Title: Improving naloxone prescribing rates for Veterans with stimulant use disorder (StUD) through AudioCARE technology at the Atlanta VA Healthcare System
Presenters: Kathryne Spratlin, PharmD
Authors: Lauren Ramshur, MD; Stephanie Oh, PharmD; Kathryne Spratlin, PharmD; Melanie Pafford, NP; Natalie Haslem, NP; Mary K. Pounders, PharmD, BCACP
Background:StUD is a prevalent diagnosis among the Veteran population. Veterans with StUD are at increased risk of accidental opioid overdose due to contamination of the illicit drug supply. Harm reduction interventions are recommended strategies to reduce stimulant-related overdose deaths. Using a real-time dashboard, eligible Veterans were identified based on diagnosis of StUD without an active naloxone prescription. This project aimed to evaluate whether AudioCARE technology, an automated Veteran outreach program, can improve naloxone distribution amongst at-risk veterans with StUD in hopes of improving rates of accidental opioid overdoses.
Methodology: This prospective quality improvement project utilized automated outreach to identify and engage Veterans at risk for accidental opioid overdose due to StUD. A real-time dashboard identified eligible patients with an active diagnosis of StUD without an active naloxone prescription. Through AudioCARE technology, these Veterans were contacted via an automated phone call and given the options to receive a naloxone kit, decline a naloxone kit, or request additional information. Actions were taken based on each individual Veterans’ response. Those who did not respond were listed as non-responders and were re-contacted using the same process 120 days after the date of initial attempt
. The dashboard was reviewed monthly to assess the number of actionable Veterans remaining. Prescribing rates, successful rates of contact, and the impact of secondary outreach were evaluated to assess the impact of the AudioCARE intervention.
Results: AudioCARE outreach successfully identified 1,439 actionable Veterans. After completion of the initial call process, 370 Veterans indicated interest in receiving a naloxone prescription. Prior to implementation of AudioCARE process, 40.1% of Veterans with StUD had an active naloxone prescription; after the first round of outreach, this increased to 47.9%. A second round of calls targeted the 952 Veterans who were unable to be reached during the first round. Of those contacted, 108 additional Veterans requested a naloxone prescription. This further increased the percentage of Veterans with StUD who had active naloxone orders to 48.3%.
Conclusions: The AudioCARE process was a feasible strategy to improve naloxone access and support harm reduction efforts for at-risk Veterans with StUD at the VA. Future areas of interest include expansion to other high-risk populations, medication adherence outreach, preventative care initiatives, and chronic disease management support.
