Canadian national consensus guidelines for naloxone prescribing by pharmacists.
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ABSTRACT:
SUBMITTER: Tsuyuki RT
PROVIDER: S-EPMC7689616 | biostudies-literature | 2020 Nov-Dec
REPOSITORIES: biostudies-literature
Publications
Canadian national consensus guidelines for naloxone prescribing by pharmacists.
Tsuyuki Ross T RT Arora Vinita V Barnes Mark M Beazely Michael A MA Boivin Michael M Christofides Anna A Patel Harsit H Laroche Julie J Sihota Aaron A So Randy R
Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC 20200826 6
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Project description: Not available
| S-EPMC10116221 | biostudies-literature
Project description:BackgroundPharmacists in Canada have been prescribing since 2007. This review aims to explore the volume, array and nature of research activity on Canadian pharmacist prescribing and to identify gaps in the existing literature.MethodsWe conducted a scoping review to examine the literature on prescribing by pharmacists in Canada according to methodological trends, research areas and key findings. We searched for peer-reviewed research articles and abstracts in the Ovid MEDLINE, Ovid EMBASE and International Pharmaceutical Abstracts databases without any date limitations. A standardized form was used to extract information.ResultsWe identified 156 articles; of these, 26 articles and 12 abstracts met inclusion criteria. One-half of the research studies (20) used quantitative methods, including surveys, trials and experimental designs; 11 studies used qualitative methods and 7 used other methods. Research on pharmacist prescribing demonstrated an improvement in patient outcomes (13 studies), varied stakeholder perceptions (10 studies) and factors that influence this practice change (11 studies). Pharmacist prescribing was adopted when pharmacists practised patient-centred care. Stakeholders held contrasting perceptions of pharmacist prescribing.DiscussionCanadian research has demonstrated the benefit of pharmacist prescribing on patient outcomes, which is not present in the international literature. Future research may consider a meta-analysis addressing the impact on patient health. Gaps in research include comparisons between provinces, effects on physicians' services, overall patient safety and access to health care systems and economic implications for society.ConclusionA growing body of research on pharmacist prescribing has captured the early impact of prescribing on patient outcomes, perceptions of practice and practice change. Opportunities exist for pan-Canadian research that examines the system impact.
| S-EPMC4637852 | biostudies-literature
Project description:BackgroundThe San Francisco Department of Public Health initiated naloxone prescribing at 6 safety net clinics. We evaluated this intervention, demonstrating that naloxone prescribing from primary care clinics is feasible and acceptable.ObjectiveTo evaluate acceptability of naloxone dispensing to patients prescribed opioids among pharmacists serving clinics participating in a naloxone intervention.MethodsWe surveyed 58 pharmacists from November 2013 through January 2015 at pharmacies that serviced San Francisco safety net clinics. Surveys collected information on demographics, experiences in dispensing naloxone, and interest in prescriptive authority. We conducted descriptive analyses and assessed bivariate relationships.ResultsMost respondents were staff (56.9%) or supervising pharmacists (34.5%). Most (92.9%) were aware their pharmacy stocked naloxone and 86.8% felt it should be prescribed to some or all patients on long-term opioids. Most (82.1%) dispensed naloxone at least once in the past 12 months. More than half were comfortable providing naloxone education. Nearly half (43.4%) indicated they would want authority to furnish without a prescription. Over half (55.2%) reported no problems dispensing. The common problem was insufficient naloxone knowledge. Only 12% reported more than one problem in dispensing naloxone, which was associated with being uncomfortable with educating patients (P = .03).ConclusionNaloxone dispensing was acceptable among pharmacists. Their most cited problem was insufficient naloxone education. This may be resolved with improved instructional materials, incentives for patient education, or mandatory training.
| S-EPMC6756989 | biostudies-literature
Project description: Not available
| S-EPMC1277045 | biostudies-literature
Project description: Not available
| S-EPMC4234715 | biostudies-literature
Project description:ObjectiveTo identify individual and site-related factors associated with frequent emergency department (ED) buprenorphine/naloxone (BUP) initiation. BUP initiation, an effective opioid use disorder (OUD) intervention, varies widely across Canadian EDs.MethodsWe surveyed emergency physicians in 6 Canadian provinces from 2018 to 2019 using bilingual paper and web-based questionnaires. Survey domains included BUP-related practice, demographics, attitudes toward BUP, and site characteristics. We defined frequent BUP initiation (the primary outcome) as at least once per month, high OUD prevalence as at least one OUD patient per shift, and high OUD resources as at least 3 out of the following 5 resources: BUP initiation pathways, BUP in ED, peer navigators, accessible addiction specialists, and accessible follow-up clinics. We excluded responses from sites with <50% participation (to minimize non-responder bias) and those missing the primary outcome. We used univariate analysis to identify associations between frequent BUP initiation and factors of interest, stratifying by OUD prevalence.ResultsWe excluded 3 responses for missing BUP initiation frequency and 9 for low response rate at one ED. Of the remaining 649 respondents from 34 EDs, 374 (58%) practiced in metropolitan areas, 384 (59%) reported high OUD prevalence, 312 (48%) had high OUD resources, and 161 (25%) initiated BUP frequently. Age, gender, board certification and years in practice were not associated with frequent BUP initiation. Site-specific factors were associated with frequent BUP initiation (high OUD resources [OR 6.91], high OUD prevalence [OR 4.45], and metropolitan location [OR 2.39],) as were individual attitudinal factors (willingness, confidence, and responsibility to initiate BUP.) Similar associations persisted in the high OUD prevalence subgroup.ConclusionsIndividual attitudinal and site-specific factors were associated with frequent BUP initiation. Training to increase physician confidence and increasing OUD resources could increase BUP initiation and benefit ED patients with OUD.
