Erick Guerrero1, Allison J Ober2, Daniel L Howard3, Tenie Khachikian4, Yinfei Kong5, Welmoed K van Deen6, Avelardo Valdez7, Rebecca Trotzky-Sirr8, Michael Menchine9. 1. I-LEAD Institute - Research to End Healthcare Disparities Corp, 150 Ocean Park Blvd, Santa Monica, CA, USA. Electronic address: erickguerrero454@gmail.com. 2. Rand Corporation, Santa Monica, CA, USA. Electronic address: ober@rand.org. 3. Texas A&M University, Public Policy Research Institute, College Station, TX, USA. Electronic address: dhoward@ppri.tamu.edu. 4. University of Chicago, IL, USA. Electronic address: tenie@uchicago.edu. 5. Mihaylo College of Business and Economics, California State University, Fullerton, CA, USA. 6. Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, CA, USA. Electronic address: welmoed.vandeen@cshs.org. 7. School of Social Work, University of Southern California, Los Angeles, CA, USA. Electronic address: avelarv@usc.edu. 8. Emergency Department, Los Angeles County + University of Southern California, Los Angeles, CA, USA. Electronic address: rtrotzky-sirr@dhs.lacounty.gov. 9. Emergency Department, Los Angeles County + University of Southern California, Los Angeles, CA, USA. Electronic address: menchine@usc.edu.
Abstract
BACKGROUND: Despite the significant increase in emergency room visits for opioid overdose, only few emergency departments (ED) have implemented best practices to treat people with opioid use disorders (OUD). Some implementation gaps may be due to practitioner factors; such as support for medication-assisted treatment (MAT) for OUD in the ED. In this study, we explore the relationship between inner setting characteristics of the EDs (e.g., leadership, readiness for change, organizational climate) and practitioner support for OUD treatment and attitudes towards people with OUD. METHODS: We surveyed 241 ED practitioners (e.g., physicians, nurses, social workers) at one of the largest EDs in the United States. We used analysis of variance and chi-square global tests to compare responses from ED practitioners in differing roles. We also conducted five multivariate logistic regressions to explore associations between ED inner setting characteristics and five antecedents of implementation; ED practitioner (1) supports MAT for OUD in the ED, (2) supports best practices to treat OUD, (3) has self-efficacy to treat OUD, (4) has stereotypes of people who use drugs, and (5) has optimism to treat people with OUD. RESULTS: We found nurses were more likely than physicians to support MAT for OUD in the ED and delivering other best practices to treat OUD. At the same time, nurses had greater bias than physicians against working with patients suffering from OUD. We also found the ED's climate for innovation and practitioners' readiness for change were positively associated with support for MAT for OUD in the ED and using best practices to treat OUD. CONCLUSIONS: Findings suggest that professional roles and some ED inner setting factors play an important role in antecedents of implementation of OUD treatment in the ED. To prepare EDs to effectively respond to the current opioid overdose epidemic, it is critical to further understand the impact of these organizational factors on the implementation of evidence-based OUD treatment practices in the nation.
BACKGROUND: Despite the significant increase in emergency room visits for opioid overdose, only few emergency departments (ED) have implemented best practices to treat people with opioid use disorders (OUD). Some implementation gaps may be due to practitioner factors; such as support for medication-assisted treatment (MAT) for OUD in the ED. In this study, we explore the relationship between inner setting characteristics of the EDs (e.g., leadership, readiness for change, organizational climate) and practitioner support for OUD treatment and attitudes towards people with OUD. METHODS: We surveyed 241 ED practitioners (e.g., physicians, nurses, social workers) at one of the largest EDs in the United States. We used analysis of variance and chi-square global tests to compare responses from ED practitioners in differing roles. We also conducted five multivariate logistic regressions to explore associations between ED inner setting characteristics and five antecedents of implementation; ED practitioner (1) supports MAT for OUD in the ED, (2) supports best practices to treat OUD, (3) has self-efficacy to treat OUD, (4) has stereotypes of people who use drugs, and (5) has optimism to treat people with OUD. RESULTS: We found nurses were more likely than physicians to support MAT for OUD in the ED and delivering other best practices to treat OUD. At the same time, nurses had greater bias than physicians against working with patients suffering from OUD. We also found the ED's climate for innovation and practitioners' readiness for change were positively associated with support for MAT for OUD in the ED and using best practices to treat OUD. CONCLUSIONS: Findings suggest that professional roles and some ED inner setting factors play an important role in antecedents of implementation of OUD treatment in the ED. To prepare EDs to effectively respond to the current opioid overdose epidemic, it is critical to further understand the impact of these organizational factors on the implementation of evidence-based OUD treatment practices in the nation.
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