Department of Emergency, Alpert Medical School, Brown University, Providence, RI; Rhode Island Department of Health, Providence, RI.
Department of Epidemiology, Brown University School of Public Health, Providence, RI.
Ann Emerg Med. 2021 Jul;78(1):68-79. doi: 10.1016/j.annemergmed.2021.02.004. Epub 2021 Apr 15.
We sought to determine the influence of the Levels of Care for Rhode Island Emergency Departments and Hospitals for Treating Overdose and Opioid Use Disorder (Levels of Care) on emergency department (ED) provision of take-home naloxone, behavioral counseling, and referral to treatment.
A retrospective analysis of Rhode Island ED visits for opioid overdose from 2017 to 2018 was performed using data from a statewide opioid overdose surveillance system. Changes in provision of take-home naloxone, behavioral counseling, and referral to treatment before and after Levels of Care implementation were assessed using interrupted time series analysis. We compared outcomes by hospital type using multivariable modified Poisson regression models with generalized estimating equation estimation to account for hospital-level variation.
We analyzed 245 overdose visits prior to Levels of Care implementation (January to March 2017) and 1340 overdose visits after implementation (hospital certification to December 2018). After implementation, the proportion of patients offered naloxone increased on average by 13% (95% confidence interval [CI] 5.6% to 20.4%). Prior to implementation, the proportion of patients receiving behavioral counseling and treatment referral was declining. After implementation, this decline slowed and stabilized, and on average 18.6% more patients received behavioral counseling (95% CI 1.3% to 35.9%) and 23.1% more patients received referral to treatment (95% CI 2.7% to 43.5%). Multivariable analysis showed that after implementation, there was a significant increase in the likelihood of being offered naloxone at Level 1 (adjusted relative risk [aRR] 1.31 [95% CI 1.06 to 1.61]) and Level 3 (aRR 3.13 [95% CI 1.08 to 9.06]) hospitals and an increase in referrals for medication for opioid use disorder (from 2.5% to 17.8%) at Level 1 hospitals (RR 7.73 [95% CI 3.22 to 18.55]). Despite these increases, less than half of the patients treated for an opioid overdose received behavioral counseling or referral to treatment CONCLUSION: The establishment of ED policies for treatment and services after opioid overdose improved naloxone distribution, behavioral counseling, and referral to treatment at hospitals without previously established opioid overdose services. Future investigations are needed to better characterize implementation barriers and evaluate policy influence on patient outcomes.
我们旨在确定罗得岛急症室和医院治疗过量和阿片类药物使用障碍的护理水平（护理水平）对急诊室（ED）提供纳洛酮、行为咨询和转介治疗的影响。
使用全州阿片类药物过量监测系统的数据，对 2017 年至 2018 年罗得岛因阿片类药物过量的急诊室就诊进行了回顾性分析。使用中断时间序列分析评估在护理水平实施前后提供家庭纳洛酮、行为咨询和转介治疗的变化。我们使用多变量修正泊松回归模型和广义估计方程估计，根据医院类型比较结果，以考虑医院层面的差异。
我们分析了在护理水平实施前（2017 年 1 月至 3 月）的 245 例过量就诊和实施后（医院认证至 2018 年 12 月）的 1340 例过量就诊。实施后，接受纳洛酮治疗的患者比例平均增加了 13%（95%置信区间 [CI] 5.6%至 20.4%）。实施前，接受行为咨询和治疗转介的患者比例呈下降趋势。实施后，这种下降速度放缓并稳定下来，平均有 18.6%的患者接受行为咨询（95%CI 1.3%至 35.9%），23.1%的患者接受治疗转介（95%CI 2.7%至 43.5%）。多变量分析表明，实施后，1 级（调整后的相对风险 [ARR] 1.31 [95%CI 1.06 至 1.61]）和 3 级（ARR 3.13 [95%CI 1.08 至 9.06]）医院提供纳洛酮的可能性显著增加，以及 1 级医院接受阿片类药物使用障碍治疗的转介（从 2.5%增加至 17.8%）（RR 7.73 [95%CI 3.22 至 18.55]）。尽管有这些增加，但不到一半接受阿片类药物过量治疗的患者接受了行为咨询或转介治疗。
在阿片类药物过量后建立 ED 治疗和服务政策，改善了没有先前建立阿片类药物过量服务的医院的纳洛酮分配、行为咨询和转介治疗。需要进一步研究以更好地描述实施障碍，并评估政策对患者结局的影响。
