Sustained Implementation of a Multicomponent Strategy to Increase Emergency Department-Initiated Interventions for Opioid Use Disorder.
Sustained Implementation of a Multicomponent Strategy to Increase Emergency Department-Initiated Interventions for Opioid Use Disorder.
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DOI：
10.1016/j.annemergmed.2021.10.012
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发表时间：
2022-03
影响因子：
6.2
通讯作者：
Delgado MK
中科院分区：
文献类型：
--
作者：
Lowenstein M;Perrone J;Xiong RA;Snider CK;O'Donnell N;Hermann D;Rosin R;Dees J;McFadden R;Khatri U;Meisel ZF;Mitra N;Delgado MK
有强有力的证据支持急诊科(ED)发起的丁丙诺啡治疗阿片类药物使用障碍(OUD)，但对如何实施这一做法知之甚少。我们的目的是描述在三个城市的学术急诊室中实施、维护和提供者采用多组件策略进行OUD治疗。我们对OUD相关就诊实施前(3/2017-11/2018)和实施后(12/2018-7/2020)成人患者的电子健康记录(EHR)数据进行了回顾分析。我们描述了患者的特征、治疗和随时间推移的过程措施，并使用患者水平的多变量Logistic回归模型进行了中断时间序列分析(ITSA)，以评估干预与丁丙诺啡使用和其他结果的相关性。最后，我们报告了实施后处方的提供者级别的差异。在研究期间，有2665次与吸食毒品有关的就诊；28%的人服药过量，8%的人戒毒，%的人患有其他疾病。13%的患者在急诊期间或之后接受了MODS。在实施干预措施后，治疗和过程措施持续增加，丁丙诺啡总量在后期净增加20%(95%可信区间16%-23%)。在调整后的患者水平模型中，在实施干预措施后，丁丙诺啡治疗的概率立即增加了24.5%(95%可信区间12.1%至37.0%)。70%的提供者至少开了一张丁丙诺啡处方，但提供者级别的丁丙诺啡处方在与OUD相关的接触中从0-61%不等。增加ED启动的OUD治疗的策略组合与治疗和过程措施的持续增加有关。然而，不同提供商的采用情况差异很大，这表明可能需要额外的策略才能更广泛地采用。
There is strong evidence supporting emergency department (ED)-initiated buprenorphine for opioid use disorder (OUD), but less is known about how to implement this practice. Our aim was to describe implementation, maintenance, and provider adoption of a multi-component strategy for OUD treatment in three urban, academic EDs. We conducted a retrospective analysis of electronic health record (EHR) data for adult patients with OUD-related visits before (3/2017-11/2018) and after (12/2018-7/2020) implementation. We describe patient characteristics, treatment, and process measures over time and conducted an interrupted time series analysis (ITSA) using a patient-level multivariable logistic regression model to assess the association of the interventions with buprenorphine use and other outcomes. Finally, we report provider-level variation in prescribing after implementation. There were 2665 OUD-related visits during the study period; 28% for overdose, 8% for withdrawal, and 64% for other conditions. 13% of patients received MOUDs during or after their ED visit. Following intervention implementation, there were sustained increases in treatment and process measures, with a net increase in total buprenorphine of 20% in the post-period (95% CI 16%-23%). In the adjusted patient-level model, there was an immediate increase in probability of buprenorphine treatment of 24.5% (95% CI 12.1% to 37.0%) with intervention implementation. 70% of providers wrote at least one buprenorphine prescription, but provider-level buprenorphine prescribing ranged from 0-61% of OUD-related encounters. A combination of strategies to increase ED-initiated OUD treatment were associated with sustained increases in treatment and process measures. However, adoption varied widely among providers, suggesting additional strategies may be needed for broader uptake.
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影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
影响因子：
120.7
作者：
Gerber, Jeffrey S.;Prasad, Priya A.;Zaoutis, Theoklis E.
通讯作者：
Zaoutis, Theoklis E.
DOI：
10.1111/add.13900
发表时间：
2017-11
期刊：
Addiction (Abingdon, England)
影响因子：
--
作者：
Busch SH;Fiellin DA;Chawarski MC;Owens PH;Pantalon MV;Hawk K;Bernstein SL;O'Connor PG;D'Onofrio G
通讯作者：
D'Onofrio G
影响因子：
5.7
作者：
Howell, Benjamin A.;Abel, Erica A.;Becker, William C.
通讯作者：
Becker, William C.
影响因子：
3
作者：
Curran GM;Bauer M;Mittman B;Pyne JM;Stetler C
通讯作者：
Stetler C