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Jack HE, Arif SA, Moore MA, Bhatraju EP, Thompson JL, Stewart MT, Hawk KF, Bartlett E. Peer support for patients with opioid use disorder in the emergency department: A narrative review. J Am Coll Emerg Physicians Open 2024; 5:e13253. [PMID: 39144727 PMCID: PMC11322658 DOI: 10.1002/emp2.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
Faced with a growing opioid overdose crisis, emergency departments (EDs) are increasingly hiring peers-people with lived experiences of addiction and recovery-to work with patients in the ED who have opioid use disorders (OUDs) or who have experienced an opioid overdose. Despite a clear need for more support for patients with OUD and rapid expansion in grant funding for peer programs, there are limited data on how these programs affect clinical outcomes and how they are best implemented within the ED. In this narrative review, we synthesize the existing evidence on how to develop and implement peer programs for OUD in the ED setting. We describe the key activities peers can undertake in the ED, outline requirements of the peer role and best practices for peer supervision and hiring, detail how ED administrators have built financial and political support for peer programs, and summarize the limited evidence on clinical and care linkage outcomes of peer programs. We highlight key resources that ED clinicians and administrators can use to develop peer programs and key areas where additional research is needed.
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Affiliation(s)
- Helen E. Jack
- Division of General Internal MedicineDepartment of MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Shaheer A. Arif
- College of Arts and SciencesUniversity of WashingtonSeattleWashingtonUSA
| | - Michael A. Moore
- Division of General Internal MedicineDepartment of MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Elenore P. Bhatraju
- Division of General Internal MedicineDepartment of MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Jennifer L. Thompson
- Department of Emergency MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Maureen T. Stewart
- Institute for Behavioral HealthThe Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
| | - Kathryn F. Hawk
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Emily Bartlett
- Department of Emergency MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA
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Forsgren E, Steiger A, Perez Y, Salazar D, McCollough M, Taira BR. Patient perspectives on emergency department initiation of medication for alcohol use disorder. Acad Emerg Med 2024; 31:471-480. [PMID: 37326129 DOI: 10.1111/acem.14758] [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: 03/17/2023] [Revised: 05/17/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Alcohol use disorder (AUD) is a leading cause of preventable death and is a frequent diagnosis in the emergency department (ED). Treatment in the ED, however, typically focuses on managing the sequelae of AUD, such as acute withdrawal, rather than addressing the underlying addiction. For many patients, these ED encounters are a missed opportunity to connect with medication for AUD. In 2020, our ED created a pathway to offer patients with AUD treatment with naltrexone (NTX) during their ED visit. The aim of this study was to identify what barriers and facilitators patients perceive to NTX initiation in the ED. METHODS Adopting the theoretical framework of the behavior change wheel (BCW), we conducted qualitative interviews with patients to elicit their perspectives on ED initiation of NTX. Interviews were coded and analyzed using both inductive and deductive approaches. Themes were categorized according to patients' capabilities, opportunities, and motivations. Barriers were then mapped through the BCW to design interventions that will improve our treatment pathway. RESULTS Twenty-eight patients with AUD were interviewed. Facilitators of accepting NTX included having recently experienced sequelae of AUD, rapid management of withdrawal symptoms by the ED provider, having a choice between intramuscular and oral formulations of the medication, and experiencing positive interactions in the ED that destigmatized the patient's AUD. Barriers to accepting treatment included lack of provider knowledge about NTX, dependence on alcohol as self-treatment for psychiatric trauma and physical pain, perceived discriminatory treatment and stigma about AUD, aversion to potential side effects, and lack of access to continued treatment. CONCLUSIONS Initiation of treatment of AUD with NTX in the ED is acceptable to patients and can be facilitated by knowledgeable ED providers who create a destigmatizing environment, effectively manage withdrawal symptoms, and connect patients to providers who will continue treatment.
