Implementation Outcomes
Implementation outcomes are measures of how well and how often naloxone is being implemented. Health outcomes are measures of whether naloxone works. Click the buttons on the left to read more about implementation outcomes and health outcomes that have been measured for Naloxone, as well as to consider some potential research questions. In addition, view the RASC guide Integrating Implementation Outcomes into Effectiveness Studies for practical guidance on how to include implementation outcomes in your studies.
OEND programs can be impacted by how they are implemented in community and care settings.
Adoption is assessed from the perspective of the individual or organization delivering the intervention. For OEND, this could be the number of organizations or the number of individual staff members within an organization that intend or attempt to distribute naloxone and provide opioid overdose education.
In one study of a “hub and spoke” model to scale up OEND in eight Kentucky counties, naloxone was sent from a centralized “hub” to partner organizations. The model resulted in 69% of potential partner organizations adopting OEND, receiving at least one shipment of naloxone. The model relied on facilitated introductions of naloxone to the partner organizations to increase uptake. Another effort to implement OEND at Veterans Affairs Hospitals provided evidenced-based information about naloxone and OEND to encourage 4,500 prescribers to adopt OEND prescribing and dispensing.
Reach is assessed from the perspective of the individual receiving the intervention. For OEND programs, this could be the number of individuals (for example, patrons of a public library or patients visiting an emergency department) that ultimately receive free naloxone and opioid overdose education or the total number of naloxone kits dispensed from the OEND program.
OEND programs were successfully adopted at Veteran’s Affairs hospitals, reaching 39,328 unique individuals through dispensing 45,000 naloxone kits.
Acceptability is assessed from the perspective of either the individual delivering the intervention or the individual receiving the intervention and is defined as the perception that a given service is agreeable, palatable, or satisfactory. This is typically measured before and after OEND program implementation using a validated survey, such as the Acceptability of Intervention Measure.
In one study of opioid overdose prevention programs in New York City, individuals attending OEND trainings rated acceptability as high. Another study evaluated the acceptability of remote OEND trainings delivered online, reporting high acceptability and overall satisfaction with training.
Adherence is one dimension of a larger concept of intervention fidelity, which describes the extent to which OEND was implemented as prescribed.
In a study of New York City opioid overdose prevention programs, fidelity ratings differed depending on the role of the assessor (trainer, trainee, independent observer), with mean adherence scores rated higher for trainer and trainee self-ratings as compared to independent observer ratings. This highlights the value of third-party assessments of intervention adherence compared to self-report.