Summa Health System, Department of Emergency Medicine, Akron, Ohio.
US Acute Care Solutions, Canton, Ohio.
West J Emerg Med. 2022 Jun 29;23(5):684-692. doi: 10.5811/westjem.2022.3.53197.
The emergency department (ED) is an effective setting for initiating medication for opioid use disorder (MOUD); however, predicting who will remain in treatment remains a central challenge. We hypothesize that baseline stage-of-change (SOC) assessment is associated with short-term treatment retention outcomes.
This is a longitudinal cohort study of all patients enrolled in an ED MOUD program over 12 months. Eligible and willing patients were treated with buprenorphine at baseline and had addiction medicine specialist follow-up arranged. Treatment retention at 30 and 90 days was determined by review of the Prescription Drug Monitoring Program. We used uni- and multivariate logistic regression to evaluate associations between patient variables and treatment retention at 30 and 90 days.
From June 2018-May 2019, 279 patients were enrolled in the ED MOUD program. Of those patients 151 (54.1%) and 120 (43.0%) remained engaged in MOUD treatment at 30 and 90 days, respectively. The odds of treatment adherence at 30 days were significantly higher for those with advanced SOC (preparation/action/maintenance) compared to those presenting with limited SOC (pre-contemplation/contemplation) (60.0% vs 40.8%; odds ratio 2.18; 95% confidence interval 1.15 to 4.1; P <0.05). At 30 days, multivariate logistic regression determined that advanced SOC, age >40, having medical insurance, and being employed were significant predictors of continued treatment adherence. At 90 days, advanced SOC, non-White race, age > 40, and having insurance were all significantly associated with higher likelihood of treatment engagement.
Greater stage-of-change was significantly associated with MOUD treatment retention at 30 and 90 days post index ED visit.
急诊部（ED）是启动阿片类药物使用障碍（MOUD）药物治疗的有效场所；然而，预测谁将继续接受治疗仍然是一个核心挑战。我们假设基线阶段变化（SOC）评估与短期治疗保留结果相关。
这是一项对在 12 个月内参加 ED MOUD 计划的所有患者进行的纵向队列研究。合格且愿意的患者在基线时接受丁丙诺啡治疗，并安排了成瘾医学专家进行随访。通过审查处方药物监测计划来确定 30 天和 90 天的治疗保留情况。我们使用单变量和多变量逻辑回归来评估患者变量与 30 天和 90 天治疗保留之间的关系。
从 2018 年 6 月至 2019 年 5 月，共有 279 名患者参加了 ED MOUD 计划。在这些患者中，分别有 151 名（54.1%）和 120 名（43.0%）在 30 天和 90 天内继续接受 MOUD 治疗。与 SOC 水平较低的患者（预备/考虑/维持）相比，SOC 水平较高的患者（预备/行动/维持）在 30 天内治疗依从性的可能性显著更高（60.0% vs. 40.8%；比值比 2.18；95%置信区间 1.15 至 4.1；P <0.05）。在 30 天时，多变量逻辑回归确定 SOC 水平较高、年龄>40 岁、有医疗保险和就业是继续治疗依从性的显著预测因素。在 90 天时，SOC 水平较高、非白种人、年龄>40 岁和有保险均与治疗参与的可能性更高显著相关。
SOC 水平较高与 ED 就诊后 30 天和 90 天 MOUD 治疗保留率显著相关。
