Study objective

There is strong evidence supporting emergency department (ED)-initiated buprenorphine for opioid use disorder, but less is known about how to implement this practice. Our aim was to describe implementation, maintenance, and provider adoption of a multicomponent strategy for opioid use disorder treatment in 3 urban, academic EDs.

Methods

We conducted a retrospective analysis of electronic health record data for adult patients with opioid use disorder-related visits before (March 2017 to November 2018) and after (December 2018 to July 2020) implementation. We describe patient characteristics, clinical treatment, and process measures over time and conducted an interrupted time series analysis 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.

Results

There were 2,665 opioid use disorder-related visits during the study period: 28% for overdose, 8% for withdrawal, and 64% for other conditions. Thirteen percent of patients received medications for opioid use disorder during or after their ED visit overall. Following intervention implementation, there were sustained increases in treatment and process measures, with a net increase in total buprenorphine of 20% in the postperiod (95% confidence interval 16% to 23%). In the adjusted patient-level model, there was an immediate increase in the probability of buprenorphine treatment of 24.5% (95% confidence interval 12.1% to 37.0%) with intervention implementation. Seventy percent of providers wrote at least 1 buprenorphine prescription, but provider-level buprenorphine prescribing ranged from 0% to 61% of opioid use disorder-related encounters.

Conclusion

A combination of strategies to increase ED-initiated opioid use disorder treatment was associated with sustained increases in treatment and process measures. However, adoption varied widely among providers, suggesting that additional strategies are needed for broader uptake.

中文翻译：

---

持续实施多组分战略以增加急诊科发起的阿片类药物使用障碍干预措施

学习目标

有强有力的证据支持急诊科 (ED) 启动丁丙诺啡治疗阿片类药物使用障碍，但对于如何实施这种做法知之甚少。我们的目的是描述在 3 个城市学术急诊室中实施、维护和提供者采用多组分策略来治疗阿片类药物使用障碍。

方法

我们对实施前（2017 年 3 月至 2018 年 11 月）和实施后（2018 年 12 月至 2020 年 7 月）成年阿片类药物使用障碍相关就诊患者的电子健康记录数据进行了回顾性分析。我们描述了随时间变化的患者特征、临床治疗和过程测量，并使用患者水平的多变量逻辑回归模型进行了间断时间序列分析，以评估干预措施与丁丙诺啡使用和其他结果的关联。最后，我们报告实施后提供者级别的处方差异。

结果

在研究期间，有 2,665 次与阿片类药物使用障碍相关的就诊：28% 是因为服用过量，8% 是因为戒断，64% 是因为其他情况。13% 的患者在急诊就诊期间或之后接受了阿片类药物使用障碍的药物治疗。干预实施后，治疗和过程措施持续增加，后期丁丙诺啡总量净增加 20%（95% 置信区间为 16% 至 23%）。在调整后的患者水平模型中，实施干预措施后，丁丙诺啡治疗的可能性立即增加了 24.5%（95% 置信区间为 12.1% 至 37.0%）。70% 的提供者至少开了一份丁丙诺啡处方，但提供者级别的丁丙诺啡处方在阿片类药物使用障碍相关遭遇中的比例从 0% 到 61% 不等。

结论

增加 ED 启动的阿片类药物使用障碍治疗的策略组合与治疗和过程措施的持续增加有关。然而，供应商之间的采用差异很大，这表明需要额外的策略才能更广泛地采用。