Reuter Quentin R, Santos Amanda Dos, McKinnon Jamie, Gothard David, Jouriles Nicholas, Seaberg David
Department of Emergency Medicine, Summa Health System, Akron, OH, United States of America.
Department of Emergency Medicine, Summa Health System, Akron, OH, United States of America.
Am J Emerg Med. 2022 May;55:98-102. doi: 10.1016/j.ajem.2022.02.041. Epub 2022 Feb 23.
Medication for Opioid Use Disorder (MOUD) has been shown to decrease mortality, reduce overdoses, and increase treatment retention for patients with opioid use disorder (OUD) and has become the state-of-the-art treatment strategy in the emergency department (ED). There is little evidence on long-term (6 and 12 month) treatment retention outcomes for patients enrolled in MOUD from the ED.
A prospective observational study used a convenience sample of patients seen at one community hospital ED over 12 months. Patients >18 years with OUD were eligible for MOUD enrollment. After medical screening, patients were evaluated by the addiction care coordinator (ACC) who evaluated and counselled the patient and if eligible, directly connected them with an addiction medicine appointment. Once enrolled, the patient received treatment with buprenorphine in the ED. A chart review was completed for all enrollments during the first year of the program. Treatment retention was determined by review of the prescription drug monitoring program and defined as patients receiving regular suboxone prescriptions at 6 and 12 months after index ED visit date.
From June 2018 - May 2019 the ACCs evaluated patients during 691 visits, screening 571 unique patients. Of the 571 unique patients screened, 279 (48.9%) were enrolled into the MOUD program. 210 (75.3%) attended their first addiction medicine appointment, 151 (54.1%) were engaged in treatment at 1 month, 120 (43.0%) at 3 months, 105 (37.6%) at 6 months, and 97 (34.8%) at 12 months post index ED visit. Self-pay insurance status was associated with a significantly decrease in the odds of long-term treatment retention.
Our ED-initiated MOUD program, in partnership with local addiction medicine services, produced high rates of long-term treatment retention.
阿片类物质使用障碍药物治疗（MOUD）已被证明可降低死亡率、减少过量用药，并提高阿片类物质使用障碍（OUD）患者的治疗留存率，已成为急诊科（ED）的标准治疗策略。关于从急诊科登记参加MOUD治疗的患者的长期（6个月和12个月）治疗留存结果的证据很少。
一项前瞻性观察性研究采用了在一家社区医院急诊科就诊超过12个月的患者的便利样本。年龄大于18岁的OUD患者有资格登记参加MOUD治疗。经过医学筛查后，患者由成瘾护理协调员（ACC）进行评估，ACC对患者进行评估和咨询，如符合条件，则直接为其安排成瘾医学预约。一旦登记，患者在急诊科接受丁丙诺啡治疗。在该项目的第一年，对所有登记患者进行了病历审查。治疗留存率通过审查处方药监测项目来确定，定义为在首次急诊科就诊日期后的6个月和12个月接受常规丁丙诺啡处方的患者。
从2018年6月至2019年5月，ACC在691次就诊中对患者进行了评估，筛查了571名不同患者。在筛查的571名不同患者中，279名（48.9%）登记参加了MOUD项目。210名（75.3%）患者参加了他们的第一次成瘾医学预约，151名（54.1%）患者在1个月时参与治疗，120名（43.0%）在3个月时参与治疗，105名（37.6%）在6个月时参与治疗，97名（34.8%）在首次急诊科就诊后的12个月时参与治疗。自费保险状况与长期治疗留存几率的显著降低相关。
我们由急诊科发起的MOUD项目，与当地成瘾医学服务机构合作，产生了较高的长期治疗留存率。