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Affiliation(s)
- Ethan Forsgren
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Athreya Steiger
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yesenia Perez
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - David Salazar
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Maureen McCollough
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Breena R Taira
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Blum K, Braverman ER, Gold MS, Dennen CA, Baron D, Thanos PK, Hanna C, Elman I, Gondre-Lewis MC, Ashford JW, Newberg A, Madigan MA, Jafari N, Zeine F, Sunder K, Giordano J, Barh D, Gupta A, Carney P, Bowirrat A, Badgaiyan RD. Addressing cortex dysregulation in youth through brain health check coaching and prophylactic brain development. INNOSC THERANOSTICS & PHARMACOLOGICAL SCIENCES 2024; 7:1472. [PMID: 38766548 PMCID: PMC11100020 DOI: 10.36922/itps.1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The Carter Center has estimated that the addiction crisis in the United States (US), if continues to worsen at the same rate, may cost the country approximately 16 trillion dollars by 2030. In recent years, the well-being of youth has been compromised by not only the coronavirus disease 2019 pandemic but also the alarming global opioid crisis, particularly in the US. Each year, deadly opioid drugs claim hundreds of thousands of lives, contributing to an ever-rising death toll. In addition, maternal usage of opioids and other drugs during pregnancy could compromise the neurodevelopment of children. A high rate of DNA polymorphic antecedents compounds the occurrence of epigenetic insults involving methylation of specific essential genes related to normal brain function. These genetic antecedent insults affect healthy DNA and mRNA transcription, leading to a loss of proteins required for normal brain development and function in youth. Myelination in the frontal cortex, a process known to extend until the late 20s, delays the development of proficient executive function and decision-making abilities. Understanding this delay in brain development, along with the presence of potential high-risk antecedent polymorphic variants or alleles and generational epigenetics, provides a clear rationale for embracing the Brain Research Commission's suggestion to mimic fitness programs with an adaptable brain health check (BHC). Implementing the BHC within the educational systems in the US and other countries could serve as an effective initiative for proactive therapies aimed at reducing juvenile mental health problems and eventually criminal activities, addiction, and other behaviors associated with reward deficiency syndrome.
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Affiliation(s)
- Kenneth Blum
- Division of Addiction Research and Education, Center for Sports, Exercise and Global Mental Health, Western University of Health Sciences, Pomona, California, United States of America
- The Kenneth Blum Behavioral and Neurogenetic Institute LLC, Austin, Texas, United States of America
- Faculty of Education and Psychology, Institute of Psychology, Eötvös Loránd University Budapest, Budapest, Hungary
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel
- Division of Personalized Medicine, Cross-Cultural Research and Educational Institute, San Clemente, California, United States of America
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology, Purba Medinipur, West Bengal, India
- Division of Personalized Recovery Science, Transplicegen Therapeutics, Llc., Austin, Tx., United of States
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, United States of America
- Division of Personalized Medicine, Ketamine Clinic of South Florida, Pompano Beach, Florida, United States of America
| | - Eric R. Braverman
- The Kenneth Blum Behavioral and Neurogenetic Institute LLC, Austin, Texas, United States of America
| | - Mark S. Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Catherine A. Dennen
- Department of Family Medicine, Jefferson Health Northeast, Philadelphia, Pennsylvania, United States of America
| | - David Baron
- Division of Addiction Research and Education, Center for Sports, Exercise and Global Mental Health, Western University of Health Sciences, Pomona, California, United States of America
| | - Panayotis K. Thanos
- Department of Psychology and Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, University of Buffalo, Buffalo, New York, United States of America
| | - Colin Hanna
- Department of Psychology and Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, University of Buffalo, Buffalo, New York, United States of America
| | - Igor Elman
- Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Marjorie C. Gondre-Lewis
- Department of Anatomy, Howard University School of Medicine, Washington, D.C., United States of America
| | - J. Wesson Ashford
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, United States of America
| | - Andrew Newberg
- Department of Integrative Medicine and Nutritional Sciences, Thomas Jefferson University and Hospital, Philadelphia, Pennsylvania, United States of America
| | - Margaret A. Madigan
- The Kenneth Blum Behavioral and Neurogenetic Institute LLC, Austin, Texas, United States of America
| | - Nicole Jafari
- Division of Personalized Medicine, Cross-Cultural Research and Educational Institute, San Clemente, California, United States of America
- Department of Human Development, California State University at Long Beach, Long Beach, California, United States of America
| | - Foojan Zeine
- Department of Human Development, California State University at Long Beach, Long Beach, California, United States of America
- Awareness Integration Institute, San Clemente, California, United States of America
| | - Keerthy Sunder
- Department of Health Science, California State University at Long Beach, Long Beach, California, United States of America
- Department of Psychiatry, University California, UC Riverside School of Medicine, Riverside, California, United States of America
| | - John Giordano
- Division of Personalized Medicine, Ketamine Clinic of South Florida, Pompano Beach, Florida, United States of America
