title: Overdose Education and Naloxone for Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff.
abstract: BACKGROUND
  The rate of fatal unintentional pharmaceutical opioid poisonings has increased substantially since the late 1990s. Naloxone is an effective opioid antidote that can be prescribed to patients for bystander use in the event of an overdose. Primary care clinics represent settings in which large populations of patients prescribed opioids could be reached for overdose education and naloxone prescription.
  
  
  OBJECTIVE
  Our aim was to investigate the knowledge, attitudes and beliefs about overdose education and naloxone prescription among clinical staff in primary care.
  
  
  METHODS
  This was a qualitative study using focus groups to elucidate both clinic-level and provider-level barriers and facilitators.
  
  
  METHODS
  Ten primary care internal medicine, family medicine and infectious disease/HIV practices in three large Colorado health systems.
  
  
  METHODS
  A focus group guide was developed based on behavioral theory. Focus group transcripts were coded for manifest and latent meaning, and analyzed for themes using a recursive approach that included inductive and deductive analysis.
  
  
  RESULTS
  Themes emerged in four content areas related to overdose education and naloxone prescription: knowledge, barriers, benefits and facilitators. Clinical staff (N = 56) demonstrated substantial knowledge gaps about naloxone and its use in outpatient settings. They expressed uncertainty about who to prescribe naloxone to, and identified a range of logistical barriers to its use in practice. Staff also described fears about offending patients and concerns about increased risk behaviors in patients prescribed naloxone. When considering naloxone, some providers reflected critically and with discomfort on their own opioid prescribing. These barriers were balanced by beliefs that prescribing naloxone could prevent death and result in safer opioid use behaviors.
  
  
  CONCLUSIONS
  Findings from these qualitative focus groups may not be generalizable to other settings.
  
  
  CONCLUSIONS
  In addition to evidence gaps, logistical and attitudinal barriers will need to be addressed to enhance uptake of overdose education and naloxone prescription for patients prescribed opioids for pain.
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, P.O Box 378066, Denver, CO, 80237-8066, USA. Ingrid.A.B.inswanger@kp.org.|Division of General Internal Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA. Ingrid.A.B.inswanger@kp.org.|Denver Health and Hospital Authority, Denver, CO, USA. Ingrid.A.B.inswanger@kp.org.
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Binswanger
authors.affiliation: Department of Anthropology, University of Colorado Denver, Denver, CO, USA.|Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Koester
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, P.O Box 378066, Denver, CO, 80237-8066, USA.|Division of General Internal Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA.|Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA.
authors.forename: Shane R
authors.initials: SR
authors.lastname: Mueller
authors.affiliation: Denver Health and Hospital Authority, Denver, CO, USA.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Gardner
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, P.O Box 378066, Denver, CO, 80237-8066, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Goddard
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, P.O Box 378066, Denver, CO, 80237-8066, USA.|Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Glanz
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003120:Colorado; D062787:Drug Overdose / Q000188:drug therapy* / Q000209:etiology; D011307:Drug Prescriptions; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D010353:Patient Education as Topic / Q000379:methods*; D058007:Physicians, Primary Care / Q000523:psychology; D011320:Primary Health Care / Q000379:methods; D036301:Qualitative Research
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone
keywords: HIV; naloxone; opioids; overdose; primary care; qualitative research