Emergency Department Treatment of Opioid Addiction: An Opportunity to Lead

Martin, Andrew; Mitchell, Andreas; Wakeman, Sarah E.; White, BA; Raja, Ali S.

doi:10.1111/acem.13367

Cited by 42 publications

(32 citation statements)

References 6 publications

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“…Several EDs have launched ED-initiated treatment programs with buprenorphine. 2,[11][12][13][14] Legislative changes are also underway to incorporate initiation of buprenorphine into ED management of patients of OUD. For example, a new State of Massachusetts law requires acute care hospitals that provide emergency services to have the capacity to initiate opioid agonist therapy to patients after an opioid-related overdose, and to directly connect the patients to continuing treatment prior to discharge.…”

Section: Importancementioning

confidence: 99%

Emergency Department Clinicians’ Attitudes Toward Opioid Use Disorder and Emergency Department-initiated Buprenorphine Treatment: A Mixed-Methods Study

Chary

Condella

et al. 2020

WestJEM

Self Cite

116

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Introduction: Emergency department (ED) visits related to opioid use disorder (OUD) have increased nearly twofold over the last decade. Treatment with buprenorphine has been demonstrated to decrease opioid-related overdose deaths. In this study, we aimed to better understand ED clinicians' attitudes toward the initiation of buprenorphine treatment in the ED. Methods: We performed a mixed-methods study consisting of a survey of 174 ED clinicians (attending physicians, residents, and physician assistants) and semi-structured interviews with 17 attending emergency physicians at a tertiary-care academic hospital. Results: A total of 93 ED clinicians (53% of those contacted) completed the survey. While 80% of respondents agreed that buprenorphine should be administered in the ED for patients requesting treatment, only 44% felt that they were prepared to discuss medication for addiction treatment. Compared to clinicians with fewer than five years of practice, those with greater experience were less likely to approve of ED-initiated buprenorphine. In our qualitative analysis, physicians had differing perspectives on the role that the ED should play in treating OUD. Most physicians felt that a buprenorphine-based intervention in the ED would be feasible with institutional support, including training opportunities, protocol support within the electronic health record, counseling and support staff, and a robust referral system for outpatient follow-up. Conclusion: ED clinicians' perception of buprenorphine varied by years of practice and training level. Most ED clinicians did not feel prepared to initiate buprenorphine in the ED. Qualitative interviews identified several addressable barriers to ED-initiated buprenorphine. [West J Emerg Med. 2020;21(2)261-271.] decade. 1 As a critical access point for patients with OUD, the ED is well positioned to provide and link patients to OUD treatment. 2 However, current practice in United States EDs for patients seeking treatment for OUD is referral to addiction

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Section: Importancementioning

confidence: 99%

Emergency Department Clinicians’ Attitudes Toward Opioid Use Disorder and Emergency Department-initiated Buprenorphine Treatment: A Mixed-Methods Study

Chary

Condella

et al. 2020

WestJEM

Self Cite

116

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“…Given the devastating toll of the opioid epidemic, this user-centered CDS was developed to give clinicians the tools necessary to engage more people suffering from OUD in effective treatment at a time when they may be particularly open to it [8-10]. However, this intervention may be challenging to disseminate for several reasons: (1) it implements a multistep practice that is not familiar to clinicians; (2) ED clinicians are unlikely to see immediate effects of their efforts; (3) the targeted patient population is often perceived to be difficult to work with; and (4) the legal status of BUP for OUD is complicated, requiring a special waiver to prescribe for home use, but no waiver required if the treatment is administered onsite for no more than 72 hours [37,38].…”

Section: Discussionmentioning

confidence: 99%

“…Initiating BUP in the ED doubles the rate of addiction treatment engagement in ED patients with OUD [8]. However, ED-initiated BUP has not yet been adopted in most hospitals [9,10]. This delay in adoption of evidence-based practice is not unique—on average, it takes 17 years from discovery to the adoption of evidence-based practices into routine care [11,12].…”

Section: Introductionmentioning

confidence: 99%

Computerized Clinical Decision Support System for Emergency Department–Initiated Buprenorphine for Opioid Use Disorder: User-Centered Design

Ray¹,

Ahmed²,

Solad³

et al. 2019

JMIR Hum Factors

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BackgroundEmergency departments (EDs) frequently care for individuals with opioid use disorder (OUD). Buprenorphine (BUP) is an effective treatment option for patients with OUD that can safely be initiated in the ED. At present, BUP is rarely initiated as a part of routine ED care. Clinical decision support (CDS) could accelerate adoption of ED-initiated BUP into routine emergency care.ObjectiveThis study aimed to design and formatively evaluate a user-centered decision support tool for ED initiation of BUP for patients with OUD.MethodsUser-centered design with iterative prototype development was used. Initial observations and interviews identified workflows and information needs. The design team and key stakeholders reviewed prototype designs to ensure accuracy. A total of 5 prototypes were evaluated and iteratively refined based on input from 26 attending and resident physicians.ResultsEarly feedback identified concerns with the initial CDS design: an alert with several screens. The timing of the alert led to quick dismissal without using the tool. User feedback on subsequent iterations informed the development of a flexible tool to support clinicians with varied levels of experience with the intervention by providing both one-click options for direct activation of care pathways and user-activated support for critical decision points. The final design resolved challenging navigation issues through targeted placement, color, and design of the decision support modules and care pathways. In final testing, users expressed that the tool could be easily learned without training and was reasonable for use during routine emergency care.ConclusionsA user-centered design process helped designers to better understand users’ needs for a Web-based clinical decision tool to support ED initiation of BUP for OUD. The process identified varying needs across user experience and familiarity with the protocol, leading to a flexible design supporting both direct care pathways and user-initiated decision support.

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“…A 2015 randomized clinical trial of 329 opioid-dependent patients who were treated at an urban teaching hospital ED demonstrated both that BUP initiation in the ED is safe and that ED patients with untreated OUD receiving BUP in the ED are twice as likely to remain engaged in addiction treatment at one month (78% vs 37%, p < 0.001) [14]. Despite this evidence, adoption of this evidence-based practice has been slow [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Progress Report on EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder

2020

J Psychiatry Brain Sci

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Emergency Department Treatment of Opioid Addiction: An Opportunity to Lead

Cited by 42 publications

References 6 publications

Emergency Department Clinicians’ Attitudes Toward Opioid Use Disorder and Emergency Department-initiated Buprenorphine Treatment: A Mixed-Methods Study

Emergency Department Clinicians’ Attitudes Toward Opioid Use Disorder and Emergency Department-initiated Buprenorphine Treatment: A Mixed-Methods Study

Computerized Clinical Decision Support System for Emergency Department–Initiated Buprenorphine for Opioid Use Disorder: User-Centered Design

Progress Report on EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder

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