| | - Debmayla Barh
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology, Purba Medinipur, West Bengal, India
| | - Ashim Gupta
- Future Biologics, Lawrenceville, Georgia, United States of America
| | - Paul Carney
- Division of Pediatric Neurology, University of Missouri Health Care-Columbia, Columbia, Missouri, United States of America
| | - Abdalla Bowirrat
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Rajendra D. Badgaiyan
- Department of Psychiatry, Mt. Sinai School of Medicine, New York City, New York, United States of America
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Avalone L, Lalane M, King C, Pfeiffer K, Linn-Walton R, Barron C. Integrating substance use peer support and screening brief intervention and referral to treatment services in the emergency department: a descriptive study of the ED leads program. Addict Sci Clin Pract 2024; 19:15. [PMID: 38419101 PMCID: PMC10902983 DOI: 10.1186/s13722-024-00445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The ED Leads program was introduced to 11 emergency departments (EDs) within New York City public hospitals from 2018 to 2019 to address a need for addiction support services in the ED. The purpose of this study is to (i) describe the ED Leads blended licensed-clinician and peer counselor team model in the ED at three hospitals, (ii) provide a descriptive analysis of patient engagement and referrals to substance use disorder (SUD) care post-intervention, and (iii) highlight potential barriers and facilitators to implementing the model. METHODS The program intended to combine Screening Brief Intervention and Referral to Treatment and peer support services. The authors analyzed electronic medical records data for patients encountered by ED Leads in the first 120 days of program launch. Data included the outcome of an encounter when a patient was engaged with one or both staff types, and 7-day attendance at an SUD treatment appointment when a patient accepted a referral within the 11-hospital system. RESULTS There were 1785 patients approached by ED Leads staff during the study period. Engagement differed by staff type and patient demographics, and encounter outcomes varied significantly by hospital. Eighty-four percent (N = 1503) of patients who were approached engaged with at least one staff type, and 6% (N = 86) engaged with both. Patients were predominantly male (N = 1438, 81%) with an average age of 45 (SD = 13), and enrolled in Medicaid (N = 1062, 59%). A majority (N = 801, 45%) had alcohol use disorder. Of the patients who accepted a referral within the system (N = 433), 63% received treatment services within 7 days of the ED Leads encounter, a majority at detoxification treatment (N = 252, 58%). CONCLUSIONS This study describes the potential value and challenges of implementing a blended peer counselor and licensed clinician model in the ED to provide SUD services. While teams provided a high volume of referrals and the analysis of post-intervention treatment follow up is promising, the blended team model was not fully realized, making it difficult to assess the benefits of this combined service. Further research might examine patient outcomes among ED patients who are offered services by both a peer counselor and licensed clinician.
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Affiliation(s)
- Lynsey Avalone
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA.
| | - Monique Lalane
- NYC Health + Hospitals/Bellevue, 462 1st Avenue, New York City, NY, 10016, USA
| | - Carla King
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA
| | - Kayna Pfeiffer
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA
| | - Rebecca Linn-Walton
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA
| | - Charles Barron
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA
- Mt. Sinai Ichan School of Medicine, 1 Gustave L. Levy Pl, New York City, NY, 10029, USA
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Bhondoekhan F, Li Y, Gaither R, Daly MM, Hallowell BD, Chambers LC, Beaudoin FL, Marshall BD. The impact of polysubstance use patterns on engagement of substance use disorder treatment among emergency department patients at high risk of opioid overdose. Addict Behav Rep 2023; 18:100512. [PMID: 37636893 PMCID: PMC10450842 DOI: 10.1016/j.abrep.2023.100512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/30/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
Background Substance use patterns are diverse, and multiple substances are often involved in fatal and nonfatal overdoses. Additionally, polysubstance use is associated with greater difficulty accessing and remaining in substance use disorder (SUD) treatment. The aim of this study was to identify substance use patterns and determine their association with SUD treatment engagement among emergency department (ED) patients at risk of opioid overdose. Methods This was a sub-analysis of a randomized controlled trial comparing two behavioral interventions for individuals at two EDs in Rhode Island from 2018 to 2021. Past six-month substance use frequency for eight substances plus injection drug use was self-reported at trial enrollment, and SUD treatment engagement within 90 days after enrollment was obtained using administrative data linkages. Latent class analysis identified substance use patterns and multivariable log-binomial models estimated the association with SUD treatment engagement. Results Among 607 participants, there were four substance use patterns: 1) low reported use (n = 295), 2) frequent injection and heroin use (n = 131), 3) high frequency broad polysubstance use (n = 62), and 4) low frequency broad polysubstance use (n = 119). Compared to participants with the low reported use pattern, those with the frequent injection and heroin pattern had a greater likelihood of SUD treatment engagement (adjusted risk ratio = 1.28; 95% confidence interval = 1.02-1.61). Conclusions Distinct and meaningful polysubstance use patterns showed differential SUD treatment engagement after ED discharge. Nuanced relationships between substance use patterns and treatment highlight the necessity for tailored harm reduction, treatment, and recovery services.
