Sustained Implementation of a Multicomponent Strategy to Increase Emergency Department-Initiated Interventions for Opioid Use Disorder - 16/02/22
, Jeanmarie Perrone, MD b, g, h, Ruiying A. Xiong, MS a, Christopher K. Snider, MPH d, Nicole O’Donnell, CRS b, Davis Hermann, MiD d, Roy Rosin, MBA d, g, Julie Dees, MBA, MA e, Rachel McFadden, BSN, RN b, Utsha Khatri, MD, MSHP f, Zachary F. Meisel, MD, MS b, g, Nandita Mitra, PhD c, g, M. Kit Delgado, MD, MS b, gAbstract |
Study objective |
There is strong evidence supporting emergency department (ED)-initiated buprenorphine for opioid use disorder, but less is known about how to implement this practice. Our aim was to describe implementation, maintenance, and provider adoption of a multicomponent strategy for opioid use disorder treatment in 3 urban, academic EDs.
Methods |
We conducted a retrospective analysis of electronic health record data for adult patients with opioid use disorder-related visits before (March 2017 to November 2018) and after (December 2018 to July 2020) implementation. We describe patient characteristics, clinical treatment, and process measures over time and conducted an interrupted time series analysis using a patient-level multivariable logistic regression model to assess the association of the interventions with buprenorphine use and other outcomes. Finally, we report provider-level variation in prescribing after implementation.
Results |
There were 2,665 opioid use disorder-related visits during the study period: 28% for overdose, 8% for withdrawal, and 64% for other conditions. Thirteen percent of patients received medications for opioid use disorder during or after their ED visit overall. Following intervention implementation, there were sustained increases in treatment and process measures, with a net increase in total buprenorphine of 20% in the postperiod (95% confidence interval 16% to 23%). In the adjusted patient-level model, there was an immediate increase in the probability of buprenorphine treatment of 24.5% (95% confidence interval 12.1% to 37.0%) with intervention implementation. Seventy percent of providers wrote at least 1 buprenorphine prescription, but provider-level buprenorphine prescribing ranged from 0% to 61% of opioid use disorder-related encounters.
Conclusion |
A combination of strategies to increase ED-initiated opioid use disorder treatment was associated with sustained increases in treatment and process measures. However, adoption varied widely among providers, suggesting that additional strategies are needed for broader uptake.
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| Please see page 238 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Donald M. Yealy, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: ML and MKD were responsible for the study concept and design. ML, CS, and MKD were responsible for acquisition of the data. ML, RAX, NM, and MKD analyzed and interpreted the data. ML and MKD drafted the manuscript, and JP, NO, DH, RR, JD, RM, UK, and ZFM critically revised the manuscript for important intellectual content. RAX and NM were responsible for statistical expertise. MKD and JD were responsible for acquisition of funding. ML takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Fundingandsupport: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This work was supported by the Penn Injury Science Center (CDC 19R49CE003083), Penn Medicine Center for Health Care Innovation Accelerator Program, and SAMHSA (H79TI081596-01). Dr. Delgado was also supported by the National Institute of Child Health and Human Development (grant K23HD090272001) and by a philanthropic grant from the Abramson Family Foundation. |
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Vol 79 - N° 3
P. 237-248 - mars 2022 Retour au numéro
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