Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey.
Boston University School of Social Work, Boston, Massachusetts.
JAMA Netw Open. 2024 Mar 4;7(3):e243614. doi: 10.1001/jamanetworkopen.2024.3614.
Patients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department-based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking.
To examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization.
DESIGN, SETTING, AND PARTICIPANTS: This intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023.
Hospital OORP implementation.
The primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access.
A total of 12 046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (-0.086; 95% CI, -0.154 to -0.018) and 5 half-years (-0.106; 95% CI, -0.184 to -0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities.
In this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.
在急诊科（ED）接受阿片类药物过量治疗的患者通常需要药物治疗，但出院后很少与服务机构联系。以 ED 为基础的同伴支持是促进治疗联系的一种很有前途的方法，但缺乏其有效性的证据。
研究阿片类药物过量康复计划（OORP），一种 ED 同伴康复支持服务，与出院后成瘾治疗的开始、重复药物过量和急性护理利用之间的关系。
设计、地点和参与者：这是一项 2014 年至 2020 年新泽西州医疗补助数据的意向治疗回顾性队列研究，研究对象为 2015 年 1 月至 2020 年 6 月在新泽西州 70 家急性护理医院接受非致命性阿片类药物过量治疗的年龄在 18 至 64 岁之间的医疗补助受保人。数据于 2022 年 8 月至 2023 年 11 月进行分析。
医院 OORP 的实施。
主要结局是出院后 60 天内开始使用治疗阿片类药物使用障碍的药物（MOUD）。次要结局包括开始接受心理社会治疗、药物过量治疗和出院后的所有原因急性护理就诊。采用事件研究设计比较了在 OORP 医院和非 OORP 医院接受治疗的患者在 180 天内的结局。分析调整了患者的人口统计学特征、合并症和既往服务使用情况，以及社区层面的社会人口统计学特征和药物治疗可及性。
共有 12046 人参与了这项研究（62.0%为男性）。在 OORP 实施前，接受 OORP 和非 OORP 治疗的患者的结局趋势相似。OORP 的实施与出院后半年内 MOUD 开始的概率增加了 0.034（95%置信区间，0.004-0.064），比实施前的平均概率 0.075（95%置信区间，0.066-0.084）增加了 45%。该项目的实施与 4 个半年（-0.086；95%置信区间，-0.154 至 -0.018）和 5 个半年（-0.106；95%置信区间，-0.184 至 -0.028）的重复接受医疗治疗的药物过量有关。结果因参考期的不同而略有差异，医院特异性模型显示设施之间的治疗效果存在很大差异。
在这项对接受阿片类药物过量治疗的患者进行的队列研究中，OORP 的实施与 MOUD 使用率的增加和重复接受医疗治疗的药物过量减少有关。医院之间结果的巨大差异表明，治疗效果存在异质性，可能取决于实施成功、项目嵌入程度以及其他医院和社区阿片类药物使用障碍服务的可用性等因素。