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Affiliation(s)
- Fiona Bhondoekhan
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Yu Li
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Rachel Gaither
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Mackenzie M. Daly
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, 14 Harrington Rd, Cranston, RI 02920, USA
| | | | - Laura C. Chambers
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Francesca L. Beaudoin
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Brandon D.L. Marshall
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
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Audet CM, Pettapiece-Phillips M, Kast K, White KD, Perkins JM, Marcovitz D. Implementation of a hospital-based intervention for MOUD initiation and referral to a Bridge Clinic for opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208961. [PMID: 36880904 PMCID: PMC10018480 DOI: 10.1016/j.josat.2023.208961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/06/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Individuals struggling with opioid use disorder (OUD) utilize the adult emergency department (ED) and psychiatric emergency department at high rates. In 2019, Vanderbilt University Medical Center created a system for individuals identified in the emergency department with OUD to transition care to a Bridge Clinic for up to three months of comprehensive behavioral health treatment, alongside primary care, infectious diseases, and pain management, regardless of their insurance status. METHODS We conducted 20 interviews with patients enrolled in treatment in our Bridge Clinic and 13 providers in the psychiatric emergency department and emergency department. Our provider interviews focused on understanding experiences identifying people with OUD and referring them to care at the Bridge Clinic. Our patient interviews focused on understanding their experiences of care-seeking, the referral process, and their satisfaction with treatment at the Bridge Clinic. RESULTS Our analysis generated 3 major themes around patient identification, referral, and quality of care from providers and patients. The study found general agreement between both groups around the high quality of care delivered in the Bridge Clinic compared with OUD treatment at nearby treatment facilities, specifically because it offered a stigma-free environment for the delivery of medication for addiction therapy and psychosocial support. Providers highlighted the lack of a systematic strategy for identifying people with OUD in an ED setting. They also found the referral process cumbersome because it could not be done through EPIC and there were limited patient slots available. In contrast, patients reported a smooth and simple referral from the ED to the Bridge Clinic. CONCLUSIONS Creating a Bridge Clinic for comprehensive OUD treatment at a large university medical center has been challenging but has resulted in the creation of a comprehensive care system that prioritizes quality care. Funding to increase the number of patient slots available, coupled with an electronic system of patient referral, will increase the reach of the program to some of Nashville's most vulnerable constituents.
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Affiliation(s)
- Carolyn M Audet
- Department of Health Policy, Vanderbilt University, Nashville, TN 37203, USA.
| | | | - Kristopher Kast
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Katie D White
- Department Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Jessica M Perkins
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN 37203, USA.
| | - David Marcovitz
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Wilson MP, Hamrick E, Stiebel V, Nordstrom K. Contemporary Practices for Medical Evaluation of the Psychiatric Patient in the Emergency Department. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:28-34. [PMID: 37205042 PMCID: PMC10172537 DOI: 10.1176/appi.focus.20220063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Although emergency department (ED) visits for patients with mental illness are frequent, medical evaluation (i.e., "medical screening") of patients presenting with psychiatric complaints is inconsistent. This may largely be related to differing goals for medical screening, which often vary according to specialty. Although emergency physicians typically focus on stabilization of life-threatening diseases, psychiatrists tend to believe that care in the ED is more comprehensive, which often places the two fields at odds. The authors discuss the concept of medical screening, review the literature on this topic, and offer a clinically oriented update to the 2017 American Association for Emergency Psychiatry consensus guidelines on medical evaluation of the adult psychiatric patient in the ED.
