Rutgers New Jersey Medical School, Newark, NJ, United States of America; New Jersey Poison Information and Education system, Newark, NJ, United States of America.
Rutgers New Jersey Medical School, Newark, NJ, United States of America.
Am J Emerg Med. 2023 Jun;68:10-16. doi: 10.1016/j.ajem.2023.02.031. Epub 2023 Mar 2.
Emergency Department Peer Navigator Programs (EDPN) have been shown to increase the prescribing of medications for opioid use disorder (MOUD) and improve linkage to addiction care. However, what is not known is whether it can improve overall clinical outcomes and healthcare utilization in patients with OUD.
This is a single-center, IRB approved, retrospective cohort study using patients with OUD enrolled in our peer navigator program from 11/7/19 to 2/16/21. On an annual basis, we determined MOUD clinic follow-up rates and clinical outcomes in those patients who utilized our EDPN program. Finally, we also looked at the social determinants of health factors (e.g., race, status of medical insurance, lack of housing, access to phone and/or internet, employment, etc.) that impact our patients clinical outcomes. ED and inpatient provider notes were reviewed to determine causes of ED visits and hospitalizations one year before and after enrollment into the program. The clinical outcomes of interest were number of ED visits from all-causes, number of ED visits from opioid-related causes, number of hospitalizations from all-causes, and number of hospitalizations from opioid-related causes one year after enrollment into our EDPN program, subsequent urine drug screens, and mortality. Demographic and socioeconomic factors (age, gender, race, employment, housing, insurance status, access to phone) were also analyzed to determine if any were independently associated with clinical outcomes. Death and cardiac arrests were noted. Clinical outcomes data were described using descriptive statistics and compared using t-tests.
149 patients with OUD were included in our study. 39.6% had an opioid-related chief complaint at their index ED visit; 51.0% had any recorded history of MOUD and 46.3% had history of buprenorphine use. 31.5% had buprenorphine given in the ED with individual doses ranging from 2 to 16 mg and 46.3% were provided with a buprenorphine prescription. The average number of ED visits 1-year pre vs post enrollment, respectively, for all-causes was 3.09 vs 2.20 (p < 0.01); for opioid related complications 1.80 vs 0.72 (p < 0. 01). The average number of hospitalizations 1-year pre and post enrollment, respectively, for all-causes was 0.83 vs 0.60 (p = 0.05); for opioid related complications 0.39 vs 0.09 (p < 0.01). ED visits from all-causes decreased in 90 (60.40%) patients, had no change in 28 (18.79%) patients, and increased in 31 (20.81%) patients (p < 0.01). ED visits from opioid-related complications decreased in 92 (61.74%) patients, had no change in 40 (26.85%) patients, and increased in 17 (11.41%) (p < 0.01). Hospitalizations from all causes decreased in 45 (30.20%) patients, had no change in 75 patients (50.34%), and increased in 29 (19.46%) patients (p < 0.01). Lastly, hospitalizations from opioid-related complications decreased in 31 (20.81%) patients, had no change in 113 (75.84%) patients, and increased in 5 (3.36%) patients (p < 0.01). There were no socioeconomic factors that had a statistically significant association with clinical outcomes. Two patients (1.2%) died within 1 year after study enrollment.
Our study found that there was an association between implementation of an EDPN program and decreases in ED visits and hospitalizations from both all-causes as well as from opioid-related complications for patients with opioid use disorder.
急诊部同伴导航员计划（EDPN）已被证明可以增加阿片类药物使用障碍（MOUD）的药物处方，并改善成瘾治疗的衔接。然而，目前尚不清楚它是否可以改善患有 OUD 患者的整体临床结果和医疗保健利用情况。
这是一项单中心、IRB 批准的回顾性队列研究，使用了我们同伴导航员计划从 11/7/19 到 2/16/21 期间招募的患有 OUD 的患者。每年，我们确定使用我们的 EDPN 计划的患者的 MOUD 诊所随访率和临床结果。最后，我们还研究了影响我们患者临床结果的健康社会决定因素（例如，种族、医疗保险状况、无住房、是否能使用电话和/或互联网、就业等）。审查 ED 和住院提供者的记录，以确定参加该计划前后一年中 ED 就诊和住院的原因。研究的临床结果包括所有原因的 ED 就诊次数、阿片类药物相关原因的 ED 就诊次数、所有原因的住院次数和阿片类药物相关原因的住院次数、随后的尿液药物筛查和死亡率。还分析了人口统计学和社会经济因素（年龄、性别、种族、就业、住房、保险状况、是否能使用电话），以确定是否有任何因素与临床结果独立相关。记录死亡和心脏骤停的情况。使用描述性统计数据描述临床结果数据，并使用 t 检验进行比较。
我们的研究纳入了 149 名患有 OUD 的患者。39.6%的患者在首次 ED 就诊时主诉与阿片类药物相关的问题；51.0%有记录的 MOUD 治疗史，46.3%有丁丙诺啡使用史。31.5%的患者在 ED 中接受了丁丙诺啡治疗，个体剂量范围为 2 至 16 毫克，46.3%的患者获得了丁丙诺啡处方。1 年前和入组后 1 年的 ED 就诊次数分别为 3.09 次和 2.20 次（p<0.01）；阿片类药物相关并发症的就诊次数分别为 1.80 次和 0.72 次（p<0.01）。1 年前和入组后 1 年的住院次数分别为 0.83 次和 0.60 次（p=0.05）；阿片类药物相关并发症的住院次数分别为 0.39 次和 0.09 次（p<0.01）。90 名（60.40%）患者的所有原因的 ED 就诊次数减少，28 名（18.79%）患者的 ED 就诊次数没有变化，31 名（20.81%）患者的 ED 就诊次数增加（p<0.01）。92 名（61.74%）患者的阿片类药物相关并发症的 ED 就诊次数减少，40 名（26.85%）患者的 ED 就诊次数没有变化，17 名（11.41%）患者的 ED 就诊次数增加（p<0.01）。45 名（30.20%）患者的所有原因的住院次数减少，75 名（50.34%）患者的住院次数没有变化，29 名（19.46%）患者的住院次数增加（p<0.01）。最后，31 名（20.81%）患者的阿片类药物相关并发症的住院次数减少，113 名（75.84%）患者的住院次数没有变化，5 名（3.36%）患者的住院次数增加（p<0.01）。没有社会经济因素与临床结果有统计学显著关联。两名患者（1.2%）在研究入组后 1 年内死亡。
我们的研究发现，实施同伴导航员计划与患有阿片类药物使用障碍的患者的 ED 就诊和住院次数从所有原因和阿片类药物相关并发症的减少有关。
