A novel social work approach to emergency department buprenorphine induction and warm hand-off to community providers

Kelly, Timothy; Hoppe, Jason; Zuckerman, Matthew; Khoshnoud, Angela; Sholl, Benjamin; Heard, Kennon

doi:10.1016/j.ajem.2019.12.038

Cited by 33 publications

(34 citation statements)

References 20 publications

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“…Referrals that enable same day intake and treatment initiation, i.e. warmhand-offs, are especially likely to improve patient follow-up and outcomes (D'Onofrio et al, 2015(D'Onofrio et al, , 2018Ahmed et al, 2019;Kelly et al, 2020). Recent work has also found success in incorporating telehealth and text messaging into referral systems to help with patient follow up, which may be especially useful in rural settings (Kmiec and Suffoletto, 2019;Wootton et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting

et al. 2020

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Background: Increased drug use has disproportionately impacted rural areas across the U.S. People who use drugs are at risk of overdose and other medical complications, including infectious diseases. Understanding barriers to healthcare access for this often stigmatized population is key to reducing morbidity and mortality, particularly in rural settings where resources may be limited. Methods: We conducted 20 semi-structured interviews with people who use drugs, including 17 who inject drugs, in rural southern Illinois between June 2018 and February 2019. Interviews were analyzed using a modified grounded theory approach where themes are coded and organized as they emerge from the data. Results: Participants reported breaches of trust by healthcare providers, often involving law enforcement and Emergency Medical Services, that dissuaded them from accessing medical care. Participants described experiences of mistreatment in emergency departments, with one account of forced catheterization. They further recounted disclosures of protected health information by healthcare providers, including communicating drug test results to law enforcement and sharing details of counseling sessions with community members without consent. Participants also described a hesitancy common among people who use drugs to call emergency medical services for an overdose due to fear of arrest. Conclusion: Breaches of trust by healthcare providers in rural communities discouraged people who use drugs from accessing medical care until absolutely necessary, if at all. These experiences may worsen healthcare outcomes and further stigmatize this marginalized community. Structural changes including reforming and clarifying law enforcement's role in Emergency Departments as well as instituting diversion policies during arrests may help rebuild trust in these communities. Other possible areas for intervention include stigma training and harm reduction education for emergency medicine providers, as well as developing and implementing referral systems between Emergency Departments and local harm reduction providers and medically assisted drug treatment programs.

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Section: Discussionmentioning

confidence: 99%

Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting

et al. 2020

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“…These factors were unstable housing, 19 unemployment, 19 poor social support system, 19 heroin use, 19 lack of transportation, 20 and receiving a referral to follow-up care to a different health system. 29…”

Section: Identification Of Patients For Inductionmentioning

confidence: 99%

“…23,[32][33][34] and warm handoffs with social workers and case managers are a particularly popular choice in EDs. 27,29,32,39,40 Recommendations for followup arrangements included having ED personnel make outpatient MAT appointments for patients 32,34 and having follow-up within-network such as with a "hub and spoke" model. 20,41 The timing of follow-up differed among articles, but all arranged follow-up within 72 hours between ED discharge and initial MAT followup visit.…”

Section: Follow-up Arrangements After Inductionmentioning

confidence: 99%

<p>Prescribing Buprenorphine for Opioid Use Disorders in the ED: A Review of Best Practices, Barriers, and Future Directions</p>

Cao¹,

Dunham²,

Simpson³

2020

OAEM

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ED-initiated addiction treatment holds promise for enhancing access to treatment for those with opioid use disorder (OUD). We present a literature review summarizing the evidence for buprenorphine induction in the ED including best practices for dosing, follow-up care, and reducing implementation barriers. A literature search of Pubmed, PsychInfo, and Embase identified articles studying OUD treatment in the ED published after 1980. Twenty-five studies were identified including eleven scientific abstracts. Multiple studies suggest that buprenorphine induction improves engagement in substance treatment up to 30 days after ED treatment. Many different induction protocols were presented, but no particular approach was best supported as criteria for induction and initial dosing vary widely. Similarly, transition of care models focused on either a "hub and spoke" model or "warm hand-offs" model, but no studies compared these approaches. Common barriers to implementing induction programs were provider inexperience, discomfort with addiction treatment, and limited time during the ED visit. No studies described the number of EDs offering induction. While ED buprenorphine induction is safe and enhances adherence to addiction treatment, uncertainty persists in how to best identify patients needing treatment, how to initiate buprenorphine, and how to enhance follow-up after ED-initiated treatment.

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“…Our search revealed eight non‐randomised observational studies, mostly performed in the last 2 years (Table 2). These have demonstrated that when buprenorphine is initiated in the ED with a warm handover (direct communication) to outpatient care, there is substantial engagement in formal addiction treatment in the following months 34–40 . In some cases, this was achieved by utilising peer workers, social workers and rapid access bridge clinics; a model that is likely to overcome the extra workload perceived by physicians and prevent loss to follow‐up during this high‐risk period 33,34,39,40 …”

Section: Resultsmentioning

confidence: 99%

“…In all studies, the majority of participants presented to their first follow‐up appointment, and at 30 days more than two thirds of participants were retained 35–39 . In one study, 37% of participants were still in active treatment at 6 months 37 .…”

Section: Resultsmentioning

confidence: 99%

Review article: Rapid review of the emergency department‐initiated buprenorphine for opioid use disorder

Salter

Hutton

Cantwell

et al. 2020

Emerg Medicine Australasia

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Opioid-related harms have been increasing in Australia over the last 5 years. Patients with opioid use disorder are over-represented in ED presentations. Opioid agonist treatment is the most effective community-based treatment. Buprenorphine is considered the safest of these treatments to use in the ED setting. This rapid review investigated the effectiveness of initiating buprenorphine in the ED setting. Medline, Embase, Emcare, PSYCinfo, CINAHL and Cochrane Central Register of Controlled Trials databases were searched. Randomised and non-randomised studies published in peer-reviewed journals that involved the initiation of buprenorphine in the ED setting were considered eligible. The search revealed 350 articles of which 11 were included in the review; three articles representing two randomised controlled trials (RCTs) and eight observational studies. Data were extracted from included papers and risk of bias assessed on the RCTs. One well-conducted RCT showed that buprenorphine initiated in the ED does improve treatment engagement up to 2 months after an ED visit. Eight observational studies, one with a comparator group reported positive results for this intervention. There is strong evidence that clinicians should consider commencing buprenorphine in the ED for patients with opioid use disorder when combined with a direct and supported referral or 'warm handover' to community care. Further implementation studies and investigation of long-acting injectable buprenorphine treatment are required.

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A novel social work approach to emergency department buprenorphine induction and warm hand-off to community providers

Cited by 33 publications

References 20 publications

Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting

Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting

<p>Prescribing Buprenorphine for Opioid Use Disorders in the ED: A Review of Best Practices, Barriers, and Future Directions</p>

Review article: Rapid review of the emergency department‐initiated buprenorphine for opioid use disorder

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