Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department–Initiated Buprenorphine Programs

Abstract

ImportanceAn increasing number of emergency departments (EDs) are initiating buprenorphine for opioid use disorder (OUD) and linking patients to ongoing community-based treatment, yet community-based clinician and staff perspectives regarding this practice have not been characterized.ObjectiveTo explore perspectives and experiences regarding ED-initiated buprenorphine among community-based clinicians and staff in geographically distinct regions.Design, Setting, and ParticipantsThis qualitative study reports findings from Project ED Health, a hybrid type 3 effectiveness-implementation study designed to evaluate the impact of implementation facilitation on ED-initiated buprenorphine with referral to ongoing medication treatment. Clinicians and staff from community-based treatment programs were identified by urban academic EDs as potential referral sites for ongoing OUD treatment in 4 cities across the US in a formative evaluation as having the capability to continue medication treatment. Focus groups were held from April 1, 2018, to January 11, 2019, to examine community OUD treatment clinician and staff perspectives on accepting patients who have received ED-initiated buprenorphine. Data were analyzed from August 2020 to August 2022.Main Outcomes and MeasuresData collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework, focusing on domains including evidence, context, and facilitation.ResultsA total of 103 individuals (mean [SD] age, 45.3 [12.0] years; 76 female and 64 White) participated in 14 focus groups (groups ranged from 3-22 participants). Participants shared negative attitudes toward buprenorphine and variable attitudes toward ED-initiated buprenorphine. Prominent barriers included the community site treatment capacity and structure as well as payment and regulatory barriers. Perceived factors that could facilitate this model included additional substance use disorder training for ED staff, referrals and communication, greater inclusion of peer navigators, and addressing sociostructural marginalization that patients faced.Conclusions and RelevanceIn this study of community-based clinicians and staff positioned to deliver OUD treatment, participants reported many barriers to successful linkages for patients who received ED-initiated buprenorphine. Strategies to improve these linkages included educating communities and programs, modeling low-barrier philosophies, and using additional staff trained in addiction as resources to improve transitions from EDs to community partners.

Identifying Barriers to OUD Treatment Linkage From the Emergency Department to the Community

“… 9 If the proposed amendments are codified into law, buprenorphine access will decrease, and people living in rural areas and underserved communities will likely bear the burden of this proposed change. The change would magnify the barriers identified in the study by Sue et al, 5 as community treatment centers already face limited treatment capacity and difficulties addressing sociostructural marginalization. 5 …”

“…The change would magnify the barriers identified in the study by Sue et al, 5 as community treatment centers already face limited treatment capacity and difficulties addressing sociostructural marginalization. 5 …”

“…In this formative evaluation, Sue and colleagues 5 explored perspectives of practitioners and staff working in community-based programs who could potentially continue providing OUD treatment for patients initiated on buprenorphine in local EDs. The study results informed implementation activities related to Project ED HEALTH, a hybrid type 3 effectiveness-implementation study that aimed to measure the outcomes associated with implementation facilitation to promote ED-initiated buprenorphine for OUD.…”

“…In the complementary Sue et al 5 and Hawk et al 3 studies, community-based addiction treatment practitioners and ED practitioners highlighted the need for expanded OUD treatment capacity in the community. A multipronged approach is essential to expand access to buprenorphine across multiple health care settings and to normalize buprenorphine prescribing among all practitioners.…”

Linking Hospitalized Patients With Opioid Use Disorder to Treatment—The Importance of Care Transitions

“…This finding may also reflect increased trust in the health care system associated with the bridge clinic group, as stigma often prevents patients with OUD from seeking and accessing care. A qualitative study that examined the perspectives of community clinicians and staff toward buprenorphine initiated in the emergency department found that barriers to successful OUD treatment linkage included negative attitudes about MOUD, limited treatment capacity, the reported need for specialized addiction clinicians, and addressing the social determinants of health to support treatment engagement . Bridge clinics address many of these while providing stigma-free, low-barrier, and expert addiction care.…”