The Emergency Department Longitudinal Integrated Care (ED-LINC) intervention targeting opioid use disorder: A pilot randomized clinical trial

Whiteside, Lauren K.; Huynh, Ly; Morse, S.; Hall, Jane; Meurer, William J; Banta‐Green, Caleb J.; Scheuer, Hannah; Cunningham, Robert J.; McGovern, Mark P.; Zatzick, Douglas

doi:10.1016/j.jsat.2021.108666

Cited by 4 publications

(5 citation statements)

References 78 publications

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“…The nding that patients employed at baseline had higher follow-up rates is consistent with research demonstrating the association between employment and better treatment and recovery outcomes [38][39][40]. In the case of the current study, it is also possible that employed patients had more consistent and reliable acccess to a working telephone, as phone access is often a barrier to telehealth and treatment engagement for this population [10,41,42].…”

Section: Discussionsupporting

confidence: 85%

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

Watson

Phalen

Medcalf

et al. 2023

Preprint

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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 emergency department bedside. However, the use of telehealth services in EDs is becoming more popular. Although these services connect PRCs with ED patients in real-time via secure communications technology, very little is known about the effectiveness of these programs as related to services and clinical outcomes. 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 emergency department. Method: Data come from records for 917 patients who engaged with a telehealth PRC one or more times (1,208 total engagements) at 1 of 13 emergency departments 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. 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 emergency department 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.

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Section: Discussionsupporting

confidence: 85%

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

Watson

Phalen

Medcalf

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Testing a multilevel intervention that includes both a patient-level intervention with a navigator or care manager and a PCP-level intervention with an opioid management component would shed light on whether Zatzick’s care management intervention findings could be replicated and perhaps amplified for this selected group. Preliminary investigation supports the feasibility of a patient-level care management intervention for patients with OUD 29…”

Section: Discussionmentioning

confidence: 76%

“…Preliminary investigation supports the feasibility of a patient-level care management intervention for patients with OUD. 29 …”

Section: Discussionmentioning

confidence: 99%

Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization

Baldwin

Katers

Sullivan

et al. 2023

Trauma Surg Acute Care Open

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BackgroundDecreasing exposure to prescription opioids is critical to lowering risk of opioid misuse, overdose and opioid use disorder. This study reports a secondary analysis of a randomized controlled trial implementing an opioid taper support program directed to primary care providers (PCPs) of patients discharged from a level I trauma center to their homes distant from the center, and shares lessons for trauma centers in supporting these patients.MethodsThis longitudinal descriptive mixed-methods study uses quantitative/qualitative data from trial intervention arm patients to examine implementation challenges and outcomes: adoption, acceptability, appropriateness, feasibility, fidelity. In the intervention, a physician assistant (PA) contacted patients after discharge to review their discharge instructions and pain management plan, confirm their PCP’s identity and encourage PCP follow-up. The PA reached out to the PCP to review the discharge instructions and offer ongoing opioid taper and pain management support.ResultsThe PA reached 32 of 37 patients randomized to the program. Of these 32, 81% discussed topics not targeted by the intervention (eg, social/financial). The PA identified and reached a PCP’s office for only 51% of patients. Of these, all PCP offices (100% adoption) received one to four consults (mean 1.9) per patient (fidelity). Few consults were with PCPs (22%); most were with medical assistants (56%) or nurses (22%). The PA reported that it was not routinely clear to patients or PCPs who was responsible for post-trauma care and opioid taper, and what the taper instructions were.ConclusionsThis level I trauma center successfully implemented a telephonic opioid taper support program during COVID-19 but adapted the program to allow nurses and medical assistants to receive it. This study demonstrates a critical need to improve care transition from hospitalization to home for patients discharged after trauma.Level of evidenceLevel IV.

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“…The finding that patients employed at baseline had higher follow-up rates is consistent with research demonstrating the association between employment and better treatment and recovery outcomes [ 40 – 42 ]. In the case of the current study, it is also possible that employed patients had more consistent and reliable acccess to a working telephone, as phone access is often a barrier to telehealth and treatment engagement for this population [ 10 , 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

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

Watson

Phalen

Medcalf

et al. 2023

Subst Abuse Treat Prev Policy

View full text Add to dashboard Cite

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.

show abstract

The Emergency Department Longitudinal Integrated Care (ED-LINC) intervention targeting opioid use disorder: A pilot randomized clinical trial

Cited by 4 publications

References 78 publications

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

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

Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization

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

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