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- Title
Assessment of Patient-Reported Naloxone Acquisition and Carrying With an Automated Text Messaging System After Emergency Department Discharge in Philadelphia.
- Authors
Agarwal, Anish K.; Sangha, Hareena K.; Spadaro, Anthony; Gonzales, Rachel; Perrone, Jeanmarie; Delgado, M. Kit; Lowenstein, Margaret
- Abstract
This cohort study uses a text messaging system to survey behavior in patients with naloxone prescriptions after discharge from emergency departments in Philadelphia. Key Points: Question: Can text messaging capture patient-reported naloxone acquisition and carrying after an emergency department (ED) encounter? Findings: In this cohort study of 41 patients discharged from 2 urban EDs, 88% reported acquiring naloxone or a naloxone prescription from the ED. Overall, 66% planned to continue carrying naloxone, including most patients who were not carrying the drug before their ED visits. Meaning: The findings suggest that text messaging can be used to interact with individuals at high risk for opioid use and overdose, and this automated system offers an opportunity to augment and support ED-based naloxone distribution efforts. 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.
- Subjects
PENNSYLVANIA; HOSPITAL emergency services; SELF-evaluation; DRUG overdose; NALOXONE; SURVEYS; HARM reduction; AUTOMATION; DESCRIPTIVE statistics; TEXT messages; ELECTRONIC health records; DISCHARGE planning; LONGITUDINAL method; OPIOID abuse
- Publication
JAMA Network Open, 2022, Vol 5, Issue 3, pe223986
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.3986