Beyond Buprenorphine: Models of Follow-up Care for Opioid Use Disorder in the Emergeny Department.
Beyond Buprenorphine: Models of Follow-up Care for Opioid Use Disorder in the Emergeny Department.
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DOI：
10.5811/westjem.2020.7.46079
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发表时间：
2020-11-02
期刊：
影响因子：
--
通讯作者：
Raja A
中科院分区：
文献类型：
--
作者：
Martin A;Butler K;Chavez T;Herring A;Wakeman S;Hayes BD;Raja A
最近的证据表明，急诊医生（EP）可以通过直接在急诊科（ED）开始药物成瘾治疗（MAT）来帮助患者获得阿片类药物使用障碍的循证治疗。许多急诊科在患者出院后难以提供维持治疗的选择。全国各地的卫生系统需要一种护理交付结构，将患有OUD的急诊科患者与丁丙诺啡开始治疗后的护理联系起来。本文回顾了在急诊科和初级保健/成瘾药物服务之间形成有效伙伴关系的三种最常见的方法：项目酒精和药物滥用服务和转诊治疗（ASSERT）模型、桥梁模型和急诊科桥梁模型。ASSERT模式的特点是，急诊科的同伴教育者或社区工作者直接将急诊科患有OUD的患者转介到当地的成瘾治疗服务。“桥”模式鼓励急诊科的开药医生对患者进行OUD筛查，为其提供丁丙诺啡的短期处方，然后将患者直接转介到位于同一家医院的“桥”门诊，但与急诊科分开。“桥”门诊由接受过成瘾培训的医生和中级临床医生组成。ED- bridge模式聘请了接受过急诊医学和成瘾医学培训的医生，在急诊科和成瘾后续诊所服务。与上面的Bridge Clinic模型不同，ED-Bridge模型中的EPs既可以筛查急诊科的高危患者，通常开始治疗，也可以在定期安排的成瘾诊所对患者进行纵向跟踪。本文提供了这三种模式的例子，以及实施和后勤细节，以支持卫生系统更好地解决社区中的OUD问题。
Recent evidence shows that emergency physicians (EP) can help patients obtain evidence-based treatment for Opioid Use Disorder by starting medication for addiction treatment (MAT) directly in the Emergency Department (ED). Many EDs struggle to provide options for maintenance treatment once patients are discharged from the ED. Health systems around the country are in need of a care delivery structure to link ED patients with OUD to care following initiation of buprenorphine. This paper reviews the three most common approaches to form effective partnerships between EDs and primary care/addiction medicine services: the Project Alcohol and Substance Abuse Services and Referral to Treatment (ASSERT) model, Bridge model, and ED-Bridge model. The ASSERT Model is characterized by peer educators or community workers in the ED directly referring patients suffering from OUD in the ED to local addiction treatment services. The Bridge model encourages prescribing physicians in an ED to screen patients for OUD, provide a short-term prescription for buprenorphine, and then refer the patient directly to an outpatient Bridge Clinic that is co-located in the same hospital but is a separate from the ED. This Bridge Clinic is staffed by addiction trained physicians and mid-level clinicians. The ED-Bridge model employs physicians trained in both emergency medicine and addiction medicine to serve within the ED as well as in the follow up addiction clinic. Distinct from the Bridge Clinic model above, EPs in the ED-Bridge model are both able to screen at-risk patients in the ED, often starting treatment, and to longitudinally follow patients in a regularly scheduled addiction clinic. This paper provides examples of these three models as well as implementation and logistical details to support a health system to better address OUD in their communities.
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