Evaluation of an interprofessional naloxone didactic and skills session with medical residents and physician assistant learners

Keywords: Naloxone, Analgesics, Opioid, Education, Medical, Physician Assistants, Health Knowledge, Attitudes, Practice, Attitude of Health Personnel, Self Efficacy, Controlled Before-After Studies, United States

Abstract

Background: The CDC has reported 399,230 opioid-related deaths from 1999-2017. In 2018, the US surgeon general issued a public health advisory, advising all Americans to carry naloxone. Studies show that enhanced naloxone access directly reduces death from opioid overdose. Despite this, health care professional learners report low knowledge and confidence surrounding naloxone. Therefore, it becomes critical that medical education programs incorporate didactic and experiential sessions improving knowledge, skills and attitudes regarding harm reduction through naloxone.

Objectives: 1. Describe the components and evaluation of a replicable and adaptable naloxone didactic and skills session model for medical providers; 2. Report the results of the evaluation from a pilot session with family medicine residents and physician assistant students; and 3. Share the session toolkit, including evaluation surveys and list of materials used.

Methods: In July 2017, a literature search was completed for naloxone skill training examining best practices on instruction and evaluation. A training session for family medicine residents and physician assistant learners was designed and led by University of Cincinnati College of Medicine and College of Pharmacy faculty. The same faculty designed a pre and post session evaluation form through internal review on elements targeting naloxone knowledge, attitude, and self-efficacy.

Results: The training session included one hour for a didactic and one hour for small group live skills demonstration in four methods of naloxone administration (syringe and ampule, nasal atomizer, branded nasal spray and auto injector). Forty-eight participants showed statistically significant (p<0.05) improvement in knowledge (67.5% to 95.9%), attitudes (71.2% to 91.2%), and self-efficacy (62.1% to 97.8%) from pre to post assessment. Forty-four of 48 participants agreed that the pace of the training was appropriate and that the information will be of use in their respective primary care practices. Supply costs for the session were USD 1,200, with the majority being reusable on subsequent trainings.

Conclusions: Our study of a naloxone didactic and skills session for primary care trainees demonstrated significant improvements in knowledge, self-efficacy, and attitudes. It provides an adaptable and efficient model for delivery of knowledge and skills in naloxone administration training. The pilot data suggest that the training was efficacious.

Downloads

Download data is not yet available.

References

Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2016. NCHS Data Brief. 2016;(294):1-8.

Hedegaard H, Miniño A,M., Warner M. Drug overdose deaths in the united states, 1999-2017. NCHS Data Brief. 2018(329):1-8.

DeMio T. Fentanyl deaths up 1,000% since 2013, so much so that even heroin's supply is dwarfed. https://www.cincinnati.com/story/news/2018/06/06/opioid-fentanyl-dwarfs-heroin-cincinnati-drug-supply-killing-more/610804002/ (accessed Apr 4, 2019).

National Institute on Drug Abuse. Ohio opioid summary. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/ohio-opioid-summary (accessed Apr 16, 2019).

Strobino Kevin. Hamilton county overdose report August 2017. Hamilton County Public Health: Hamilton County, Ohio.

Thomas A. Hamilton county overdose report April 2019. Hamilton County Public Health: Hamilton County, Ohio.

Sporer K. Strategies for preventing heroin overdose. BMJ. 2003;326(7386):442-444. https://doi.org/10.1136/bmj.326.7386.442

Doyon S, Aks SE, Schaeffer S; American Academy of Clinical Toxicology; American College of Medical Toxicology; American Association of Poison Control Centers. Expanding access to naloxone in the united states. Clin Toxicol (Phila). 2014;52(10):989-992. https://doi.org/10.3109/15563650.2014.968657

Centers for Disease Control and Prevention. Still not enough naloxone where it’s most needed. https://www.cdc.gov/media/releases/2019/p0806-naloxone.html (accessed Aug 6, 2019).

