Implementation of emergency department-initiated buprenorphine for opioid use disorder in a rural southern state.
Implementation of emergency department-initiated buprenorphine for opioid use disorder in a rural southern state.
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在南部农村州实施由急诊部门启动的丁丙诺啡治疗阿片类药物使用障碍。
DOI：
10.1016/j.jsat.2020.02.007
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发表时间：
2020-03
影响因子：
3.9
通讯作者：
Brady K
中科院分区：
文献类型：
--
作者：
Bogan C;Jennings L;Haynes L;Barth K;Moreland A;Oros M;Goldsby S;Lane S;Funcell C;Brady K
美国国家药物滥用研究所（NIDA）临床试验网络（CTN）是一个旨在连接研究人员和社区药物滥用治疗提供者以开发新治疗方法的实体，它对D 'Onofio的随机临床试验结果的传播感兴趣，该试验表明在急诊室（艾德）启动丁丙诺啡可增强与治疗的联系[JAMA 2015; 313（16）：1636-1644]。在CTN的南方联盟节点中，作者采取了实施科学方法，通过在三个不同的南卡罗来纳州ED中实施基于ED的丁丙诺啡启动计划，利用主要的同伴恢复教练模型，扩展了D 'Onofrio研究。该试点计划的目的是在医院急诊室从根本上整合普遍筛查、简短干预和转诊治疗（SBIRT），以识别有风险物质使用的患者。通过简短的干预，患者导航员评估了患者的改变准备和治疗动机。愿意接受治疗的患者被转介到适当的社区资源。被确定患有阿片类药物使用障碍（OUD）并愿意接受治疗的患者有资格接受ED启动的丁丙诺啡治疗，并由同伴恢复教练协助安排第二天与社区治疗计划或其他当地提供者进行后续治疗。医院合作伙伴包括一家大型学术医疗中心、一家大型私立医院和一家小型社区医院。在实施这一质量改进计划之前，作者在每个站点完成了艾德工作流程分析，建立了内部规划委员会，包括确定“医院冠军”，促进电子健康记录修改，教育了200多名艾德护士和提供者，并确定了一个能够接受患者次日预约的当地社区“快速通道”提供者网络。在14个月内，所有三个站点都全面投入使用，3个艾德站点的项目工作人员对6523名患者进行了药物滥用筛查，其中33.0%的筛查结果为高危药物使用阳性。按物质列出的阳性筛查结果如下：907例酒精、100例可卡因、40例甲基苯丙胺、7例苯丙胺、96例大麻、12例苯二氮卓类、3例摇头丸/摇头丸/莫莉、10例其他/未知物质、274例海洛因、90例处方阿片类、32例其他/未知阿片类、254例未确定的多种物质使用（不含阿片类）和331例多种物质与阿片类一起使用。在727例非医用阿片类药物使用的阳性筛选患者中，70.0%被确定可能有资格接受丁丙诺啡治疗。231例患者开始接受一剂8 mg舌下丁丙诺啡或8-2 mg舌下丁丙诺啡/纳洛酮; 76.6%的患者在第二天预约继续接受阿片类药物使用障碍（MOUD）治疗; 59.9%的患者在30天时继续接受治疗。在转诊患者中，艾德就诊时的支付者如下：71.1%未投保，21.4%州医疗补助，1.6%医疗保险和5.9%私人健康保险。在充足的资源和机构支持下，实施以OUD为重点的循证质量改进举措是可行的，并加强了与南方农村州循证治疗的联系。从本实施研究中吸取的经验教训可以用来指导未来的CTN研究侧重于艾德设置。由南卡罗来纳州卫生和人类服务部提供财政支持，并由马赛克集团和南卡罗来纳州酒精和其他药物服务部提供咨询和指导。
The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN), an entity aimed at bridging researchers and community-based substance abuse treatment providers to develop new treatment approaches, has taken an interest in the dissemination of findings from a randomized clinical trial by D’Onoffio demonstrating that initiating buprenorphine in the emergency department (ED) enhances linkage to treatment [JAMA 2015; 313 (16): 1636–1644]. In the Southern Consortium Node of the CTN, the authors have taken an implementation science approach to expand on the D’Onofrio study by implementing an ED-based buprenorphine initiation program in three diverse South Carolina EDs utilizing a predominantly peer recovery coach model. The aim of this pilot program was to foundationally integrate universal screening, brief interventions and referral to treatment (SBIRT) in hospital EDs to identify patients with at-risk substance use. Through brief interventions, patient navigators assessed readiness to change and motivation for treatment of patients. Patients willing to engage in treatment were referred to appropriate community resources. Patients identified to have opioid use disorder (OUD) and willing to engage in treatment were eligible for ED-initiated buprenorphine and peer recovery coaches assisted in arranging next day follow up with a community treatment program or other local provider for ongoing treatment. Hospital partner sites included a large academic medical center, a large private hospital, and a small community hospital. Prior to implementing this quality improvement initiative, the authors completed an ED workflow analysis at each site, developed internal planning committees including identification of a “hospital champion,” facilitated electronic health record modifications, educated more than 200 ED nurses and providers, and identified a network of local community “fast-track” providers able to accept patients for next-day appointments. Within 14 months, all three sites were fully operationalized and project staff in 3 ED sites screened 6523 patients for substance misuse with 33.0% screened positive for at-risk substance use. Positive screening results were as follows by substance: 907 alcohol, 100 cocaine, 40 methamphetamine, 7 amphetamines, 96 marijuana, 12 benzodiazepines, 3 Ecstasy/MDMA/Molly, 10 other/unknown substance, 274 heroin, 90 prescription opioids, 32 other/unknown opioid, 254 undetermined polysubstance use without opioids, and 331 polysubstance use with opioids. Of the 727 positive screened patients for non-medical opioid use, 70.0% were determined potentially eligible to receive buprenorphine initiation. Two-hundred thirty-one patients were initiated with one dose of 8 mg sublingual buprenorphine or 8-2 mg sublingual buprenorphine/naloxone; 76.6% of those initiated arrived to next-day appointments for continued medications for opioid use disorder (MOUD); and 59.9% of those patients were retained in treatment at 30 days. Of referred patients, payor at time of ED visit were as follows: 71.1% uninsured, 21.4% state Medicaid, 1.6% Medicare, and 5.9% private health insurance. With adequate resources and institutional support, implementation of evidence-based quality improvement initiatives focused on OUDs are feasible and enhance linkage to evidence-based treatment in a rural Southern state. Lessons learned from this implementation study can be used to guide future CTN studies focused on ED settings. Financially supported by South Carolina Department of Health and Human Services with consultation and guidance from Mosaic Group and South Carolina Department of Alcohol and Other Drug Services.
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影响因子：
5.7
作者：
D'Onofrio, Gail;Chawarski, Marek C.;Fiellin, David A.
通讯作者：
Fiellin, David A.
影响因子：
3.9
作者：
Moreland, Angela;McCauley, Jenna;Brady, Kathleen
通讯作者：
Brady, Kathleen
影响因子：
6.2
作者：
Weiner, Scott G.;Baker, Olesya;Schuur, Jeremiah D.
通讯作者：
Schuur, Jeremiah D.
影响因子：
7.2
作者：
Chamberlain, Patricia;Brown, C. Hendricks;Saldana, Lisa
通讯作者：
Saldana, Lisa
影响因子：
120.7
作者：
D'Onofrio, Gail;O'Connor, Patrick G.;Fiellin, David A.
通讯作者：
Fiellin, David A.