Lower Mainland Pharmacy Services, Vancouver, BC, Canada.
Pharmacy Department, Vancouver General Hospital, 899 W 12th avenue, Vancouver, BC, V5Z 1M9, Canada.
BMC Health Serv Res. 2024 Feb 15;24(1):211. doi: 10.1186/s12913-023-10271-7.
Take-home buprenorphine/naloxone is an effective method of initiating opioid agonist therapy in the Emergency Department (ED) that requires ED healthcare worker buy-in for large-scale implementation. We aimed to investigate healthcare workers perceptions of ED take-home buprenorphine/naloxone, as well as barriers and facilitators from an ED healthcare worker perspective.
In the context of a take-home buprenorphine/naloxone feasibility study at a tertiary care teaching hospital we conducted a descriptive qualitative study. We conducted one-on-one in person or telephone interviews and focus groups with ED healthcare workers who cared for patients given take-home buprenorphine/naloxone in the feasibility study at Vancouver General Hospital from July 2019 to March 2020. We conducted 37 healthcare worker interviews from December 2019 to July 2020. We audio recorded interviews and focus groups and transcribed them verbatim. We completed interviews until we reached thematic saturation.
We inductively coded a sample of transcripts to generate a provisional coding structure and to identify emerging themes, which were reviewed by our multidisciplinary team. We then used the final coding structure to analyze the transcripts. We present our findings descriptively.
Participants identified a number of context-specific facilitators and barriers to take-home buprenorphine/naloxone provision in the ED. Participants highlighted ED conditions having either facilitative or prohibitive effects: provision of buprenorphine/naloxone was feasible when ED volume was low and space was available but became less so as ED volume increased and space decreased. Similarly, participants noted that patient-related factors could have a facilitative or prohibitive effect, such as willingness to wait (willing to stay in the ED for study-related activities and buprenorphine/naloxone initiation activities), receptiveness to buprenorphine/naloxone, and comprehension of the instructions. As for staff-related factors, time was identified as a consistent barrier. Time included time available and time required to initiate buprenorphine/naloxone (including time building rapport). Healthcare worker familiarity with buprenorphine/naloxone was noted as either a facilitating factor or a barrier, and healthcare workers indicated that ongoing training would have been advantageous. Many healthcare workers identified that the ED is an important first point of contact for the target patient population.
Integrating a buprenorphine/naloxone program into ED care requires organizational supports (e.g., for managing buprenorphine/naloxone within limitations of ED volume, space, and time), and ongoing education of healthcare workers to minimize identified barriers.
带教美沙酮/纳洛酮是在急诊室（ED）启动阿片类激动剂治疗的有效方法，需要 ED 医护人员的认可才能大规模实施。我们旨在从 ED 医护人员的角度调查他们对 ED 带教美沙酮/纳洛酮的看法，以及障碍和促进因素。
在一家三级教学医院的带教美沙酮/纳洛酮可行性研究的背景下，我们进行了一项描述性定性研究。我们对 2019 年 7 月至 2020 年 3 月在温哥华综合医院参加可行性研究的接受带教美沙酮/纳洛酮的患者进行了 ED 医护人员的一对一面对面或电话访谈和焦点小组。我们于 2019 年 12 月至 2020 年 7 月进行了 37 名医护人员的访谈。我们对访谈和焦点小组进行了录音，并逐字记录下来。我们完成了访谈，直到达到主题饱和。
我们对一个转录本样本进行了归纳编码，以生成一个临时编码结构，并确定新兴主题，然后由我们的多学科团队进行审查。然后，我们使用最终的编码结构来分析转录本。我们以描述性的方式呈现我们的发现。
参与者确定了 ED 中带教美沙酮/纳洛酮提供的一些特定于情境的促进因素和障碍。参与者强调了 ED 条件对带教美沙酮/纳洛酮的提供具有促进或抑制作用：当 ED 量低且空间可用时，提供美沙酮/纳洛酮是可行的，但随着 ED 量的增加和空间的减少，这种情况变得不那么可行。同样，参与者注意到患者相关因素可能具有促进或抑制作用，例如愿意等待（愿意留在 ED 参加与研究相关的活动和启动美沙酮/纳洛酮）、对美沙酮/纳洛酮的接受程度以及对说明的理解。至于员工相关因素，时间被确定为一个持续的障碍。时间包括可用时间和启动美沙酮/纳洛酮所需的时间（包括建立融洽关系的时间）。医护人员对美沙酮/纳洛酮的熟悉程度被认为是促进因素或障碍，医护人员表示，持续培训将是有利的。许多医护人员认为 ED 是目标患者人群的重要第一接触点。
将美沙酮/纳洛酮计划纳入 ED 护理需要组织支持（例如，管理 ED 量、空间和时间限制内的美沙酮/纳洛酮），并对医护人员进行持续教育，以尽量减少已确定的障碍。
