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Seliski N, Madsen T, Eley S, Colosimo J, Engar T, Gordon A, Barnett C, Humiston G, Morsillo T, Stolebarger L, Smid MC, Cochran G. Implementation of a rural emergency department-initiated buprenorphine program in the mountain west: a study protocol. Addict Sci Clin Pract 2024; 19:63. [PMID: 39228007 PMCID: PMC11369999 DOI: 10.1186/s13722-024-00496-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 08/19/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Opioid related overdose morbidity and mortality continue to significantly impact rural communities. Nationwide, emergency departments (EDs) have seen an increase in opioid use disorder (OUD)-related visits compared to other substance use disorders (SUD). ED-initiated buprenorphine is associated with increased treatment engagement at 30 days. However, few studies assess rural ED-initiated buprenorphine implementation, which has unique implementation barriers. This protocol outlines the rationale and methods of a rural ED-initiated buprenorphine program implementation study. METHODS This is a two-year longitudinal implementation design with repeated qualitative and quantitative measures of an ED-initiated buprenorphine program in the rural Mountain West. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outlines intervention assessments. The primary outcome is implementation measured by ED-initiated buprenorphine protocol core components. Reach, adoption, and maintenance are secondary outcomes. External facilitators from an academic institution with addiction medicine and prior program implementation expertise partnered with community hospital internal facilitators to form an implementation team. External facilitators provide ongoing support, recommendations, education, and academic detailing. The implementation team designed and implemented the rural ED-initiated buprenorphine program. The program includes OUD screening, low-threshold buprenorphine initiation, naloxone distribution and administration training, and patient navigator incorporation to provide warm hand off referrals for outpatient OUD management. To address rural based implementation barriers, we organized implementation strategies based on Expert Recommendations for Implementing Change (ERIC). Implementation strategies include ED workflow redesign, local needs assessments, ED staff education, hospital leadership and clinical champion involvement, as well as patient and community resources engagement. DISCUSSION Most ED-initiated buprenorphine implementation studies have been conducted in urban settings, with few involving rural areas and none have been done in the rural Mountain West. Rural EDs face unique barriers, but tailored implementation strategies with external facilitation support may help address these. This protocol could help identify effective rural ED-initiated buprenorphine implementation strategies to integrate more accessible OUD treatment within rural communities to prevent further morbidity and mortality. TRIAL REGISTRATION ClinicalTrials.gov National Clinical Trials, NCT06087991. Registered 11 October 2023 - Retrospectively registered, https://clinicaltrials.gov/study/NCT06087991 .
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Affiliation(s)
- Natasha Seliski
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Suite A, Salt Lake City, UT, 84108, USA.
| | - Troy Madsen
- Department of Emergency Medicine, University of Utah School of Medicine, 50 N. Medical Drive, Salt Lake City, UT, 84132, USA
- Wound Care and Hyperbaric Medicine, St. Mark's Hospital, 1200 East 3900 South #G175, Salt Lake City, UT, 8412, USA
| | - Savannah Eley
- Castleview Hospital, 300 N Hospital Drive, Price, UT, 84501, USA
| | | | - Travis Engar
- Castleview Hospital, 300 N Hospital Drive, Price, UT, 84501, USA
| | - Adam Gordon
- Clinical Care, Knowledge, and Advocacy, Department of Internal Medicine, Program for Addiction Research, University of Utah School of Medicine, 30 North Mario Capecchi Drive, 3rd Floor North, Salt Lake City, UT, 84112, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | | | - Grace Humiston
- Clinical Care, Knowledge, and Advocacy, Department of Internal Medicine, Program for Addiction Research, University of Utah School of Medicine, 30 North Mario Capecchi Drive, 3rd Floor North, Salt Lake City, UT, 84112, USA
| | - Taylor Morsillo
- Utah Department of Health and Human Services, 195 North, West, Salt Lake City, UT, 1950, 84116, USA
| | - Laura Stolebarger
- Clinical Care, Knowledge, and Advocacy, Department of Internal Medicine, Program for Addiction Research, University of Utah School of Medicine, 30 North Mario Capecchi Drive, 3rd Floor North, Salt Lake City, UT, 84112, USA
| | - Marcela C Smid
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, School of Medicine, University of Utah Health, 30 North 1900 East #2B200, Salt Lake City, UT, 84132, USA
| | - Gerald Cochran
- Clinical Care, Knowledge, and Advocacy, Department of Internal Medicine, Program for Addiction Research, University of Utah School of Medicine, 30 North Mario Capecchi Drive, 3rd Floor North, Salt Lake City, UT, 84112, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
