Development and implementation of a best practice alerting process for naloxone prescribing at rural community pharmacies in Wisconsin: A pilot study

Abstract

Background

The opioid overdose epidemic continues to worsen in the United States, with opioid-related deaths increasing by 13 folds from 2000 to 2022 in Wisconsin. Naloxone, an opioid antagonist, can save lives by reversing opioid overdose in a matter of minutes. However, naloxone access and utilization remain suboptimal.

Objective

This study examined the development and implementation of best practice alerting (BPA) processes within community pharmacies. This study assessed to what extent the BPA processes (1a) prompted pharmacists to discuss naloxone with high-risk patients; (1b) increased the number of naloxone prescriptions dispensed; and (2) evaluated the facilitators and barriers to implementing the BPA processes.

Methods

A pilot study was conducted to develop and implement a BPA process in 3 rural community pharmacies in Wisconsin. The process involved staff identifying high-risk patients, initiating naloxone discussions, and offering naloxone prescriptions. Quantitative monthly data were recorded by pharmacies. Semi-structured interviews were conducted with one pharmacist from each pharmacy to assess the implementation process and outcomes. Descriptive statistics were used to analyze quantitative data. Interview transcripts were analyzed for key themes describing facilitators and barriers to the implementation process.

Results

The naloxone alerting process resulted in a notable increase in naloxone discussions and naloxone prescriptions dispensed. Pharmacists reported that pharmacy staff buy-in and engagement, adequate staffing, developing meaningful partnerships, and using depersonalizing, destigmatizing, and normalizing approaches in discussing naloxone with patients were key facilitators. Key barriers included naloxone cost or co-payment and time constraints.

Conclusion

Implementing a BPA process in community pharmacies can notably increase naloxone prescribing for high-risk patients. Positive message framing, staffing, meaningful partnerships, and staff buy-in were key facilitators of implementation. Identified barriers were cost or co-payment and time constraints.