Group visits for overdose education and naloxone distribution in primary care: A pilot quality improvement initiative

Abstract

Objective. Opioid prescribing for chronic pain significantly contributes to opioid overdose deaths in the United States. Naloxone as a takehome antidote to opioid overdose is underutilized and has not been evaluated in the high-risk chronic pain population. The objective was to increase overdose education and naloxone distribution (OEND) to high-risk patients on long-term opioid therapy for pain by utilizing group visits in primary care. Design. Quality improvement intervention among two primary care clinics. Setting. A large, academic facility within the Veterans Health Administration. Subjects. Patients prescribed ≥ 100mg morphineequivalent daily dose or coprescribed opioids and benzodiazepines. Methods. One clinic provided usual care with respect to OEND; another clinic encouraged attendance at an OEND group visit to all of its high-risk patients. Results. We used attendance at group visits, prescriptions of naloxone issued, and patient satisfaction scores to evaluate this format of OEND. Key Results. Group OEND visits resulted in significantly more naloxone prescriptions than usual care. At these group visits, patients were engaged, valued the experience, and all requested a prescription for the naloxone kit. Conclusion. This quality improvement pilot study suggests that OEND group visits are a promising model of care.