Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America.
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America.
J Subst Abuse Treat. 2022 May;136:108658. doi: 10.1016/j.jsat.2021.108658. Epub 2021 Nov 8.
Emergency departments (ED) are a critical touchpoint for patients with opioid use disorder (OUD). In 2019, Pennsylvania had the fifth highest drug overdose mortality rate in the United States. State efforts have focused on implementing evidence-based ED care protocols, including induction of buprenorphine and warm handoffs to community treatment.
We examined hospital staff's perspectives on the processes, challenges, and facilitators to buprenorphine initiation and warm handoff protocols in the ED.
We used a qualitative case study design to focus on six Pennsylvania hospitals. The study selected hospitals using purposive sampling to capture varying hospital size, rurality, teaching status, and phase of protocol implementation. The study staff interviewed hospital staff with key roles in OUD care delivery in the ED, which included administrators, physicians, nurses, recovery support professionals, care coordinators, a social worker, and a pharmacist. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured virtual interviews with 21 key informants from June to November 2020. Interviews were transcribed, deductively coded, and analyzed using CFIR domains and constructs to summarize factors influencing implementation of OUD ED care protocols and warm handoff to care protocols, as well as suggestions that emerged between and across cases.
Despite variation in the local context between hospitals, we identified common themes that influenced buprenorphine and warm handoffs across sites. Attention to hospital OUD care through state-level initiatives like the Hospital Quality Improvement Program generated hospital leadership buy-in toward implementing best OUD care practices. Factors at the hospital-level that influenced implementation success included supporting interdisciplinary OUD care champions, addressing knowledge gaps and biases around patients with OUD, having data systems that capture OUD care and integrate clinical protocols, incorporating patient comorbidities and non-medical needs into care, and fostering community provider linkages and capacity for warm handoffs. Although themes were largely consistent among hospital and staff types, protocol implementation was tailored by each hospital's size, patient volume, and hospital and community resources.
By understanding frontline staff's perspectives around factors that impact OUD care practices in the ED, stakeholders may better optimize implementation efforts.
急诊科（ED）是患有阿片类药物使用障碍（OUD）患者的关键接触点。2019 年，宾夕法尼亚州的药物过量死亡率在美国排名第五。该州的努力重点是实施基于证据的 ED 护理方案，包括丁丙诺啡诱导和向社区治疗的温暖交接。
我们研究了医院工作人员对 ED 中丁丙诺啡启动和温暖交接方案的过程、挑战和促进因素的看法。
我们使用定性案例研究设计，重点关注宾夕法尼亚州的六家医院。该研究使用目的抽样选择医院，以捕捉不同医院的规模、农村、教学地位和协议实施阶段。研究人员采访了在 ED 中 OUD 护理提供方面具有关键作用的医院工作人员，包括管理人员、医生、护士、康复支持专业人员、护理协调员、社会工作者和药剂师。研究人员以实施研究综合框架（CFIR）为指导，于 2020 年 6 月至 11 月期间对 21 名关键信息提供者进行了半结构化虚拟访谈。访谈记录被转录，使用 CFIR 领域和结构进行演绎编码和分析，以总结影响 OUD ED 护理方案和向护理方案进行温暖交接实施的因素，以及在各个案例之间出现的建议。
尽管医院之间的当地情况存在差异，但我们确定了影响跨站点丁丙诺啡和温暖交接的共同主题。通过州级倡议，如医院质量改进计划，关注医院 OUD 护理，使医院领导层对实施最佳 OUD 护理实践产生了认同。影响实施成功的医院层面因素包括支持跨学科 OUD 护理冠军、解决对 OUD 患者的知识差距和偏见、拥有可捕获 OUD 护理并整合临床方案的数据分析系统、将患者合并症和非医疗需求纳入护理、以及促进社区提供者的联系和温暖交接的能力。尽管主题在医院和工作人员类型之间基本一致，但每个医院的规模、患者量以及医院和社区资源决定了协议的实施方式。
通过了解一线工作人员对 ED 中 OUD 护理实践的影响因素的看法，利益相关者可以更好地优化实施工作。