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Lin CH, Siao SF, Lin PY, Shelley M, Chi YC, Lee YH. Understanding Healthcare Providers' Care for Patients with Medications Treating Opioid Use Disorder in the Emergency Department: A Scoping Review. Subst Use Misuse 2024; 59:622-637. [PMID: 38115559 DOI: 10.1080/10826084.2023.2294964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND There is limited research exploring the changing clinical practices among healthcare providers (HPs) care for patients with Emergency Department (ED)-initiated Medication for Opioid Use Disorder (MOUD). METHODS This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus for related studies from inception through October 12, 2022. Following the application of inclusion and exclusion criteria, 16 studies were included. Subsequently, they were charted and analyzed thematically based on ecological systems theory. RESULTS The main determinants in the four ecological systems were generated as follows: (1) microsystem: willingness and attitude, professional competence, readiness, and preference; (2) mesosystem: ED clinical practices, departmental factors; (3) exosystem: multidisciplinary approaches, discharge planning, and (4) macrosystem: stigma, health insurance, policy. The findings have implications for HPs and researchers, as insufficient adoption, implementation, and retention of MOUD in the ED affect clinical practices. CONCLUSIONS Across the four ecological systems, ED-initiated MOUD is shaped by multifaceted determinants. The microsystem underscores pivotal patient-HP trust dynamics, while the mesosystem emphasizes interdepartmental synergies. Exosystemically, resource allocation and standardized training remain paramount. The macrosystem reveals profound effects of stigma, insurance disparities, and evolving policies on treatment access and efficacy. Addressing these interconnected barriers is crucial for optimizing patient outcomes in the context of MOUD.
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Affiliation(s)
- Chia-Hung Lin
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Fen Siao
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Ying Lin
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mack Shelley
- Department of Political Science, Department of Statistics, Iowa State University, Ames, IA, USA
| | - Yu-Chi Chi
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Han Lee
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
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Perlmutter D, Wettemann C, Fockele CE, Frohe T, Williams W, Holland N, Oliphant-Wells T, Meischke H, van Draanen J. "Another tool in the toolkit"-Perceptions, suggestions, and concerns of emergency service providers about the implementation of a supervised consumption site. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104005. [PMID: 36972652 PMCID: PMC10164065 DOI: 10.1016/j.drugpo.2023.104005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/17/2023] [Accepted: 03/11/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND As Supervised Consumption Sites (SCS) are implemented in the United States, it is important to consider the needs and perceptions of impacted stakeholders. Emergency service providers (ESP) have a central role in responding to the overdose epidemic. This study intended to assess the how ESP perceive the potential implementation of an SCS in their community, as well as solicit program design and implementation-related concerns and suggestions. METHODS In-depth interviews were conducted by videoconference with 22 ESP, including firefighters, paramedics, police, and social workers in King County, Washington, USA. Data were analyzed using a thematic analysis approach. RESULTS Participants expressed the importance of feeling safe while responding to calls where drug use is involved and highlighted how this perception would be linked to ESP response times to calls from an SCS. Suggestions for improving the perceived safety of an SCS included training program staff in de-escalation as well as planning the layout of the SCS to accommodate ESP. The inadequacy of the emergency department as a point of care for PWUD was also identified as a theme, and some participants expressed enthusiasm regarding the prospect of the SCS as an alternative destination for transport. Finally, support for the SCS model was conditional on the appropriate utilization of emergency services and a reduction in call volume. Participants listed clarifying roles and pursuing opportunities for collaboration as ways to ensure appropriate utilization and maintain positive working relationships. CONCLUSION This study builds on literature regarding stakeholder perceptions of SCS by focusing on the perceptions of a critically important stakeholder group. Results enhance understanding of what motivates ESP to support SCS implementation in their community. Other novel insights pertain to ESP thoughts about alternative care delivery models and strategies for emergency department visit diversion.
