析。对拒绝和接受THN的参与者的特征进行比较,对分类变量使用卡方检验,对连续变量使用t检验。建立了一个多变量模型来评估统计学和临床相关特征与THN拒绝的关系。结果711例ED患者接受THN治疗,其中334例(46%)拒绝接受THN治疗。在未经调整的分析中,以拒绝THN为自变量,目前正在接受阿片类药物使用障碍(mod)的药物治疗与更大的拒绝几率相关(OR 1.9, 95%CI 1.3-2.6),而任何药物相关过量(OR 0.6, 95%CI 0.4-0.8)或在急诊室开丁丙诺啡处方(OR 0.2, 95%CI 0.1-0.9)都与更低的拒绝几率相关。结论接受与拒绝THN的人口学特征无显著差异。已经接受mod的患者更有可能拒绝THN,而在急诊室开始mod的患者则不太可能拒绝THN。需要进一步的研究来确定患者THN下降的根本原因,并制定有针对性的干预措施来解决这些原因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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