Association between a Law Change Allowing Pharmacists to Provide Naloxone under a Physician-Approved Protocol and Naloxone Dispensing Rates.
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| Language: | English |
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University of Cincinnati / OhioLINK
2020
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| Online Access: | http://rave.ohiolink.edu/etdc/view?acc_num=ucin159216924639219 |
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ndltd-OhioLink-oai-etd.ohiolink.edu-ucin159216924639219 |
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oai_dc |
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NDLTD |
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English |
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NDLTD |
| topic |
Pharmaceuticals Opioids Naloxone Physician-approved protocol Standing order Policy Pharmacist |
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Pharmaceuticals Opioids Naloxone Physician-approved protocol Standing order Policy Pharmacist Gangal, Neha S., M.S. Association between a Law Change Allowing Pharmacists to Provide Naloxone under a Physician-Approved Protocol and Naloxone Dispensing Rates. |
| author |
Gangal, Neha S., M.S. |
| author_facet |
Gangal, Neha S., M.S. |
| author_sort |
Gangal, Neha S., M.S. |
| title |
Association between a Law Change Allowing Pharmacists to Provide Naloxone under a Physician-Approved Protocol and Naloxone Dispensing Rates. |
| title_short |
Association between a Law Change Allowing Pharmacists to Provide Naloxone under a Physician-Approved Protocol and Naloxone Dispensing Rates. |
| title_full |
Association between a Law Change Allowing Pharmacists to Provide Naloxone under a Physician-Approved Protocol and Naloxone Dispensing Rates. |
| title_fullStr |
Association between a Law Change Allowing Pharmacists to Provide Naloxone under a Physician-Approved Protocol and Naloxone Dispensing Rates. |
| title_full_unstemmed |
Association between a Law Change Allowing Pharmacists to Provide Naloxone under a Physician-Approved Protocol and Naloxone Dispensing Rates. |
| title_sort |
association between a law change allowing pharmacists to provide naloxone under a physician-approved protocol and naloxone dispensing rates. |
| publisher |
University of Cincinnati / OhioLINK |
| publishDate |
2020 |
| url |
http://rave.ohiolink.edu/etdc/view?acc_num=ucin159216924639219 |
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AT gangalnehasms associationbetweenalawchangeallowingpharmaciststoprovidenaloxoneunderaphysicianapprovedprotocolandnaloxonedispensingrates |
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ndltd-OhioLink-oai-etd.ohiolink.edu-ucin1592169246392192021-08-03T07:15:21Z Association between a Law Change Allowing Pharmacists to Provide Naloxone under a Physician-Approved Protocol and Naloxone Dispensing Rates. Gangal, Neha S., M.S. Pharmaceuticals Opioids Naloxone Physician-approved protocol Standing order Policy Pharmacist Background:Prescription drugs in general, and opioids in particular, are now the second-most abused substance, after marijuana in young adults. More than 42,000 Americans died from opioid overdose in 2016, which is more than a 100% increase from 2010. Naloxone is a controlled substance that reverses the respiratory and central nervous system depression which is caused by opioid overdose. In the last few years many states have implemented a law called physician-approved protocol in order to increase the access to this life saving drug. Goal of this study was to evaluate the impact of this law on the naloxone dispensing rate.Objectives: To determine the association between a pharmacist naloxone dispensing law and naloxone dispensing rates in Ohio. To determine the impact of the physician-approved protocol on naloxone dispensing rates nationally.MethodsFor the first objective we used Ohio Medicaid and Kroger pharmacy claims for the 88 counties in Ohio. Area Health Resource File was used to incorporate the county level variables. Any patient 18 years or older with at least 1 naloxone order dispensed through Ohio Medicaid or filled by a Kroger pharmacy in Ohio during the study period of July 16, 2014, to January 15, 2017, was included in the study. A segmented regression analysis of an interrupted time series was performed for 30 consecutive months to evaluate the change in the naloxone dispensing rate before and after the implementation of the state law.For the second objective, we used national Kroger data which included data for 31 states and Area Heath Resource File (AHRF) data set for the state level variables. The study sample included all patients who received at least one naloxone prescription that was filled in any Kroger pharmacy during the study period from July 16, 2014 to January 16, 2017. A multiple regression analysis was performed for 30 consecutive months to evaluate the change in naloxone prescription dispensing rate.ResultsIn the Ohio Medicaid population, the number of naloxone orders dispensed after the policy was implemented increased by 2328% compared with the pre-policy period. The rate of naloxone orders dispensed per month per county after the policy was implemented increased by 4% (p<0.01) in the Ohio Medicaid population and by 3% (p<0.01) in the Kroger populations compared with the pre-policy period. Similar results were observed in the National Kroger population as well. States with physician-approved protocol had 426.20% higher naloxone prescriptions dispensed compared to states without the protocol. According to the overall regression model, the dispensing rate was 15 times higher in the states with policy. In the individual payer models, the dispensing rate was highest for the private payers (14.86 times) followed by Medicare (14.62 times), cash (6.32 times) and Medicaid (4.75 times). In both the populations, significant impact of the law was seen in the low-employment areas. The rate of naloxone orders dispensed after the policy was implemented increased by 18% (p=0.02) per month in low-employment counties compared to high employment counties, in the Ohio Medicaid population. For the national Kroger population, number of prescriptions dispensed in the low-employment states with the protocol in place was 24 times higher compared to states without the protocol.ConclusionImplementation of the physician-approved protocol allowing pharmacists to dispense naloxone without a prescription was successful across the payer types and was associated with the significant increase in the naloxone dispensing rates. This increase was especially seen in the low-employment areas depicting the success of the policy. 2020-06-16 English text University of Cincinnati / OhioLINK http://rave.ohiolink.edu/etdc/view?acc_num=ucin159216924639219 http://rave.ohiolink.edu/etdc/view?acc_num=ucin159216924639219 unrestricted This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws. |