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Affiliation(s)
- Michael P Wilson
- Department of Emergency Medicine and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Wilson); Department of Psychiatry (Hamrick, Stiebel) and Department of Emergency Medicine (Stiebel), West Virginia University, Morgantown; Department of Psychiatry, University of Colorado Denver, Denver (Nordstrom)
| | - Edward Hamrick
- Department of Emergency Medicine and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Wilson); Department of Psychiatry (Hamrick, Stiebel) and Department of Emergency Medicine (Stiebel), West Virginia University, Morgantown; Department of Psychiatry, University of Colorado Denver, Denver (Nordstrom)
| | - Victor Stiebel
- Department of Emergency Medicine and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Wilson); Department of Psychiatry (Hamrick, Stiebel) and Department of Emergency Medicine (Stiebel), West Virginia University, Morgantown; Department of Psychiatry, University of Colorado Denver, Denver (Nordstrom)
| | - Kimberly Nordstrom
- Department of Emergency Medicine and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Wilson); Department of Psychiatry (Hamrick, Stiebel) and Department of Emergency Medicine (Stiebel), West Virginia University, Morgantown; Department of Psychiatry, University of Colorado Denver, Denver (Nordstrom)
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Crilly J, Huang Y, Krahe M, Wilhelms D, Ekelund U, Hörlin E, Hayes J, Keijzers G. Research priority setting in emergency care: A scoping review. J Am Coll Emerg Physicians Open 2022; 3:e12852. [PMID: 36518881 PMCID: PMC9742830 DOI: 10.1002/emp2.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/13/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022] Open
Abstract
Objective Priority areas for emergency care research are emerging and becoming ever more important. The objectives of this scoping review were to (1) provide a comprehensive overview of published emergency care priority-setting studies by collating and comparing priority-setting methodology and (2) describe the resulting research priorities identified. Methods The Joanna Briggs Institute methodological framework was used. Inclusion criteria were peer-review articles available in English, published between January 1, 2008 and March 31, 2019 and used 2 or more search terms. Five databases (Scopus, AustHealth, EMBASE, CINAHL, and Ovid MEDLINE) were searched. REporting guideline for PRIority SEtting of health research (REPRISE) criteria were used to assess the quality of evidence of included articles. Results Forty-five studies were included. Fourteen themes for emergency care research were considered within 3 overarching research domains: emergency populations (pediatrics, geriatrics), emergency care workforce and processes (nursing, shared decision making, general workforce, and process), and emergency care clinical areas (imaging, falls, pain management, trauma care, substance misuse, infectious diseases, mental health, cardiology, general clinical care). Variation in the reporting of research priority areas was evident. Priority areas to drive the global agenda for emergency care research are limited given the country and professional group-specific context of existing studies. Conclusion This comprehensive summary of generated research priorities across emergency care provides insight into current and future research agendas. With the nature of emergency care being inherently broad, future priorities may warrant population (eg, children, geriatrics) or subspecialty (eg, trauma, toxicology, mental health) focus and be derived using a rigorous framework and patient engagement.
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Affiliation(s)
- Julia Crilly
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia
- School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Ya‐Ling Huang
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia
- School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
- Faculty of Health (Nursing)Southern Cross UniversityQueenslandGold CoastAustralia
| | - Michelle Krahe
- Office of the Pro Vice Chancellor (Indigenous)Griffith UniversityMeadowbrookQueenslandAustralia
| | - Daniel Wilhelms
- Department of Emergency MedicineLocal Health Care ServicesCentral ÖstergötlandLinköpingSweden
- Department of Biomedical and Clinical SciencesLinköping UniversitySweden
| | - Ulf Ekelund
- Department of Clinical SciencesFaculty of MedicineLund UniversityLundSweden
| | - Erika Hörlin
- Department of Emergency MedicineLocal Health Care ServicesCentral ÖstergötlandLinköpingSweden
- Department of Biomedical and Clinical SciencesLinköping UniversitySweden
| | - Jessica Hayes
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia
- School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
| | - Gerben Keijzers
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
- School of MedicineGriffith UniversityGold CoastQueenslandAustralia
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O’Grady MA, Kapoor S, Harrison L, Kwon N, Suleiman AO, Muench FJ. Implementing a text-messaging intervention for unhealthy alcohol use in emergency departments: protocol for implementation strategy development and a pilot cluster randomized implementation trial. Implement Sci Commun 2022; 3:86. [PMID: 35933560 PMCID: PMC9356403 DOI: 10.1186/s43058-022-00333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/25/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Unhealthy alcohol use (UAU) is a leading cause of premature mortality among adults in the USA. Emergency departments (EDs) are key intervention settings for UAU but often have limited time and resources. One low-burden, scalable approach to address UAU is text-messaging interventions. Despite strong research support and promise for scalability, there is little research on how to implement such interventions in healthcare settings. The process of providers making them available to patients in an efficient