Evaluation of an emergency department-based opioid overdose survivor intervention: Difference-in-difference analysis of electronic health record data to assess key outcomes

Watson, Dennis P.; Weathers, Tess D.; McGuire, Alan B.; Cohen, Alex; Huynh, Philip; Bowes, Clay; O’Donnell, Daniel; Brucker, Krista; Gupta, Sumedha

doi:10.1016/j.drugalcdep.2021.108595

Cited by 18 publications

(21 citation statements)

References 38 publications

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“…To our knowledge, there is a paucity of studies rigorously evaluating peer recovery support services, and to date, none have been conducted in the ED setting. 16,17 Pilot programs of ED-based peer support have shown promise in increasing access to substance use disorder (SUD) treatment and care, [18][19][20] but it is still unknown whether a peer-led approach is more effective than other approaches. We sought to compare the effectiveness of a peer-led behavioral intervention vs a standard one to increase treatment uptake among ED patients who were at greatest risk of accidental drug-related death.…”

Section: Introductionmentioning

confidence: 99%

Effect of a Peer-Led Behavioral Intervention for Emergency Department Patients at High Risk of Fatal Opioid Overdose

et al. 2022

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IMPORTANCE Fatal and nonfatal opioid overdoses are at record levels, and emergency department (ED) visits may be an opportune time to intervene. Peer-led models of care are increasingly common; however, little is known about their effectiveness. OBJECTIVE To evaluate the effect of a peer-led behavioral intervention compared with the standard behavioral intervention delivered in the ED on engagement in substance use disorder (SUD) treatment within 30 days after the ED encounter. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial recruited 648 patients from 2 EDs from November 15, 2018, to May 31, 2021. Patients were eligible to participate if they were in the ED for an opioid overdose, receiving treatment related to an opioid use disorder, or identified as having had a recent opioid overdose. INTERVENTIONS Participants were randomly assigned to receive a behavioral intervention from a certified peer recovery specialist (n = 323) or a standard intervention delivered by a hospitalemployed licensed clinical social worker (n = 325). A certified peer recovery specialist was someone with at least 2 years of recovery who completed a 45-hour training program and had 500 hours of supervised work experience. After the ED intervention, the certified peer recovery specialists offered continued contact with participants for up to 90 days. MAIN OUTCOMES AND MEASURESThe primary outcome was receipt of SUD treatment within 30 days of enrollment, assessed with deterministic linkage of statewide administrative databases.Treatment engagement was defined as admission to a formal, publicly licensed SUD treatment program or receipt of office-based medication for opioid use disorder within 30 days of the initial ED visit. RESULTS Among the 648 participants, the mean (SD) age was 36.9 (10.8) years, and most were male (442 [68.2%]) and White (444 [68.5%]). Receipt of SUD treatment occurred for 103 of 323 participants (32%) in the intervention group vs 98 of 325 participants (30%) in the usual care group within 30 days of the ED visit. Among all participants, the most accessed treatments were outpatient medication for opioid use disorder (buprenorphine, 119 [18.4%]; methadone, 44 [6.8%]) and residential treatment (44 [6.8%]). CONCLUSIONS AND RELEVANCEOverall, this study found that a substantial proportion of participants in both groups engaged in SUD treatment within 30 days of the ED visit. An ED-based behavioral intervention is likely effective in promoting treatment engagement, but who delivers the (continued) Key Points Question Can peer-led behavioral interventions in the emergency department for patients who have had a recent opioid overdose increase shortterm treatment engagement after the emergency department visit? Findings In this randomized clinical trial of 648 emergency department patients at high risk of opioid overdose, there was no difference in treatment engagement within 30 days of the visit for participants who received a peer-led intervention vs those who received a standard behavioral intervention by a clin...

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Section: Introductionmentioning

confidence: 99%

Effect of a Peer-Led Behavioral Intervention for Emergency Department Patients at High Risk of Fatal Opioid Overdose

et al. 2022

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“…The initial idea for the RCPSI was partially inspired by peer support programs developed for patients presenting with OUD in urban EDs [ 8 , 9 ]. While a small but developing body of research supports the potential effectiveness of ED-based peer supports for improving outcomes for people with OUD [ 8 10 ], no recognized standard for the implementation of these programs currently exists. However, prior research has identified three core functions of such programs [ 6 ]: (1) peers are somehow integrated into the ED environment; (2) patients presenting with OUD are identified and connected with peer supports; and (3) peers connect patients with medication for opioid use disorder (MOUD) or other treatment services and supports.…”

Section: Introductionmentioning

confidence: 99%

Identifying unique barriers to implementing rural emergency department-based peer services for opioid use disorder through qualitative comparison with urban sites

