Jacobi Medical Center, Department of Emergency Medicine, Bronx, New York.
Albert Einstein College of Medicine, Department of Emergency Medicine, Bronx, New York.
West J Emerg Med. 2024 May;25(3):303-311. doi: 10.5811/westjem.18320.
Emergency departments (ED) are in the unique position to initiate buprenorphine, an evidence-based treatment for opioid use disorder (OUD). However, barriers at the system and clinician level limit its use. We describe a series of interventions that address these barriers to ED-initiated buprenorphine in one urban ED. We compare post-intervention physician outcomes between the study site and two affiliated sites without the interventions.
This was a cross-sectional study conducted at three affiliated urban EDs where the intervention site implemented OUD-related electronic note templates, clinical protocols, a peer navigation program, education, and reminders. Post-intervention, we administered an anonymous, online survey to physicians at all three sites. Survey domains included demographics, buprenorphine experience and knowledge, comfort with addressing OUD, and attitudes toward OUD treatment. Physician outcomes were compared between the intervention site and the control sites with bivariate tests. We used logistic regression controlling for significant demographic differences to compare physicians' buprenorphine experience.
Of 113 (51%) eligible physicians, 58 completed the survey: 27 from the intervention site, and 31 from the control sites. Physicians at the intervention site were more likely to spend <75% of their work week in clinical practice and to be in medical practice for <7 years. Buprenorphine knowledge (including status of buprenorphine prescribing waiver), comfort with addressing OUD, and attitudes toward OUD treatment did not differ significantly between the sites. Physicians were 4.5 times more likely to have administered buprenorphine at the intervention site (odds ratio [OR] 4.5, 95% confidence interval 1.4-14.4, = 0.01), which remained significant after adjusting for clinical time and years in practice, (OR 3.5 and 4.6, respectively).
Physicians exposed to interventions addressing system- and clinician-level implementation barriers were at least three times as likely to have administered buprenorphine in the ED. Physicians' buprenorphine knowledge, comfort with addressing and attitudes toward OUD treatment did not differ significantly between sites. Our findings suggest that ED-initiated buprenorphine can be facilitated by addressing implementation barriers, while physician knowledge, comfort, and attitudes may be harder to improve.
急诊部门（ED）处于独特的位置，可以启动丁丙诺啡，这是一种治疗阿片类药物使用障碍（OUD）的循证治疗方法。然而，系统和临床医生层面的障碍限制了其使用。我们描述了一系列干预措施，旨在解决一个城市 ED 中启动丁丙诺啡的这些障碍。我们比较了研究地点和两个没有干预措施的附属地点的干预后医生的结果。
这是一项在三个附属城市 ED 进行的横断面研究，干预地点实施了与 OUD 相关的电子记录模板、临床方案、同伴导航计划、教育和提醒。干预后，我们向所有三个地点的医生进行了匿名在线调查。调查领域包括人口统计学、丁丙诺啡经验和知识、处理 OUD 的舒适度以及对 OUD 治疗的态度。通过二元检验比较干预地点和对照地点的医生结果。我们使用逻辑回归控制显著的人口统计学差异，比较医生的丁丙诺啡经验。
在 113 名（51%）符合条件的医生中，有 58 名完成了调查：27 名来自干预地点，31 名来自对照地点。干预地点的医生更有可能每周工作时间少于 75%，并且从事医疗工作不到 7 年。在处理 OUD 的舒适度和对 OUD 治疗的态度方面，各地点之间没有显著差异。在干预地点接受丁丙诺啡治疗的医生可能性是对照地点的 4.5 倍（比值比[OR]4.5，95%置信区间 1.4-14.4，=0.01），调整临床时间和从业年限后仍然显著（OR 分别为 3.5 和 4.6）。
接触解决系统和临床医生层面实施障碍的干预措施的医生，至少有三倍的可能性在 ED 中开出丁丙诺啡。医生的丁丙诺啡知识、处理 OUD 的舒适度和对 OUD 治疗的态度在各地点之间没有显著差异。我们的研究结果表明，通过解决实施障碍，可以促进 ED 启动丁丙诺啡，而医生的知识、舒适度和态度可能更难改善。
