Ajumobi Olufemi, Friedman Sarah, Granner Michelle, Lucero Julie, Westhoff John, Koch Brandon, Wagner Karla D
School of Public Health, University of Nevada, Reno, NV, USA.
College of Health, University of Utah, Salt Lake City, UT, USA.
Implement Sci Commun. 2024 Sep 27;5(1):104. doi: 10.1186/s43058-024-00649-x.
Patients presenting to Emergency Departments (ED) with opioid use disorder may be candidates for buprenorphine treatment, making EDs an appropriate setting to initiate this underused, but clinically proven therapy. Hospitals are devoting increased efforts to routinizing buprenorphine initiation in the ED where clinically appropriate, with the greatest successes occurring in academic medical centers. Overall, however, clinician participation in these efforts is suboptimal. Hospitals need more information to inform the standardized implementation of these programs nationally. Using an implementation science framework, we investigated ED providers' concerns about ED buprenorphine programs and their willingness to prescribe buprenorphine in the ED.
We conducted Consolidated Framework for Implementation Research (CFIR)-informed interviews with 11 ED staff in Nevada and analyzed the transcripts using a six-step thematic approach. Results were organized within the CFIR 1.0 domains of inner setting, outer setting, intervention characteristics, and individual characteristics; potential implementation strategies were recommended.
Physicians expressed that the ED is a suitable location for prescribing buprenorphine. However, they expressed concerns about: information gaps in the prescribing protocols (inner setting), patient outcomes beyond the ED, buprenorphine effectiveness and appropriate timing of treatment initiation (intervention characteristics), and their own competence in managing opioid withdrawal (individual characteristics). Some were anxious about patients' outcomes and continuity of care in the community (outer setting), others desired access to prospective data that demonstrate buprenorphine effectiveness. Additional concerns included a lack of availability of the required support to prescribe buprenorphine, a lack of physicians' experience and competence, and concerns about opioid withdrawal. Recommended implementation strategies to address these concerns include: designating personnel at the ED to bridge the information gap, engaging emergency physicians through educational meetings, creating a community of practice, facilitating mentorship opportunities, and leveraging existing collaborative learning platforms.
Overall, physicians in our study believed that implementing a buprenorphine program in the ED is appropriate, but had concerns. Implementation strategies could be deployed to address concerns at multiple levels to increase physician willingness and program uptake.
因阿片类药物使用障碍而前往急诊科（ED）就诊的患者可能是丁丙诺啡治疗的候选对象，这使得急诊科成为启动这种未得到充分利用但经临床验证的治疗方法的合适场所。医院正在加大力度，在临床上合适的情况下，在急诊科常规启动丁丙诺啡治疗，在学术医疗中心取得的成功最为显著。然而，总体而言，临床医生对这些努力的参与度并不理想。医院需要更多信息，以便在全国范围内规范实施这些项目。我们使用实施科学框架，调查了急诊科医护人员对急诊科丁丙诺啡项目的担忧以及他们在急诊科开具丁丙诺啡的意愿。
我们在内华达州对11名急诊科工作人员进行了基于实施研究综合框架（CFIR）的访谈，并采用六步主题分析法对访谈记录进行了分析。结果按照CFIR 1.0的内部环境、外部环境、干预特征和个人特征等领域进行整理；并推荐了潜在的实施策略。
医生们表示，急诊科是开具丁丙诺啡的合适场所。然而，他们表达了以下担忧：处方协议中的信息空白（内部环境）、急诊科之外的患者治疗结果、丁丙诺啡的有效性以及开始治疗的合适时机（干预特征），以及他们自己管理阿片类药物戒断的能力（个人特征）。一些人担心患者在社区的治疗结果和护理连续性（外部环境），另一些人希望能够获取证明丁丙诺啡有效性的前瞻性数据。其他担忧包括缺乏开具丁丙诺啡所需的支持、医生缺乏经验和能力，以及对阿片类药物戒断的担忧。针对这些担忧推荐的实施策略包括：在急诊科指定人员以弥合信息差距、通过教育会议吸引急诊医生、创建实践社区、促进指导机会，以及利用现有的协作学习平台。
总体而言，我们研究中的医生认为在急诊科实施丁丙诺啡项目是合适的，但存在担忧。可以部署实施策略，在多个层面解决这些担忧，以提高医生的意愿和项目的采用率。