Watson

Staton

2022

Addict Sci Clin Pract

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Background In an effort to address the current opioid epidemic, a number of hospitals across the United States have implemented emergency department-based interventions for engaging patients presenting with opioid use disorder. The current study seeks to address gaps in knowledge regarding implementation of a sub-type of such interventions, emergency department-based peer support services, in rural areas by comparing implementation of rural and urban programs that participated in Indiana’s Recovery Coach and Peer Support Initiative (RCPSI). Methods We conducted a secondary analysis of qualitative semi-structured implementation interviews collected as part of an evaluation of 10 programs (4 rural and 6 urban) participating in the RCPSI. We conducted interviews with representatives from each program at 3 time points over the course of the first year of implementation. Our deductive coding process was guided by the Consolidated Framework for Implementation Research (CFIR) and an external context taxonomy. Results We identified key differences for rural programs corresponding to each of the 5 primary constructs in the coding scheme. (1) Intervention characteristics: rural sites questioned intervention fit with their context, required more adaptations, and encountered unexpected costs. (2) External context: rural sites were not appropriately staffed to meet patient needs, encountered logistical and legal barriers regarding patient privacy, and had limited patient transportation options. (3) Inner setting: rural sites lacked strong mechanisms for internal communication and difficulties integrating with pre-existing culture and climate. (4) Characteristics of individuals: some rural providers resisted working with peers due to pre-existing attitudes and beliefs. (5) Implementation process: rural sites spent more time identifying external partners and abandoned more components of their initial implementation plans. Conclusions Findings demonstrate how rural programs faced greater challenges implementing emergency department-based peer services over time. These challenges required flexible adaptations to originally intended plans. Rural programs likely require flexibility to adapt interventions that were developed in urban settings to ensure success considering local contextual constraints that were identified by our analysis.

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“…7 Recognizing this opportunity, over the past decade, EDs across the U.S. began providing take-home naloxone, behavioral counseling, and medication for opioid use disorder (MOUD), specifically buprenorphine. [8][9][10][11][12][13][14][15][16][17][18][19] Although these interventions have been shown to be feasible in ED settings, uptake has been slow and unevenly distributed. [20][21][22][23][24][25] There are multiple ongoing efforts to improve the quality of post-overdose ED care and dissemination of ED take-home naloxone, behavioral counseling, and treatment initiation through local, state, and national initiatives.…”

Section: Introductionmentioning

confidence: 99%

“…[20][21][22][23][24][25] There are multiple ongoing efforts to improve the quality of post-overdose ED care and dissemination of ED take-home naloxone, behavioral counseling, and treatment initiation through local, state, and national initiatives. 16,17,19,22,[26][27][28] However, there is limited knowledge about maintenance of post-overdose services provision and implementation moderators, specifically patient, clinician, and institutional factors influencing access to and acceptance of takehome naloxone, behavioral counseling, and referral to treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Among an otherwise young and healthy patient population, an overdose‐related ED visit may be the only encounter a person with opioid use disorder (OUD) and/or people at risk for opioid overdose have with the healthcare system, and therefore represents a key opportunity to provide patients life‐saving harm reduction services and addiction treatment 7 . Recognizing this opportunity, over the past decade, EDs across the U.S. began providing take‐home naloxone, behavioral counseling, and medication for opioid use disorder (MOUD), specifically buprenorphine 8–19 . Although these interventions have been shown to be feasible in ED settings, uptake has been slow and unevenly distributed 20–25 …”

Section: Introductionmentioning

confidence: 99%

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Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program

Jacka

Ziobrowski

Lawrence

et al. 2021

Academic Emergency Medicine

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Study Objective: Emergency department (ED)-based naloxone distribution and peerbased behavioral counseling have been shown to be feasible, but little is known about utilization maintenance over time and clinician, patient, and visit level factors influencing implementation. Methods: We conducted a retrospective cohort study of an ED overdose prevention program providing take-home naloxone, behavioral counseling, and treatment linkage for patients treated for an opioid overdose at two Rhode Island EDs from 2017 to 2020: one tertiary referral center and a community hospital. Utilizing a Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we evaluated program reach, adoption, implementation modifiers, and maintenance using logistic and Poisson regression.Results: Seven hundred forty two patients were discharged after an opioid overdose, comprising 966 visits (median: 32 visits per month; interquartile range: 29, 41). At least one intervention was provided at most (86%, 826/966) visits. Take-home naloxone was provided at 69% of visits (637/919). Over half (51%, 495/966) received behavioral counseling and treatment referral (65%, 609/932). Almost all attending physicians provided take-home naloxone (97%, 105/108), behavioral counseling (95%, 103/108), or treatment referral (95%, 103/108) at least once. Most residents and advanced practice practitioners (APPs) provided take home naloxone (78% residents; 72% APPs), behavioral counseling (76% residents; 67% APPs), and treatment referral (80% residents; 81% APPs) at least once. Most clinicians provided these services for over half of the opioid overdose patients they cared for. Patients were twice as likely to receive behavioral counseling when treated by an attending in combination with a resident and/or APP (adjusted odds ratio: 2.29; 95% confidence interval, 1.68, 3.12) compared to an attending alone. There was no depreciation in use over time.

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Evaluation of an emergency department-based opioid overdose survivor intervention: Difference-in-difference analysis of electronic health record data to assess key outcomes

Cited by 18 publications

References 38 publications

Effect of a Peer-Led Behavioral Intervention for Emergency Department Patients at High Risk of Fatal Opioid Overdose

Effect of a Peer-Led Behavioral Intervention for Emergency Department Patients at High Risk of Fatal Opioid Overdose

Identifying unique barriers to implementing rural emergency department-based peer services for opioid use disorder through qualitative comparison with urban sites

Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program

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