Evaluation of post-discharge engagement for emergency department patients with opioid use history who received telehealth recovery coaching services

Abstract

Background In recent years, emergency departments (EDs) across the nation have implemented peer recovery coach (PRC) services to support patients who use opioids. The majority of such interventions discussed in the literature follow an in-person modality where PRCs engage patients directly at the ED bedside. However, the use of telehealth services in EDs is becoming more popular. These services connect PRCs with ED patients in real-time via secure communications technology, and very little is known about the service- and clinical-based outcomes with which they are associated. The current study sought to assess factors associated with successful post-discharge follow-up of patients with a history of opioid use who received PRC telehealth services while in the ED. Method Data come from records for 917 patients who engaged with a telehealth PRC one or more times (1208 total engagements) at 1 of 13 EDs within the same health system. A multilevel Poisson regression model was used to assess the degree to which variables predicted successful post-discharge follow-up, defined as the number of times a PRC successfully spoke with the patient each month after ED discharge. Results At least one follow-up was successfully completed by a PRC for 23% of enrolled patients. Significant predictors of successful follow-up included patient employment at baseline (Incidence Rate Ratio [IRR]: 2.8, CI: 2.05–3.9), living in a rural area (IRR: 1.8, CI: 1.04–3.2), PRC provision of referrals (IRR: 1.7, CI: 1.2–2.2), number of ED encounters in the previous 365 days (IRR: 0.99, CI: 0.98–0.99), and duration of the initial PRC telehealth interaction (IRR: 0.87, CI: 0.85–0.88). Conclusion Given that relationship development is a key tool in the PRC profession, understanding successful follow-up associated with telehealth engagement has unique importance. The results have potential utility for planning and implementing peer telehealth services in EDs and other locations, which is needed for the development of the PRC profession and the likely expansion of peer telehealth services.

Results From the POINT Pragmatic Randomized Trial: An Emergency Department-Based Peer Support Specialist Intervention to Increase Opioid Use Disorder Treatment Linkage and Reduce Recurrent Overdose

“…These results contribute to the growing body of evidence related to the effectiveness of ED-based PRSS interventions for OUD, with most prior research of similar interventions focusing on relatively short-term servicerelated outcomes (eg, naloxone dispensation, time to MOUD initiation), being retrospective or cross-sectional, or lacking a control group. 21,23,34 The findings of this trial are similar to that of another randomized study conducted by Beaudoin et al 9 that also did not support an effect of PRSSs on post-ED treatment engagement. However, this prior work focused on short-term MOUD linkage, making the POINT study the first randomized trial of such an intervention to consider longer-term overdose outcomes.…”

“…18,19 Thus, PRSSs can provide alternative harm reduction and recovery paths for patients who decline treatment or who face greater access barriers. 20,21 Prior research has demonstrated ED-based PRSSs' ability to engage patients and distribute the overdose-reversing drug naloxone. 22,23 However, their capability to improve treatment linkage, including linkage to evidence-based medications for OUD (MOUD; eg, methadone, buprenorphine, and injectable, long-acting naltrexone) or to improve clinical outcomes such as overdose and ED re-presentations have not been fully demonstrated.…”

A Pilot Randomized Controlled Trial Evaluating Peer Recovery Coaches for Addiction Recovery among Indigenous Americans

“…We had a relatively high attrition rate during the trial which likely resulted in a degree of attrition bias. High drop-out rates are common in both addiction treatment [63,64] and research [62]. The expected drop-out rate was likely compounded by our restriction to distance contact during the pandemic.…”

“…An analysis of a large cohort in a treatment setting found that only 20% of individuals completed a 30-day program [63]. In another analysis of 1,208 patient encounters in an emergency department, PRCs were able to complete at least one follow up with only 23% of individuals [64]. In practice settings, adherence varies significantly and most often ranges between 33%40,65 and 66%.66 Some programs have shown much higher rates of adherence but these are most often in conjunction with much more intensive interventions such as methadone treatment which make them incomparable with PRC services alone [53,67].…”

Digitally Assisted Peer Recovery Coach to Facilitate Linkage to Outpatient Treatment Following Inpatient Alcohol Withdrawal Treatment: Proof-of-Concept Pilot Study

“…Additionally, mobile technologies are increasingly studied to improve treatment outcomes for a variety of illnesses, including AUD [ 9 ]. Prior trials that have combined smartphones with peer recovery coaches have included primary care patients with hazardous drinking [ 10 , 11 ] or individuals in the emergency department with opioid use disorder [ 12 ]. However, there are no prior studies that have attempted to leverage technology to increase engagement with peer recovery coaches to specifically improve linkage to care following inpatient alcohol withdrawal management treatment.…”