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Affiliation(s)
- David Perlmutter
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Fourth Floor, 98195 Seattle, WA, USA
| | - Courteney Wettemann
- Research with Expert Advisors on Drug Use, University of Washington, Seattle, WA, USA
| | | | - Tessa Frohe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Will Williams
- Research with Expert Advisors on Drug Use, University of Washington, Seattle, WA, USA
| | - Nathan Holland
- Research with Expert Advisors on Drug Use, University of Washington, Seattle, WA, USA
| | | | - Hendrika Meischke
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Fourth Floor, 98195 Seattle, WA, USA
| | - Jenna van Draanen
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Fourth Floor, 98195 Seattle, WA, USA; Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, USA.
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Chambers LC, Hallowell BD, Samuels EA, Daly M, Baird J, Beaudoin FL. Evaluation of a Statewide Policy to Improve Post-Overdose Care in Emergency Departments and Subsequent Treatment Engagement. RHODE ISLAND MEDICAL JOURNAL (2013) 2023; 106:34-39. [PMID: 36848541 PMCID: PMC11457868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To evaluate the impact of a statewide treatment standards policy for post-overdose emergency department (ED) care on services provided and subsequent treatment engagement. METHODS This pre-/post-study used electronic health record data and surveillance data from Rhode Island. Outcomes were compared for patients attending EDs for opioid overdose before (03/1/2015-02/28/2017) and after (04/01/2017-03/31/2021) policy release. RESULTS Overall, 2,134 patients attended 2,891 ED visits for opioid overdose. Compared to pre-policy, visits post-policy more often included initiation of buprenorphine in or from the ED (<1% vs. 3%, p<0.01), provision of a take-home naloxone kit or prescription (41% vs. 58%, p<0.01), and referral to treatment (0% vs. 34%, p<0.01). Provision of behavioral counseling in the ED and initiation of treatment within 30 days of the visit were similar during the two periods. CONCLUSIONS Statewide post-overdose treatment standards may improve provision of some ED services. Additional strategies are needed to improve subsequent treatment engagement.
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Affiliation(s)
- Laura C Chambers
- Lead Research Scientist and Assistant Professor of the Practice of Epidemiology in the Department of Epidemiology at Brown University in Providence, Rhode Island
| | - Benjamin D Hallowell
- Program Manager of the Substance Use Epidemiology Program at the Rhode Island Department of Health in Providence, Rhode Island
| | - Elizabeth A Samuels
- Assistant Professor in the Departments of Epidemiology and Emergency Medicine at Brown University and an Assistant Medical Director for the Drug Overdose Prevention Program at the Rhode Island Department of Health in Providence, Rhode Islan
| | - Mackenzie Daly
- Chief Health Program Evaluator in the Research, Data Evaluation, and Compliance Unit at the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals in Providence, Rhode Island
| | - Janette Baird
- Assistant Professor of Research in the Department of Emergency Medicine at Brown University in Providence, Rhode Island
| | - Francesca L Beaudoin
- Associate Professor and Interim Chair of the Department of Epidemiology, as well as an Associate Professor of Emergency Medicine and Health Services, Policy, and Practice, at Brown University in Providence, Rhode Island
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