Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study.
Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study.
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DOI：
10.1186/s13722-021-00224-y
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发表时间：
2021-03-09
影响因子：
3.7
通讯作者：
Hawk K
中科院分区：
文献类型：
--
作者：
McCormack RP;Rotrosen J;Gauthier P;D'Onofrio G;Fiellin DA;Marsch LA;Novo P;Liu D;Edelman EJ;Farkas S;Matthews AG;Mulatya C;Salazar D;Wolff J;Knight R;Goodman W;Hawk K
由于多种原因，急诊科 (ED) 是启动 OUD 干预措施的关键场所。急诊室的普遍文化是，物质使用障碍是非紧急情况，最好在急诊室之外解决，因为那里的资源较少。这项研究及其快速资助机制和加速的时间表源于迫切需要了解急诊科启动的丁丙诺啡 (BUP) 转诊治疗 OUD 是否具有普遍性，以及制定策略以促进其在各种急诊科环境和现实条件下的采用。它补充并使用了改编自 ED Health 项目 (CTN-0069) 的方法，该项目是一项混合类型 3 实施有效性研究，利用实施促进 (IF) 来整合 ED 发起的 BUP 和转诊计划。 ED-CONNECT (CTN 0079) 是一项三地点实施研究，探讨在需求高、资源有限和人员结构不同的农村和城市环境中引入 ED 发起的 BUP 的可行性、可接受性和影响。我们采用多方面的方法来开发、引入和迭代完善针对阿片类药物使用障碍 (OUD) 筛查、急诊科发起的 BUP 和转诊治疗的特定地点 ED 临床方案和实施计划。我们采用了参与式行动研究方法，并使用混合方法，结合了从医疗记录和管理数据中提取的数据、对招募的急诊患者参与者的评估，以及涉及急诊科和社区、患者和其他利益相关者的定性和定量调查。本研究旨在提供必要的、时间敏感的了解，了解如何在以前不提供急诊室启动的 BUP 的急诊室中识别 OUD 并启动 BUP 治疗，而在这些社区中最需要这种干预：高需求、低资源环境。试验注册：该研究于 2018 年 6 月 1 日在 ClinicalTrials.gov (NCT03544112) 上前瞻性注册：https://clinicaltrials.gov/ct2/show/NCT03544112。
For many reasons, the emergency department (ED) is a critical venue to initiate OUD interventions. The prevailing culture of the ED has been that substance use disorders are non-emergent conditions better addressed outside the ED where resources are less constrained. This study, its rapid funding mechanism, and accelerated timeline originated out of the urgent need to learn whether ED-initiated buprenorphine (BUP) with referral for treatment of OUD is generalizable, as well as to develop strategies to facilitate its adoption across a variety of ED settings and under real-world conditions. It both complements and uses methods adapted from Project ED Health (CTN-0069), a Hybrid Type 3 implementation-effectiveness study of using Implementation Facilitation (IF) to integrate ED-initiated BUP and referral programs. ED-CONNECT (CTN 0079) was a three-site implementation study exploring the feasibility, acceptability, and impact of introducing ED-initiated BUP in rural and urban settings with high-need, limited resources, and different staffing structures. We used a multi-faceted approach to develop, introduce and iteratively refine site-specific ED clinical protocols and implementation plans for opioid use disorder (OUD) screening, ED-initiated BUP, and referral for treatment. We employed a participatory action research approach and use mixed methods incorporating data derived from abstraction of medical records and administrative data, assessments of recruited ED patient-participants, and both qualitative and quantitative inquiry involving staff from the ED and community, patients, and other stakeholders. This study was designed to provide the necessary, time-sensitive understanding of how to identify OUD and initiate treatment with BUP in the EDs previously not providing ED-initiated BUP, in communities in which this intervention is most needed: high need, low resource settings. Trial registration: The study was prospectively registered on ClinicalTrials.gov (NCT03544112) on June 01, 2018: https://clinicaltrials.gov/ct2/show/NCT03544112.
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