i
Sustained implementation of a multi-component strategy to increase emergency department-initiated interventions for opioid use disorder
-
3-2022
Source: Ann Emerg Med. 79(3):237-248 -
Alternative Title:Ann Emerg Med
-
Personal Author:
-
Description:Objectives:
There is strong evidence supporting emergency department (ED)-initiated buprenorphine for opioid use disorder (OUD), but less is known about how to implement this practice. Our aim was to describe implementation, maintenance, and provider adoption of a multi-component strategy for OUD treatment in three urban, academic EDs.
Methods:
We conducted a retrospective analysis of electronic health record (EHR) data for adult patients with OUD-related visits before (3/2017-11/2018) and after (12/2018-7/2020) implementation. We describe patient characteristics, treatment, and process measures over time and conducted an interrupted time series analysis (ITSA) 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 2665 OUD-related visits during the study period; 28% for overdose, 8% for withdrawal, and 64% for other conditions. 13% of patients received MOUDs during or after their ED visit. Following intervention implementation, there were sustained increases in treatment and process measures, with a net increase in total buprenorphine of 20% in the post-period (95% CI 16%-23%). In the adjusted patient-level model, there was an immediate increase in probability of buprenorphine treatment of 24.5% (95% CI 12.1% to 37.0%) with intervention implementation. 70% of providers wrote at least one buprenorphine prescription, but provider-level buprenorphine prescribing ranged from 0-61% of OUD-related encounters.
Conclusions:
A combination of strategies to increase ED-initiated OUD treatment were associated with sustained increases in treatment and process measures. However, adoption varied widely among providers, suggesting additional strategies may be needed for broader uptake.
-
Subject:
-
Source:
-
Pubmed ID:34922776
-
Pubmed Central ID:PMC8860858
-
Document Type:
-
Collection(s):
-
Main Document Checksum:
-
File Type:
[PDF-438.16 KB]
Details:
Supporting Files
More +
Email
CDC-INFO
