The Emergency Department Longitudinal Integrated Care (ED-LINC) intervention targeting opioid use disorder: A pilot randomized clinical trial.
The Emergency Department Longitudinal Integrated Care (ED-LINC) intervention targeting opioid use disorder: A pilot randomized clinical trial.
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DOI：
10.1016/j.jsat.2021.108666
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发表时间：
2022-05
影响因子：
3.9
通讯作者：
Zatzick, Douglas F.
中科院分区：
文献类型：
--
作者：
Whiteside, Lauren K.;Huynh, Ly;Morse, Sophie;Hall, Jane;Meurer, William;Banta-Green, Caleb J.;Scheuer, Hannah;Cunningham, Rebecca;McGovern, Mark;Zatzick, Douglas F.
关键词：
阿片类药物使用障碍（OUD）和相关共病状况在急诊科（艾德）就诊的患者中非常普遍。研究已经开发了一些综合性疾病管理策略，用于向艾德就诊的高危患者，这些策略既减少了非法阿片类药物的使用，又改善了OUD（MOUD）药物治疗的启动和保留。研究小组进行了一项试点实用的临床试验，将40名患者随机分配到一个单一的艾德到一个合作护理干预（n = 20）与常规护理控制（n = 20）条件。访谈者对患者干预和对照组状态不知情，在向ED介绍后的1个月，3个月和6个月对参与者进行随访。针对OUD风险患者的3个月急诊科纵向综合护理（ED-LINC）协作护理干预包括：1）在床边进行简短的协商访谈，2）过量教育和促进MOUD，3）纵向主动护理管理，4）利用全州健康信息交换平台，全天候跟踪复发性艾德的使用情况，5）每周一次的病例量监督，将基于测量的护理治疗评估与对有顽固症状患者的加强护理相结合。总体而言，ED-LINC干预是可行的，患者可以接受。初步研究在1个月、3个月和6个月的随访率均超过80%。在校正的纵向混合模型回归分析中，与接受常规治疗的患者相比，ED-LINC干预患者在过去30天内使用阿片类药物的天数不存在统计学显著差异（发生率比（IRR）1.50，95% CI 0.54-4.16）。两组在1个月和3个月随访时间点的未校正的非法阿片类药物使用平均天数减少。ED-LINC干预组患者MOUD启动率高于对照组患者（50% vs 30%）;干预组与对照组的比较没有达到统计学显著性，尽管在试点中检测显著差异的能力有限。对于OUD患者的ED-LINC干预可以切实可行地实施，并保证在更大规模、充分把握度的随机化实用临床试验研究中进行测试。
Opioid use disorder (OUD) and related comorbid conditions are highly prevalent among patients presenting to emergency department (ED) settings. Research has developed few comprehensive disease management strategies for at-risk patients presenting to the ED that both decrease illicit opioid use and improve initiation and retention in medication treatment for OUD (MOUD). The research team conducted a pilot pragmatic clinical trial that randomized 40 patients presenting to a single ED to a collaborative care intervention (n = 20) versus usual care control (n = 20) conditions. Interviewers blinded to patient intervention and control group status followed-up with participants at 1, 3, and 6 months after presentation to the ED. The 3-month Emergency Department Longitudinal Integrated Care (ED-LINC) collaborative care intervention for patients at risk for OUD included: 1) a Brief Negotiated Interview at bedside, 2) overdose education and facilitation of MOUD, 3) longitudinal proactive care management, 4) utilization of the statewide health information exchange platform for 24/7 tracking of recurrent ED utilization, and 5) weekly caseload supervision that incorporated measurement-based care treatment assessment with stepped-up care for patients with recalcitrant symptoms. Overall, the ED-LINC intervention was feasibly delivered and acceptable to patients. The pilot study achieved > 80% follow-up rates at 1, 3, and 6 months. In adjusted longitudinal mixed model regression analyses, no statistically significant differences existed in days of opioid use over the past 30 days for ED-LINC intervention patients when compared to patients receiving usual care (incidence-rate ratio (IRR) 1.50, 95% CI 0.54–4.16). The unadjusted mean number of days of illicit opioid use decreased at the 1-month and 3-month follow-up time points for both groups. ED-LINC intervention patients had increased rates of MOUD initiation compared to control patients (50% versus 30%); intervention versus control comparisons did not achieve statistical significance, although power to detect significant differences in the pilot was limited. The ED-LINC intervention for patients with OUD can be feasibly implemented and warrants testing in larger scale, adequately powered randomized pragmatic clinical trial investigations.
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