Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Suite A, Salt Lake City, UT, 84108, USA.
Department of Emergency Medicine, University of Utah School of Medicine, 50 N. Medical Drive, Salt Lake City, UT, 84132, USA.
Addict Sci Clin Pract. 2024 Sep 3;19(1):63. doi: 10.1186/s13722-024-00496-0.
Opioid related overdose morbidity and mortality continue to significantly impact rural communities. Nationwide, emergency departments (EDs) have seen an increase in opioid use disorder (OUD)-related visits compared to other substance use disorders (SUD). ED-initiated buprenorphine is associated with increased treatment engagement at 30 days. However, few studies assess rural ED-initiated buprenorphine implementation, which has unique implementation barriers. This protocol outlines the rationale and methods of a rural ED-initiated buprenorphine program implementation study.
This is a two-year longitudinal implementation design with repeated qualitative and quantitative measures of an ED-initiated buprenorphine program in the rural Mountain West. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outlines intervention assessments. The primary outcome is implementation measured by ED-initiated buprenorphine protocol core components. Reach, adoption, and maintenance are secondary outcomes. External facilitators from an academic institution with addiction medicine and prior program implementation expertise partnered with community hospital internal facilitators to form an implementation team. External facilitators provide ongoing support, recommendations, education, and academic detailing. The implementation team designed and implemented the rural ED-initiated buprenorphine program. The program includes OUD screening, low-threshold buprenorphine initiation, naloxone distribution and administration training, and patient navigator incorporation to provide warm hand off referrals for outpatient OUD management. To address rural based implementation barriers, we organized implementation strategies based on Expert Recommendations for Implementing Change (ERIC). Implementation strategies include ED workflow redesign, local needs assessments, ED staff education, hospital leadership and clinical champion involvement, as well as patient and community resources engagement.
Most ED-initiated buprenorphine implementation studies have been conducted in urban settings, with few involving rural areas and none have been done in the rural Mountain West. Rural EDs face unique barriers, but tailored implementation strategies with external facilitation support may help address these. This protocol could help identify effective rural ED-initiated buprenorphine implementation strategies to integrate more accessible OUD treatment within rural communities to prevent further morbidity and mortality.
ClinicalTrials.gov National Clinical Trials, NCT06087991. Registered 11 October 2023 - Retrospectively registered, https://clinicaltrials.gov/study/NCT06087991 .
阿片类药物相关的过量发病率和死亡率继续对农村社区产生重大影响。全国范围内，与其他物质使用障碍（SUD）相比，急诊部（ED）的阿片类药物使用障碍（OUD）相关就诊人数有所增加。ED 启动的丁丙诺啡与 30 天内增加的治疗参与度相关。然而，很少有研究评估农村 ED 启动丁丙诺啡的实施情况，因为这存在独特的实施障碍。本方案概述了在农村西部 ED 启动丁丙诺啡项目实施研究的基本原理和方法。
这是一项为期两年的纵向实施设计，通过对农村山区西部 ED 启动丁丙诺啡项目的重复定性和定量措施来评估该项目。Reach、Effectiveness、Adoption、Implementation 和 Maintenance（RE-AIM）框架概述了干预措施的评估。主要结果是通过 ED 启动丁丙诺啡方案的核心组成部分来衡量实施情况。可达性、采用率和维持率是次要结果。具有成瘾医学和先前项目实施专业知识的学术机构的外部推动者与社区医院内部推动者合作，组成了一个实施团队。外部推动者提供持续的支持、建议、教育和学术细化。实施团队设计并实施了农村 ED 启动的丁丙诺啡项目。该项目包括 OUD 筛查、低门槛丁丙诺啡启动、纳洛酮分发和管理培训以及患者导航员的纳入，以提供门诊 OUD 管理的温暖交接转诊。为了解决农村地区的实施障碍，我们根据专家推荐的变革实施（ERIC）组织实施策略。实施策略包括 ED 工作流程重新设计、当地需求评估、ED 员工教育、医院领导和临床拥护者的参与，以及患者和社区资源的参与。
大多数 ED 启动的丁丙诺啡实施研究都是在城市环境中进行的，很少有涉及农村地区的，也没有在农村山区西部进行的。农村 ED 面临着独特的障碍，但外部推动的量身定制的实施策略可能有助于解决这些问题。该方案可以帮助确定有效的农村 ED 启动丁丙诺啡实施策略，以在农村社区中整合更便捷的 OUD 治疗，以防止进一步的发病率和死亡率。
ClinicalTrials.gov 国家临床试验，NCT06087991。2023 年 10 月 11 日注册-回顾性注册，https://clinicaltrials.gov/study/NCT06087991。