way within already busy and overburdened ED workflows and patients adopting them remains a new area of research. The purpose of this three-phase study is to develop and test an implementation strategy for UAU text-messaging interventions in EDs. METHOD Our first aim is to examine barriers and facilitators to staff offering and patients accepting a text-messaging intervention in the ED using an explanatory, sequential mixed methods approach. We will examine alcohol screening data in the electronic health records of 17 EDs within a large integrated health system in the Northeast and conduct surveys among chairpersons in each. This data will be used to purposively sample 4 EDs for semi-structured interviews among 20 clinical staff, 20 patients, and 4 chairpersons. Our second aim is to conduct a stakeholder-engaged intervention mapping process to develop a multi-component implementation strategy for EDs. Our third aim is to conduct a mixed method 2-arm cluster randomized pilot study in 4 EDs that serve ~11,000 UAU patients per year to assess the feasibility, acceptability, and preliminary effectiveness of the implementation strategy. The Integrated Promoting Action on Research Implementation in Health Services framework will guide study activities. DISCUSSION Low-burden technology, like text messaging, along with targeted implementation support and strategies driven by identified barriers and facilitators could sustain large-scale ED-based alcohol screening programs and provide much needed support to patients who screen positive while reducing burden on EDs. The proposed study would be the first to develop and test this targeted implementation strategy and will prepare for a larger, fully powered hybrid effectiveness-implementation trial. Findings may also be broadly applicable to implementation of patient-facing mobile health technologies. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov (NCT05350878) on 4/28/2022.
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Affiliation(s)
- Megan A. O’Grady
- grid.208078.50000000419370394Department of Public Health Sciences, School of Medicine, University of Connecticut, 263 Farmington Ave, Farmington, CT 06030-6325 USA
| | - Sandeep Kapoor
- grid.416477.70000 0001 2168 3646Northwell Health, 350 Community Drive, Manhasset, NY 11030 USA ,grid.512756.20000 0004 0370 4759Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549 USA
| | - Laura Harrison
- grid.416477.70000 0001 2168 3646Northwell Health, 350 Community Drive, Manhasset, NY 11030 USA
| | - Nancy Kwon
- grid.416477.70000 0001 2168 3646Northwell Health, 350 Community Drive, Manhasset, NY 11030 USA ,grid.512756.20000 0004 0370 4759Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549 USA
| | - Adekemi O. Suleiman
- grid.208078.50000000419370394Department of Public Health Sciences, School of Medicine, University of Connecticut, 263 Farmington Ave, Farmington, CT 06030-6325 USA
| | - Frederick J. Muench
- grid.475801.fPartnership to End Addiction, 711 Third Avenue, 5th Floor, Suite 500, New York, NY 10017 USA
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10
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Philippine T, Forsgren E, DeWitt C, Carter I, McCollough M, Taira BR. Provider perspectives on emergency department initiation of medication assisted treatment for alcohol use disorder. BMC Health Serv Res 2022; 22:456. [PMID: 35392901 PMCID: PMC8988541 DOI: 10.1186/s12913-022-07862-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Alcohol use disorder (AUD) is ubiquitous and its sequelae contribute to high levels of healthcare utilization, yet AUD remains undertreated. The ED encounter represents a missed opportunity to initiate medication assisted treatment (MAT) for patients with AUD. The aims of this study are to identify barriers and facilitators to the treatment of AUD in the ED, and to design interventions to address identified barriers. Methods Using an implementation science approach based on the Behavior Change Wheel framework, we conducted qualitative interviews with staff to interrogate their perspectives on ED initiation of AUD treatment. Subjects included physicians, nurses, nurse practitioners, clinical social workers, and pharmacists. Interviews were thematically coded using both inductive and deductive approaches and constant comparative analysis. Themes were further categorized as relating to providers’ capabilities, opportunities, or motivations. Barriers were then mapped to corresponding intervention functions. Results Facilitators at our institution included time allotted for continuing education, the availability of clinical social workers, and favorable opinions of MAT based on previous experiences implementing buprenorphine for opioid use disorder. Capability barriers included limited familiarity with naltrexone and difficulty determining which patients are candidates for therapy. Opportunity barriers included the limited supply of naltrexone and a lack of clarity as to who should introduce naltrexone and assess readiness for change. Motivation barriers included a sense of futility in treating patients with AUD and stigmas associated with alcohol use. Evidence-based interventions included multi-modal provider education, a standardized treatment algorithm and order set, selection of clinical champions, and clarification of roles among providers on the team. Conclusions A large evidence-practice gap exists for the treatment of AUD with Naltrexone, and the ED visit is a missed opportunity for intervention. ED providers are optimistic about implementing AUD treatment in the ED but described many barriers, especially related to knowledge, clarification of roles, and stigma associated with AUD. Applying a formal implementation science approach guided by the Behavior Change Wheel allowed us to transform qualitative interview data into evidence-based interventions for the implementation of an ED-based program for the treatment of AUD. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07862-1.
