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加州参与 CA 桥梁项目的急诊部门快速采用低门槛丁丙诺啡治疗。

Rapid Adoption of Low-Threshold Buprenorphine Treatment at California Emergency Departments Participating in the CA Bridge Program.

机构信息

Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA; CA Bridge Program, Public Health Institute, Oakland, CA.

Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.

出版信息

Ann Emerg Med. 2021 Dec;78(6):759-772. doi: 10.1016/j.annemergmed.2021.05.024. Epub 2021 Aug 2.

DOI:10.1016/j.annemergmed.2021.05.024

PMID:34353655

Abstract

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.

摘要

研究目的

我们使用 RE-AIM（覆盖范围、效果、采用、实施、维持）框架，回顾性评估了参与 CA 桥梁计划的 52 家医院实施低门槛急诊科（ED）丁丙诺啡治疗的情况。

方法

CA 桥梁模型包括低门槛丁丙诺啡、与门诊护理的联系和减少伤害。实施于 2019 年 3 月开始。参与医院在项目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、丁丙诺啡管理和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 桥梁计划之间的关系。

结果

覆盖范围：2019 年 3 月和 8 月分两阶段共招募了 52 家加利福尼亚州的多样化和地理分布的医院；其中 12 家（23%）为农村医院，13 家（25%）为教学医院。效果：在 14 个月的实施期间，确定了 12009 例阿片类药物使用障碍患者就诊，其中 7179 例（59.7%）给予丁丙诺啡，4818 例（40.1%）参加了随访。采用：在多变量分析中，农村与城市或教学与非教学医院之间的采用情况没有显著差异。

实施

在项目完成时，所有 52 家（100%）医院均使用丁丙诺啡治疗阿片类药物使用障碍；45 家（86.5%）在纳洛酮逆转后给予丁丙诺啡；41 家（84.6%）为住院患者提供丁丙诺啡；48 家（92.3%）为孕妇开始丁丙诺啡治疗；29 家（55.8%）提供纳洛酮带回家。维持：在 8 个月的随访中，所有 52 个地点均报告继续进行丁丙诺啡治疗。