Impact of pharmacist contact via telephone vs letter on rate of acquisition of naloxone rescue kits by patients with opioid use disorder

Abstract

Background: Limited data describes the effectiveness of strategies to optimize naloxone rescue kit distribution. Mental health clinical pharmacy specialists (CPS) at VA St. Louis HCS aimed to increase distribution of naloxone rescue kits to patients with Opioid Use Disorder (OUD). An informational letter detailing the purpose of rescue kits and how to obtain one were sent to patients with OUD who had no active order for a naloxone rescue kit within the previous year. Roughly half of these patients were targeted for follow-up education via telephone. Methods: A retrospective study was conducted comparing the effectiveness of these contact methods. Study groups included those contacted by letter alone and those contacted by both letter and phone call. The primary outcome was order placement for a rescue kit within 90 days of contact. Post-hoc analysis included a multivariate regression, case-control evaluation of variables potentially associated with kit distribution. Results: In total, 335 patients were included. Of 185 patients targeted for phone follow-up, 81 were reached (43.8%), and 254 received the letter alone. The primary outcome was achieved by 13 (5.1%) and 52 (64.2%) participants in the letter alone and letter plus phone contact groups, respectively (p < 0.001). In multivariate analysis, phone contact (OR 38.6; 95% CI 17.5–85.0), nonwhite race (OR 3.4; 95% CI 1.5–7.6), prior participation in the substance abuse rehabilitation treatment program (OR 3.2; 95% CI 1.3–8.0), and current active opioid prescription (OR 3.7; 95% CI 1.3–10.2) were independently associated with an order for a naloxone rescue kit. Conclusions: In patients with OUD, those contacted by phone in addition to receiving a letter were significantly more likely to receive a naloxone kit than those contacted via letter alone. In addition to contact by phone, nonwhite race, prior participation in rehabilitation and active opioid prescription were associated with a higher rate of kit obtainment.