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Affiliation(s)
| | - Ethan Forsgren
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
| | | | - Inanna Carter
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Maureen McCollough
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Breena R Taira
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
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11
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Molteni L, Cafaro R, Varinelli A, Espa I, Mora Conde M, Maria Brambilla A, Viganò C, Dell'Osso B. Do adolescents and young adults accessing the Emergency Room with substance use receive poor therapeutic indications at discharge? An observational retrospective study. Int J Clin Pract 2021; 75:e14890. [PMID: 34538005 DOI: 10.1111/ijcp.14890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Emergency rooms (ERs) are usually the first point of contact with mental health services for adolescents with Substance Use Disorders (SUDs). However, only a minority of them receives proper treatment and follow-up indications, increasing the risk of relapses and poor prognosis. In this perspective, we sought to characterize and compare socio-demographic and clinical characteristics of adolescents with vs without SUDs accessing the ER, assessing potential differences in terms of discharge instructions. METHODS A sample of 557 ER accesses of patients aged 15-25 years old in need of a psychiatric evaluation or with a psychiatric diagnosis at discharge was retrospectively analyzed. Patients were divided in two subgroups according to the presence of SUDs. RESULTS About 32.1% of patients had SUDs when accessing the ER. Among these, 62% were unknown to any psychiatric services and 57% were at their psychiatric onset. Nevertheless, considering discharge instructions, patients with current substance use received less therapeutic indication or were less frequently referred to psychiatric facilities, than those without substance use (57.8% vs 42.2%, P = .002). CONCLUSIONS Substance abuse is strongly linked to psychopathology and ER accesses in young patients. However, we observed a large rate of SUDs patients unknown by any specialized mental health service, who received poor therapeutic and follow-up instructions at discharge. Improving communication between ER operators and young patients with SUDs could longitudinally reduce the risk of addiction and related disability, morbidity and mortality.
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Affiliation(s)
- Laura Molteni
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Rita Cafaro
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Alberto Varinelli
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Irene Espa
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | | | - Anna Maria Brambilla
- Department of Emergency, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Caterina Viganò
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, CA, USA
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
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12
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Porturas T, Taylor RA. Forty years of emergency medicine research: Uncovering research themes and trends through topic modeling. Am J Emerg Med 2020; 45:213-220. [PMID: 33059985 DOI: 10.1016/j.ajem.2020.08.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022] Open
Abstract
STUDY OBJECTIVE Topic identification can facilitate knowledge curation, discover thematic relationships, trends, and predict future direction. We aimed to determine through an unsupervised, machine learning approach to topic modeling the most common research themes in emergency medicine over the last 40 years and summarize their trends and characteristics. METHODS We retrieved the complete reference entries including article abstracts from Ovid for all original research articles from 1980 to 2019 within emergency medicine for six widely-cited journals. Abstracts were processed through a natural language pipeline and analyzed by a latent Dirichlet allocation topic modeling algorithm for unsupervised topic discovery. Topics were further examined through trend analysis, word associations, co-occurrence metrics, and two-dimensional embeddings. RESULTS We retrieved 47,158 articles during the defined time period that were filtered to 20,528 articles for further analysis. Forty topics covering methodologic and clinical areas were discovered. These topics separated into distinct clusters when embedded in two-dimensional space and exhibited consistent patterns of interaction. We observed the greatest increase in popularity in research themes involving risk factors (0.4% to 5.2%), health utilization (1.2% to 5.0%), and ultrasound (0.7% to 3.3%), and a relative decline in research involving basic science (8.9% to 1.1%), cardiac arrest (6.5% to 2.2%), and vitals (6.3% to 1.3%) over the past 40 years. Our data show only very modest growth in mental health and substance abuse research (1.0% to 1.6%), despite ongoing crises. CONCLUSIONS Topic modeling via unsupervised machine learning applied to emergency medicine abstracts discovered coherent topics, trends, and patterns of interaction.
