Naloxone Telephone Outreach Program in an Outpatient Mental Health Clinic: A Quality Improvement Project.

Over half of veterans diagnosed with OUD have experienced an overdose leading to hospitalization or death. Naloxone is an opioid receptor antagonist that reverses the effects of opioid overdose. Telephone outreach improves naloxone access in high-risk populations. In June 2022, 47.37% of at-risk veterans in an outpatient facility were prescribed naloxone which was significantly lower than the 65.10% national average of other facilities. The nurse-led intervention team implemented the telephone outreach from June 7, 2022, to September 7, 2022. The naloxone prescription rate for veterans diagnosed with OUD in the facility increased from 47.37% in June 2022 (n = 19) to 82.35% in September 2022. The rate for at-risk veterans increased from 20.0% in June 2022 (n = 90) to 58.24% in September 2022. The telephone outreach exceeded goals and increased the naloxone prescription rates for at-risk veterans at the facility in three months.

High risk of obesity and weight gain for HIV-infected uninsured minorities.

BACKGROUND: Obesity and HIV disproportionately affect minorities and have significant health risks, but few studies have examined disparities in weight change in HIV-seropositive (HIV+) cohorts. OBJECTIVE: To determine racial and health insurance disparities in significant weight gain in a predominately Hispanic HIV+ cohort. METHODS: Our observational cohort study of 1214 nonunderweight HIV+ adults from 2007 to 2010 had significant weight gain [≥3% annual body mass index (BMI) increase] as the primary outcome. The secondary outcome was continuous BMI over time. A 4-level race-ethnicity/insurance predictor reflected the interaction between race-ethnicity and insurance: insured white (non-Hispanic), uninsured white, insured minority (Hispanic or black), or uninsured minority. Logistic and mixed-effects models adjusted for baseline BMI, age, gender, household income, HIV transmission category, antiretroviral therapy type, CD4 count, plasma HIV-1 RNA, observation months, and visit frequency. RESULTS: The cohort was 63% Hispanic and 14% black; 13.3% were insured white, 10.0% uninsured white, 40.9% insured minority, and 35.7% uninsured minority. At baseline, 37.5% were overweight, 22.1% obese. Median observation was 3.25 years. Twenty-four percent of the cohort had significant weight gain, which was more likely for uninsured minority patients than insured whites [adjusted odds ratio = 2.85, 95% confidence intervals (CIs): 1.66 to 4.90]. The rate of BMI increase in mixed-effects models was greatest for uninsured minorities. Of 455 overweight at baseline, 29% were projected to become obese in 4 years. CONCLUSIONS AND RELEVANCE: In this majority Hispanic HIV+ cohort, 60% were overweight or obese at baseline, and uninsured minority patients gained weight more rapidly. These data should prompt greater attention by HIV providers for prevention of obesity.