Sustained implementation of a multi-component strategy to increase emergency department-initiated interventions for opioid use disorder

Details

• Alternative Title:
  Ann Emerg Med
• Personal Author:
  Lowenstein, Margaret ; Perrone, Jeanmarie ; Xiong, Ruiying Aria ; Snider, Christopher K. ; O’Donnell, Nicole ; Hermann, Davis ; Rosin, Roy ; Dees, Julie ; McFadden, Rachel ; Khatri, Utsha ; Meisel, Zachary F. ; Mitra, Nandita ; Delgado, M. Kit
• 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.
  
  
• Subjects:
  Article Child Female Gender Identity Gender Role Humans Male Nigeria Sex Offenses Sexual Behavior
• Source:
  Ann Emerg Med. 79(3):237-248
• Pubmed ID:
  34922776
• Pubmed Central ID:
  PMC8860858
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  79
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:50cf870fd783718de7d2bb81c31afd5ae9b6c83b2d43f1bb2f700ca202e07a78
• Download URL:
  https://stacks.cdc.gov/view/cdc/114729/cdc_114729_DS1.pdf
• File Type:
  [PDF - 438.16 KB ]