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Rapid Adoption of Low-Threshold Buprenorphine Treatment at California Emergency Departments Participating in the CA Bridge Program
Annals of Emergency Medicine ( IF 6.2 ) Pub Date : 2021-08-02 , DOI: 10.1016/j.annemergmed.2021.05.024
Hannah Snyder 1 , Mariah M Kalmin 2 , Aimee Moulin 3 , Arianna Campbell 4 , David Goodman-Meza 5 , Howard Padwa 6 , Serena Clayton 7 , Melissa Speener 7 , Steve Shoptaw 2 , Andrew A Herring 8
Affiliation  

Study objective

We retrospectively evaluated the implementation of low-threshold emergency department (ED) buprenorphine treatment at 52 hospitals participating in the CA Bridge Program using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework.

Methods

The CA Bridge model included low-threshold buprenorphine, connection to outpatient care, and harm reduction. Implementation began in March 2019. Participating hospitals reported aggregated clinical data monthly after program initiation. Outcomes included identification of opioid use disorder, buprenorphine administration, and linkage to outpatient addiction treatment. Multivariable models assessed associations between hospital location (rural versus urban) and teaching status (clinical teaching hospital versus community hospital) and outcomes in adopting the CA Bridge Program.

Results

Reach: A diverse and geographically distributed group of 52 California hospitals were enrolled in 2 phases (March and August 2019); 12 (23%) were rural and 13 (25%) were teaching hospitals. Effectiveness: Over a 14-month implementation period, 12,009 opioid use disorder patient encounters were identified, including 7,179 (59.7%) where buprenorphine was administered and 4,818 (40.1%) where follow-up visits were attended. Adoption: In multivariable analysis, adoption did not differ significantly between rural and urban or teaching and nonteaching hospitals. Implementation: By program completion, all 52 (100%) hospitals treated opioid use disorder with buprenorphine; 45 (86.5%) administered buprenorphine after naloxone reversal; 41 (84.6%) offered buprenorphine for inpatients; 48 (92.3%) initiated buprenorphine in pregnant women; and 29 (55.8%) offered take-home naloxone. Maintenance: At 8-month follow-up, all 52 sites reported continued buprenorphine treatment.

Conclusion

Low-threshold ED buprenorphine treatment implemented with a harm reduction approach and active navigation to outpatient addiction treatment was successful in achieving buprenorphine treatment for opioid use disorder in diverse California communities.



中文翻译:

参与加州桥梁计划的加州急诊部门迅速采用低阈值丁丙诺啡治疗

学习目标

我们使用 RE-AIM(范围、有效性、采用、实施、维护)框架回顾性评估了参与 CA 桥梁计划的 52 家医院的低阈值急诊科 (ED) 丁丙诺啡治疗的实施情况。

方法

CA Bridge 模型包括低阈值丁丙诺啡、与门诊护理的联系和减少危害。实施于 2019 年 3 月开始。参与医院在计划启动后每月报告汇总的临床数据。结果包括确定阿片类药物使用障碍、丁丙诺啡给药以及与门诊成瘾治疗的联系。多变量模型评估了医院位置(农村与城市)和教学状态(临床教学医院与社区医院)与采用 CA Bridge 计划的结果之间的关联。

结果

覆盖范围:在两个阶段(2019 年 3 月和 8 月)招募了一个由 52 家加州医院组成的多元化和地理分布的群体;12 家(23%)是农村医院,13 家(25%)是教学医院。有效性:在 14 个月的实施期内,确定了 12,009 例阿片类药物使用障碍患者遭遇,其中 7,179 例(59.7%)使用丁丙诺啡,4,818 例(40.1%)进行随访。采用率:在多变量分析中,农村和城市或教学医院和非教学医院的采用率没有显着差异。执行:到项目完成时,所有 52 (100%) 家医院都使用丁丙诺啡治疗了阿片类药物使用障碍;45 (86.5%) 名在纳洛酮逆转后服用丁丙诺啡;41 (84.6%) 名住院患者提供丁丙诺啡;48 (92.3%) 名孕妇开始使用丁丙诺啡;29 个 (55.8%) 提供带回家的纳洛酮。维持:在 8 个月的随访中,所有 52 个中心都报告继续接受丁丙诺啡治疗。

结论

低阈值 ED 丁丙诺啡治疗采用减少危害的方法和主动导航到门诊成瘾治疗,成功地在加州不同社区实现了对阿片类药物使用障碍的丁丙诺啡治疗。

更新日期:2021-08-02
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