关于在肯塔基州扩大过量用药教育和纳洛酮分发影响的组织观点。
Organizational perspectives on the impacts of scaling up overdose education and naloxone distribution in Kentucky.
作者信息
Knudsen Hannah K, Back-Haddix Sandra, Andrews-Higgins Shaquita, Goetz Michael, Davis Olivia A, Oyler Douglas R, Walsh Sharon L, Freeman Patricia R
机构信息
Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA.
Substance Use Research Priority Area, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA.
出版信息
Addict Sci Clin Pract. 2025 Mar 14;20(1):27. doi: 10.1186/s13722-025-00553-2.
BACKGROUND
Efforts to scale up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, was a major focus of the HEALing Communities Study (HCS). The aim of this analysis is to describe the qualitative perspectives of partner organizations regarding the impacts of implementing OEND in a state that used a naloxone "hub with many spokes" model for scaling up this strategy.
METHODS
Small group (n = 20) and individual (n = 24) qualitative interviews were conducted with staff from 44 agencies in eight Kentucky counties that implemented OEND from April 2020 to June 2022. Interviews were conducted between 6 and 8 months after the end of the intervention. Initial deductive coding used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework, and then additional inductive sub-coding focused on passages within the OEND Effectiveness code. Thematic analysis was then utilized to identify themes regarding the impacts of implementing OEND.
RESULTS
Participants identified multi-level impacts of implementing OEND. At the individual-level, participants described lives being saved, greater access to naloxone for individuals served by the agency, reduced stigma toward OEND by clients, and greater client-level self-efficacy to respond to overdoses. Organizational impacts included improved staff readiness for overdose response, enhanced clinical relationships between staff and clients, and reduced staff stigma. Participants described positive impacts on their organizational networks and clients' social networks. Community-level impacts included greater overall access and reduced stigma toward OEND.
CONCLUSIONS
These qualitative data revealed that staff from agencies involved in a community-wide effort to scale up OEND perceived multi-level benefits, including saving lives, reducing stigma, improving naloxone access, and enhancing staff and client readiness, while strengthening organizational and community networks.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939.
背景
扩大过量用药教育和纳洛酮分发（OEND）是减少阿片类药物过量死亡率的一项循证实践，是“治愈社区研究”（HCS）的主要重点。本分析的目的是描述合作组织对于在一个采用纳洛酮“一中心多分支”模式扩大该策略实施的州实施OEND的影响的定性观点。
方法
对肯塔基州八个县的44个实施OEND（从2020年4月至2022年6月）的机构的工作人员进行了小组定性访谈（n = 20）和个人定性访谈（n = 24）。访谈在干预结束后的6至8个月进行。初始演绎编码使用了覆盖范围、有效性、采用、实施和维持（RE-AIM）框架，然后额外的归纳子编码聚焦于OEND有效性编码内的段落。然后利用主题分析来确定关于实施OEND影响的主题。
结果
参与者确定了实施OEND的多层次影响。在个人层面，参与者描述了生命得以挽救、机构服务的个人更容易获得纳洛酮、客户对OEND的耻辱感降低以及客户层面应对过量用药的自我效能感增强。组织影响包括工作人员对过量用药应对的准备更加充分、工作人员与客户之间的临床关系得到加强以及工作人员的耻辱感降低。参与者描述了对其组织网络和客户社交网络的积极影响。社区层面的影响包括OEND的总体可及性提高和耻辱感降低。
结论
这些定性数据显示，参与社区范围内扩大OEND工作的机构工作人员认识到了多层次的益处，包括挽救生命、减少耻辱感、改善纳洛酮可及性以及增强工作人员和客户的准备程度，同时加强了组织和社区网络。
试验注册
ClinicalTrials.gov，NCT04111939。2019年9月30日注册，https://clinicaltrials.gov/ct2/show/NCT04111939 。
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