TY - JOUR
KW - Adult
KW - Analgesics, Opioid/therapeutic use
KW - Cohort Studies
KW - Drug Overdose/drug therapy/epidemiology
KW - Emergency Service, Hospital
KW - Female
KW - Humans
KW - Naloxone/therapeutic use
KW - Opiate Overdose
KW - Patient Discharge
KW - Patient reported outcome measures
KW - Philadelphia/epidemiology
KW - Text Messaging
AU - A. K. Agarwal
AU - H. K. Sangha
AU - A. Spadaro
AU - R. Gonzales
AU - J. Perrone
AU - M. K. Delgado
AU - M. Lowenstein
A1 - 
AB - IMPORTANCE: A central tenet of harm reduction and prevention of opioid overdose deaths is the distribution and use of naloxone. Patient-centered methods that investigate naloxone acquisition and carrying can guide opioid overdose education and naloxone distribution efforts. OBJECTIVE: To assess patients' self-reported naloxone acquisition and carrying after an emergency department (ED) encounter using automated text messaging. DESIGN, SETTING, AND PARTICIPANTS: This cohort study investigated self-reported patient behaviors involving naloxone after ED discharge in a large, urban academic health system in Philadelphia, Pennsylvania. Adult patients who were prescribed or dispensed naloxone and who had a mobile phone number listed in the electronic health record provided informed consent after ED discharge, and data were collected prospectively using text messaging from October 10, 2020, to March 19, 2021. Patients who did not respond to the survey or who opted out were excluded. EXPOSURE: Automated text message-based survey after ED discharge for patients who were prescribed or dispensed naloxone. MAIN OUTCOMES AND MEASURES: The primary outcome was patient-reported naloxone acquisition, carrying, and use. Descriptive statistics were used to summarize patient demographic characteristics. RESULTS: Of 205 eligible patients, 41 (20.0%) completed the survey; of those patients, the mean (SD) age was 39.5 (13.7) years, and 21 (51.2%) were women. Fifteen (36.6%) had a personal history of being given naloxone after an overdose. As indicated by the ED record, 27 participants (65.9%) had naloxone dispensed in the ED, and 36 (87.8%) self-reported acquiring naloxone during or after their ED visit. Twenty-four participants (58.5%) were not carrying naloxone in the week before their ED visit. Twenty participants (48.8%) were carrying naloxone after the ED visit, and 27 (65.9%) reported planning to continue carrying naloxone in the future. Of the 24 individuals (58.5%) not carrying naloxone before their ED encounter, 13 (54.2%) reported planning to continue carrying naloxone in the future. CONCLUSIONS AND RELEVANCE: In this cohort study of adult patients dispensed or prescribed naloxone from the ED, most reported acquiring naloxone on or after discharge. The ED remains a key point of access to naloxone for individuals at high risk of opioid use and overdose, and text messaging could be a method to engage and motivate patient-reported behaviors in enhancing naloxone acquisition and carrying.
AD - Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.; Center for Health Care Innovation, University of Pennsylvania, Philadelphia.; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.; Center for Health Care Innovation, University of Pennsylvania, Philadelphia.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.; Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
BT - JAMA network open
C5 - Opioids & Substance Use
CP - 3
DO - 10.1001/jamanetworkopen.2022.3986
IS - 3
JF - JAMA network open
LA - eng
M1 - Journal Article
N2 - IMPORTANCE: A central tenet of harm reduction and prevention of opioid overdose deaths is the distribution and use of naloxone. Patient-centered methods that investigate naloxone acquisition and carrying can guide opioid overdose education and naloxone distribution efforts. OBJECTIVE: To assess patients' self-reported naloxone acquisition and carrying after an emergency department (ED) encounter using automated text messaging. DESIGN, SETTING, AND PARTICIPANTS: This cohort study investigated self-reported patient behaviors involving naloxone after ED discharge in a large, urban academic health system in Philadelphia, Pennsylvania. Adult patients who were prescribed or dispensed naloxone and who had a mobile phone number listed in the electronic health record provided informed consent after ED discharge, and data were collected prospectively using text messaging from October 10, 2020, to March 19, 2021. Patients who did not respond to the survey or who opted out were excluded. EXPOSURE: Automated text message-based survey after ED discharge for patients who were prescribed or dispensed naloxone. MAIN OUTCOMES AND MEASURES: The primary outcome was patient-reported naloxone acquisition, carrying, and use. Descriptive statistics were used to summarize patient demographic characteristics. RESULTS: Of 205 eligible patients, 41 (20.0%) completed the survey; of those patients, the mean (SD) age was 39.5 (13.7) years, and 21 (51.2%) were women. Fifteen (36.6%) had a personal history of being given naloxone after an overdose. As indicated by the ED record, 27 participants (65.9%) had naloxone dispensed in the ED, and 36 (87.8%) self-reported acquiring naloxone during or after their ED visit. Twenty-four participants (58.5%) were not carrying naloxone in the week before their ED visit. Twenty participants (48.8%) were carrying naloxone after the ED visit, and 27 (65.9%) reported planning to continue carrying naloxone in the future. Of the 24 individuals (58.5%) not carrying naloxone before their ED encounter, 13 (54.2%) reported planning to continue carrying naloxone in the future. CONCLUSIONS AND RELEVANCE: In this cohort study of adult patients dispensed or prescribed naloxone from the ED, most reported acquiring naloxone on or after discharge. The ED remains a key point of access to naloxone for individuals at high risk of opioid use and overdose, and text messaging could be a method to engage and motivate patient-reported behaviors in enhancing naloxone acquisition and carrying.
PY - 2022
SN - 2574-3805; 2574-3805
T1 - Assessment of Patient-Reported Naloxone Acquisition and Carrying With an Automated Text Messaging System After Emergency Department Discharge in Philadelphia
T2 - JAMA network open
TI - Assessment of Patient-Reported Naloxone Acquisition and Carrying With an Automated Text Messaging System After Emergency Department Discharge in Philadelphia
U1 - Opioids & Substance Use
U2 - 35323949
U3 - 10.1001/jamanetworkopen.2022.3986
VL - 5
VO - 2574-3805; 2574-3805
Y1 - 2022
Y2 - Mar 1
ER -