Abstracts
Résumé
Plusieurs interventions visent à réduire les surdoses aux opioïdes, dont la formation sur l’administration de la naloxone, un antidote permettant de renverser temporairement une surdose. Néanmoins, celles-ci ciblent davantage des personnes qui fréquentent les organismes de rue ou les cliniques spécialisées en dépendance. Moins nombreuses sont les initiatives ciblant les patients suivis en clinique de médecine familiale et traités avec des opioïdes pour la douleur chronique ou recevant un traitement par agonistes opioïdes (TAO) pour un trouble lié à l’usage des opioïdes. Cette étude à série temporelle visait à générer des données préliminaires sur l’efficacité d’une formation sur l’utilisation de naloxone chez les patients du groupe de médecine familiale universitaire (GMF-U) Charles-LeMoyne, en déterminant la rétention des concepts clés en lien avec les facteurs de risque, la reconnaissance et la prise en charge d’une surdose aux opioïdes. Les participants étaient des utilisateurs d’opioïdes (douleur chronique ou TAO) n’ayant pas suivi de formation antérieure sur la gestion des surdoses. L’intervention étudiée était une formation standardisée en petit groupe portant sur la gestion des surdoses aux opioïdes. L’instrument de mesure utilisé était le Opioid Overdose Knowledge Scale, un questionnaire validé et traduit de 14 questions totalisant 44 points. Il a été complété avant (T0), immédiatement après (T1) et 3 mois suivant la formation (T2) pour mesurer la rétention de l’information. Les pointages des 23 participants inclus étaient de 24,8/44 à T0, 39,1/44 à T1 et 35,0/44 à T2, suggérant une connaissance accrue et soutenue de la gestion des surdoses aux opioïdes dans les deux groupes. La majorité des participants formés se disaient confiants ou très confiants de savoir administrer la naloxone trois mois post-formation. Dans le contexte de la crise des opioïdes, la formation des patients à risque en médecine familiale est prometteuse et permettrait de rejoindre une population plus diversifiée d’utilisateurs d’opioïdes.
Mots-clés :
- naloxone,
- formation,
- douleur chronique,
- première ligne
Abstract
Various interventions exist to reduce opioid-related mortality, including Take Home Naloxone Programs. However, the overwhelming majority of these interventions are community programs targeting non-medical drug users. Only a few interventions target patients in primary care clinics taking prescription opioids for chronic pain or opioid agonist therapy (OAT) for opioid use disorder. The aim of this quasi-experimental time-series design study was to generate preliminary data on the effectiveness of an overdose prevention and naloxone training program in a primary care clinic setting. Study participants were opioid users (chronic pain or OAT) followed at Charles-LeMoyne family medicine group, who had no previous training on naloxone. The intervention was a standardized 1-hour group training session about overdose risk and management. A 14-question form used to evaluate naloxone training programs, the Opioid Overdose Knowledge Scale (OOKS), was used to assess the participant’s understanding and information retention. Means for OOKS scores were 24.8/44 at T0, 39.1/44 at T1 and 35.0/44 at T2, suggesting an increased and sustained knowledge regarding overdose management and naloxone use in both groups, following the training session. Most participants reported an increased confidence in their ability to use naloxone appropriately three months after the intervention. In the North American opioid crisis context, training at-risk patients in primary care clinics is promising and would allow reaching more opioid users to prevent opioid-related adverse events.
Keywords:
- naloxone,
- training,
- chronic pain,
- primary care
Resumen
Diversas intervenciones tienen como objetivo reducir las sobredosis de opioides, entre ellas la formación en administración de la naloxona, un antídoto que permite revertir temporalmente una sobredosis. Sin embargo, las mismas están destinadas más bien a las personas que frecuentan los organismos de calle o las clínicas especializadas en dependencia. Menos numerosas son las iniciativas destinadas a los pacientes que se sigue en clínica de medicina familiar y que son tratados con opioides por dolor crónico o que reciben un tratamiento de antagonistas opioides (TAO) por un problema relacionado con el uso de opioides. Este estudio de serie temporal está destinado a generar datos preliminares sobre la eficacia de una formación sobre lautilización de la naloxona entre los pacientes del grupo de medicina familiar universitaria Charles-LeMoyne, determinando la retención de los conceptos clave relacionados con los factores de riesgo, el reconocimiento y el tratamiento de una sobredosis de opioides. Los participantes eran usuarios de opioides (dolores crónicos o TAO) que no habían seguido una formación anterior sobre la gestión de las sobredosis. La intervención estudiada consistía en una formación normalizada por pequeños grupos, referida a las sobredosis de opioides. El instrumento de medida utilizado era el Opioid Overdose Knowledge Scale [escala de conocimiento de sobredosis de opioides], un cuestionario validado y traducido de 14 preguntas que totalizaban 44 puntos. Fue completado antes (T0), inmediatamente después (T4) y tres meses después de la formación (T1), con el objetivo de medir la retención de la información. Los puntajes de los 23 participantes incluidos fueron de 24,8/44 a T0, 39,1/44 à T1 y 35,0/44 à T2, lo que sugiere un conocimiento aumentado y sostenido de la gestión de las sobredosis de opioides en los dos grupos. La mayoría de los participantes declaraban tener confianza o mucha confianza en poder administrar la naloxona tres meses después de la formación. En el contexto de la crisis de los opioides, la formación de los pacientes a riesgo en medicina familiar es prometedora y permitiría alcanzar una población más diversificada de usuarios de opioides.
Palabras clave:
- naloxona,
- formación,
- dolor crónico,
- primera línea
Appendices
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