HHS Office of the Secretary. U.S. surgeon general's advisory on naloxone and opioid overdose. april 5, 2018. www.hhs.gov/surgeongeneral/priorities/opioids-and-addiction/naloxone-advisory/index.html (accessed Jul 31, 2019).

Devries J, Rafie S, Polston G. Implementing an overdose education and naloxone distribution program in a health system. J Am Pharm Assoc (2003). 2017;57(2S):S154-S160. https://doi.org/10.1016/j.japh.2017.01.002

Wheeler E, Jones TS, Gilbert MK, Davidson PJ. Opioid overdose prevention programs providing naloxone to laypersons - United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(23):631-635.

Walley AY, Xuan Z, Hackman HH, Quinn E, Doe-Simkins M, Sorensen-Alawad A, Ruiz S, Ozonoff A. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: Interrupted time series analysis. BMJ. 2013;346:f174. https://doi.org/10.1136/bmj.f174

Bulloch M. As naloxone accessibility increases, pharmacist's role expands. https://www.pharmacytimes.com/contributor/marilyn-bulloch-pharmd-bcps/2016/10/as-naloxone-accessibility-increases-pharmacists-role-expands (accessed Apr 16, 2019).

Davis C, Chang S, Carr D, Hernandez-Delgado H. Legal interventions to reduce overdose mortality: Naloxone access and overdose good samaritan laws. The Network for Public Health Law. May 2017. Available at: https://www.networkforphl.org/_asset/qz5pvn/legal-interventions-to-reduce-overdose.pdf (accessed Jul 31, 2019).

Wilson JD, Spicyn N, Matson P, Alvanzo A, Feldman L. Internal medicine resident knowledge, attitudes, and barriers to naloxone prescription in hospital and clinic settings. Subst Abus. 2016;37(3):480-487. https://doi.org/10.1080/08897077.2016.1142921

Binswanger IA, Koester S, Mueller SR, Gardner EM, Goddard K, Glanz JM. Overdose education and naloxone for patients prescribed opioids in primary care: A qualitative study of primary care staff. J Gen Intern Med. 2015;30(12):1837-1844. https://doi.org/10.1007/s11606-015-3394-3

Green TC, Bowman SE, Zaller ND, Ray M, Case P, Heimer R. Barriers to medical provider support for prescription naloxone as overdose antidote for lay responders. Subst Use Misuse. 2013;48(7):558-567. https://doi.org/10.3109/10826084.2013.787099

Mayet S, Manning V, Williams A, Loaring J, Strang J. Impact of training for healthcare professionals on how to manage an opioid overdose with naloxone: Effective, but dissemination is challenging. Int J Drug Policy. 2011;22(1):9-15. https://doi.org/10.1016/j.drugpo.2010.09.008

Monteiro K, Dumenco L, Collins S, Bratberg J, MacDonnell C, Jacobson A, Dollase R, George P. An interprofessional education workshop to develop health professional student opioid misuse knowledge, attitudes, and skills. J Am Pharm Assoc (2003). 2017;57(2S):S113-S117. https://doi.org/10.1016/j.japh.2016.12.069

Kunins HV, Sohler NL, Giovanniello A, Thompson D, Cunningham CO. A buprenorphine education and training program for primary care residents: Implementation and evaluation. Subst Abus. 2013;34(3):242-247. https://doi.org/10.1080/08897077.2012.752777

American Academy of Family Physicians. Recommended curriculum guidelines for family medicine residents: Substance use disorders. 2016;277:1-13 https://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint277_Substance.pdf (accessed Apr 3, 2019).

Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in family medicine. Family Medicine. 2017. Available at: http://msm.edu/Education/GME/Documents/FamilyMedicine/ACGME_Requirements_eff_170107.pdf (accessed Apr 3, 2019).

