Department of Emergency Medicine,University of Pennsylvania, Philadelphia, PA.
Department of Emergency Medicine,University of Pennsylvania, Philadelphia, PA; Center for Digital Health at the Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA.
Ann Emerg Med. 2020 Aug;76(2):206-214. doi: 10.1016/j.annemergmed.2020.02.020. Epub 2020 May 4.
Emergency department (ED) initiation of buprenorphine for patients with opioid use disorder increases treatment engagement but remains an uncommon practice. One important barrier to ED-initiated buprenorphine is the additional training requirement (X waiver). Our objective is to evaluate the influence of a financial incentive program on emergency physician completion of X-waiver training. Secondary objectives are to evaluate the program's effect on buprenorphine prescribing and to explore physician attitudes toward the incentive.
We conducted a prospective, observational cohort study set in 3 urban academic EDs before and after implementation of a financial incentive program providing $750 for completion of X-waiver training. We describe program participation as well as rates of buprenorphine prescribing per opioid use disorder-related encounter before and after the intervention period, using electronic health record data. We also completed a postintervention physician survey assessing attitudes about the incentive program.
Overall, 89% of eligible emergency physicians (56/63) completed the X-waiver training during the 6-week incentive period. In the 5 months after the incentive, buprenorphine prescribing per opioid use disorder-related encounter increased from 0.5% to 16% (Δ 15%; 95% confidence interval 10.6% to 19.9%), with substantial variability across sites (range 8% to 22% of opioid use disorder-related encounters). In a postintervention survey, 67% of participating physicians indicated that they would have completed the training for a lower amount.
A financial incentive paying approximately half the clinical rate was effective in promoting emergency physician X-waiver training. The effect on ED-based buprenorphine prescribing was positive but variable across sites, and likely dependent on the availability of additional supports.
在急诊部（ED）为阿片类药物使用障碍患者启动丁丙诺啡治疗可增加治疗参与度，但这仍然是一种不常见的做法。ED 启动丁丙诺啡的一个重要障碍是额外的培训要求（X 豁免）。我们的目标是评估财务激励计划对急诊医师完成 X 豁免培训的影响。次要目标是评估该计划对丁丙诺啡处方的影响，并探讨医生对激励措施的态度。
我们进行了一项前瞻性、观察性队列研究，在 3 家城市学术急诊部进行，在实施提供 750 美元完成 X 豁免培训的财务激励计划之前和之后。我们使用电子健康记录数据描述计划参与情况以及干预前后每例阿片类药物使用障碍相关就诊的丁丙诺啡处方率。我们还完成了一项干预后医生调查，评估对激励计划的态度。
总体而言，63 名符合条件的急诊医师中有 89%（56/63）在 6 周的激励期内完成了 X 豁免培训。在激励计划后的 5 个月内，每例阿片类药物使用障碍相关就诊的丁丙诺啡处方率从 0.5%增加到 16%（Δ 15%；95%置信区间 10.6%至 19.9%），各站点之间差异很大（阿片类药物使用障碍相关就诊的 8%至 22%）。在干预后的调查中，67%的参与医生表示他们会为较低的金额完成培训。
支付大约一半临床费用的财务激励措施有效地促进了急诊医师 X 豁免培训。对 ED 中丁丙诺啡处方的影响是积极的，但各站点之间存在差异，这可能取决于额外支持的可用性。