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Affiliation(s)
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale University School of Medicine, United States.
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13
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Joseph JW, Marshall KD, Reich BE, Boyle KL, Hill KP, Weiner SG, Derse AR. How Emergency Physicians Approach Refusal of Observation after Naloxone Resuscitation. J Emerg Med 2020; 58:148-159. [PMID: 31753755 DOI: 10.1016/j.jemermed.2019.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/03/2019] [Accepted: 09/13/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients who are resuscitated with naloxone frequently refuse a period of observation, even though they may be suffering from a variety of medical and psychiatric comorbidities. Emergency physicians (EPs) are then confronted with the challenge of how best to serve patients' interests while respecting autonomy. OBJECTIVES We sought to characterize how EPs think about this kind of dilemma and the strategies they use to resolve them. METHODS We conducted qualitative semi-structured interviews with a convenience sample of 59 emergency physicians attending the American College of Emergency Physicians' Scientific Assembly in October 2018. Three case vignettes highlighting different clinical and ethical features served as prompts. Interviews were analyzed using a constant comparative method to identify patterns of responses and derive key themes. RESULTS Across the vignettes, EPs demonstrated diverse approaches to observation, assessing decision-making capacity and encouraging compliance. Some EPs refused to comply with a patient's wishes even when they had determined a patient demonstrated capacity. Conversely, a few EPs were willing to allow patients to leave the emergency department (ED) without assessing capacity, or despite determining that the patient lacked capacity. Common reasons for complying with patients' demands were concerns about the patients' rights and concerns about the safety of staff. Most physicians interviewed reported no institutional guidelines or education on the topic, and many physicians expressed an interest in providing medication for addiction treatment in the ED. CONCLUSIONS EPs approach this clinical and ethical dilemma in widely divergent ways. Consensus about strategies for navigating patients' wishes relative to clinical concerns are needed to help EPs manage these challenging cases.
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Affiliation(s)
- Joshua W Joseph
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kenneth D Marshall
- Department of Emergency Medicine, University of Kansas Health System, Kansas City, Kansas; University of Kansas Medical School, Kansas City, Kansas
| | - Betzalel E Reich
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Katherine L Boyle
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kevin P Hill
- Harvard Medical School, Boston, Massachusetts; Division of Addiction Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Scott G Weiner
- Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Arthur R Derse
- Center for Bioethics and Medical Humanities, Institute for Health and Society, Milwaukee, Wisconsin; Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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14
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Wilson MP, Shenvi C, Rives L, Nordstrom K, Schneider S, Gerardi M. Opportunities for Research in Mental Health Emergencies: Executive Summary and Methodology. West J Emerg Med 2019; 20:380-385. [PMID: 30881561 PMCID: PMC6404701 DOI: 10.5811/westjem.2019.1.39260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction Despite the ever-increasing numbers of mental health patients presenting to United States emergency departments, there are large gaps in knowledge about acute care of the behavioral health patient. To address this important problem, the Coalition on Psychiatric Emergencies convened a research consensus conference in December 2016 consisting of clinical researchers, clinicians from emergency medicine, psychiatry and psychology, and representatives from governmental agencies and patient advocacy groups. Methods Participants used a standardized methodology to select and rank research questions in the order of importance to both researchers and patients. Results Three working groups (geriatrics, substance use disorders, and psychosis) reached consensus on 26 questions within their respective domains. These questions are summarized in this document. Conclusion The research consensus conference is the first of its kind to include non-clinicians in helping identify knowledge gaps in behavioral emergencies. It is hoped that these questions will prove useful to prioritize future research within the specialty.
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Affiliation(s)
- Michael P Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Little Rock, Arkansas
| | - Christina Shenvi
- University of North Carolina, Department of Emergency Medicine, Chapel Hill, North Carolina
| | - Loren Rives
- American College of Emergency Physicians, Irving, Texas
| | - Kimberly Nordstrom
- University of Colorado School of Medicine, Department of Psychiatry, Denver, Colorado
| | - Sandra Schneider
- American College of Emergency Physicians, Irving, Texas.,John Peter Smith Hospital, Department of Emergency Medicine, Fort Worth, Texas.,Hofstra Northwell School of Medicine, Hempstead, New York
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