Dion KA. Improving outcomes of opioid overdose preparing nursing students to intervene. J Addict Nurs. 2016;27(1):7-11. https://doi.org/10.1097/JAN.0000000000000106

Winograd RP, Davis CS, Niculete M, Oliva E, Martielli RP. Medical providers' knowledge and concerns about opioid overdose education and take-home naloxone rescue kits within veterans affairs health care medical treatment settings. Subst Abus. 2017;38(2):135-140. https://doi.org/10.1080/08897077.2017.1303424

Behar E, Bagnulo R, Coffin PO. Acceptability and feasibility of naloxone prescribing in primary care settings: A systematic review. Prev Med. 2018;114:79-87. https://doi.org/10.1016/j.ypmed.2018.06.005

Peckham AM, Niculete ME, Steinberg H, Boggs DL. A survey of prescribers' attitudes, knowledge, comfort, and fear of consequences related to an opioid overdose education and naloxone distribution program. J Public Health Manag Pract. 2018;24(4):310-317. https://doi.org/10.1097/PHH.0000000000000668

Taylor JL, Rapoport AB, Rowley CF, Mukamal KJ, Stead W. An opioid overdose curriculum for medical residents: Impact on naloxone prescribing, knowledge, and attitudes. Subst Abus. 2018;39(3):371-376. https://doi.org/10.1080/08897077.2018.1439800

Berland N, Fox A, Tofighi B, Hanley K. Opioid overdose prevention training with naloxone, an adjunct to basic life support training for first-year medical students. Subst Abus. 2017;38(2):123-128. https://doi.org/10.1080/08897077.2016.1275925

Maguire MA, Pavlakos RN, Mehta BH, Schmuhl KK, Beatty SJ. A naloxone and harm reduction educational program across four years of a doctor of pharmacy program. Curr Pharm Teach Learn. 2018;10(1):72-77. https://doi.org/10.1016/j.cptl.2017.09.007

Panther SG, Bray BS, White JR. The implementation of a naloxone rescue program in university students. J Am Pharm Assoc (2003). 2017;57(2S):S107-S112. https://doi.org/10.1016/j.japh.2016.11.002

Zhang X, Marchand C, Sullivan B, Klass EM, Wagner KD. Naloxone access for emergency medical technicians: An evaluation of a training program in rural communities. Addict Behav. 2018;86:79-85. https://doi.org/10.1016/j.addbeh.2018.03.004

Kirane H, Ketteringham M, Bereket S, Dima R, Basta A, Mendoza S, Hansen H. Awareness and attitudes toward intranasal naloxone rescue for opioid overdose prevention. J Subst Abuse Treat. 2016;69:44-49. https://doi.org/10.1016/j.jsat.2016.07.005

Beletsky L, Ruthazer R, Macalino GE, Rich JD, Tan L, Burris S. Physicians' knowledge of and willingness to prescribe naloxone to reverse accidental opiate overdose: Challenges and opportunities. J Urban Health. 2007;84(1):126-136. https://doi.org/10.1007/s11524-006-9120-z

Gatewood AK, Van Wert MJ, Andrada AP, Surkan PJ. Academic physicians' and medical students' perceived barriers toward bystander administered naloxone as an overdose prevention strategy. Addict Behav. 2016;61:40-46. https://doi.org/10.1016/j.addbeh.2016.05.013

Abouk R, Pacula RL, Powell D. Association between state laws facilitating pharmacy distribution of naloxone and risk of fatal overdose. JAMA Intern Med. 2019;179(6):805-811. https://doi.org/10.1001/jamainternmed.2019.0272

Published
2019-09-12
How to Cite
1.
Hargraves D, White CC, Mauger MR, Puthota A, Pallerla H, Wigle P, Brubaker SL, Schlaudecker JD. Evaluation of an interprofessional naloxone didactic and skills session with medical residents and physician assistant learners. Pharm Pract (Granada) [Internet]. 2019Sep.12 [cited 2019Nov.14];17(3):1591. Available from: https://pharmacypractice.org/journal/index.php/pp/article/view/1591
Section
Original Research