| S-EPMC10843078 | biostudies-literature
Project description:Background: Naloxone-prescription opioid co-prescribing mandates have increasingly been proposed and adopted in the U.S., at both the national and state levels, as a public health intervention for mitigating the impacts of opioid overdoses. In this study, we assess whether a hypothetical national, naloxone co-prescribing mandate has become less costly for the U.S. health system since 2018. Methods: We expand and update an existing economic model of naloxone co-prescribing to estimate annual health system spending. We refresh the model inputs through 2021 to reflect changes to the opioid and naloxone landscapes, expand the model to account for more types of market responses, and develop additional scenarios around alternate implementation strategies such as bulk purchasing. Results: We estimate annual spending increases across all retail opioid patients of $1.4-$4.0 billion with naloxone nasal sprays and auto-injectors, and $0.6-$0.9 billion with traditional injectable naloxone formulations. We also find that bulk purchasing could lead to higher spending increases in some patient populations absent volume discounts. Conclusions: Our estimates are substantially lower than prior research. Key drivers include lower prices for naloxone, higher current naloxone distribution, a longer approved shelf life for naloxone, and lower estimated sizes for some patient populations. Additional research is needed to estimate the potential benefits of naloxone co-prescribing for mitigating opioid overdoses, and whether they could outweigh spending increases. Steps that could make this policy more beneficial or less costly include targeting higher risk patient populations and promoting large-scale purchasing agreements with volume discounts to help offset potential price increases.
| S-EPMC10544767 | biostudies-literature
Project description:BackgroundExpanding access to naloxone is crucial for mitigating the public health epidemic of opioid overdose deaths in America. Pharmacists now have greater independent authority to dispense naloxone to the public due to a wave of enhanced pharmacy naloxone access laws. It is unknown to what extent pharmacists are required to receive specialized training to serve in this capacity.ObjectivesThe goal of this study was to review naloxone training mandates from states with enhanced pharmacy naloxone access laws.MethodsStructured internet searches were completed using publicly available legislative, regulatory, and administrative records to identify the type of enhanced pharmacy naloxone access law and the presence and characteristics of a pharmacist naloxone training mandate in each state.ResultsAs of November 22, 2017, all 50 states have implemented an enhanced pharmacy naloxone access law. Only 19 states mandated targeted naloxone education before pharmacists engaged in independent naloxone dispensing/prescribing activities.ConclusionsA lack of standardized naloxone training requirements for naloxone-dispensing pharmacists may affect the rate of adoption of enhanced pharmacy naloxone dispensing practices at community pharmacies and suboptimal education of patients at risk of opioid overdose. Ensuring pharmacists' preparedness to serve as naloxone providers is necessary to meaningfully prevent opioid overdose deaths in their communities.
| S-EPMC6173665 | biostudies-literature
Project description:Background and objectivesA meeting of a Canadian group with significant experience and knowledge in HIV management, consisting of five physicians, a pharmacist and an AIDS researcher, was convened. Their goal was to develop guidance for Canadian HIV-treating physicians on the appropriate use of raltegravir (MK-0518, Isentress(R), Merck Frosst Canada Inc) in HIV-infected adults.MethodsEvidence from the published literature and conference presentations, as well as expert opinions of the group members, was considered and evaluated to develop the recommendations. Feedback on the draft recommendations was obtained from this core group, as well as from five other physicians and scientists across Canada with expertise in HIV treatment and antiretroviral drug resistance, and experience in the use of raltegravir. The final recommendations represent the core group's consensus agreement once all feedback was considered.Results/conclusionsRecommendations were developed to guide physicians in the optimal use of raltegravir. The issues considered included raltegravir's role in overall treatment strategy, efficacy, durability of effect, rate of viral load reduction, resistance, safety/toxicity, pharmacokinetics and drug interactions.
| S-EPMC2770304 | biostudies-literature
Project description:Standard guidelines for the management of early and locally advanced cervical cancer are available from various academic consortiums nationally and internationally. However, implementing standard-of-care treatment poses unique challenges within low- and middle-income countries, such as India, where diverse clinical care practices may exist. The National Cancer Grid, a consortium of 108 institutions in India, aims to homogenize care for patients with cervical cancer by achieving consensus on not only imaging and management, but also in addressing potential solutions to prevalent challenges that affect the homogenous implementation of standard-of-care treatment. These guidelines therefore represent a consensus statement of the National Cancer Grid gynecologic cancer expert group and will assist in homogenization of the therapeutic management of patients with cervical cancer in India.
| S-EPMC6223405 | biostudies-literature