Kathryn Hawk1, Lauretta E Grau2, David A Fiellin1,3, Marek Chawarski4, Patrick G O'Connor3, Nikolas Cirillo1,5, Chris Breen1,6, Gail D'Onofrio1,2. 1. Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA. 2. School of Public Health, Yale University, New Haven, Connecticut, USA. 3. Department of Internal Medicine, Yale University, New Haven, Connecticut, USA. 4. Department of Psychiatry, Yale University, New Haven, Connecticut, USA. 5. Department of Psychology, Nova Southeastern University, Fort Lauderdale, Florida, USA. 6. School of Medicine, Yale University, New Haven, Connecticut, USA.
Abstract
OBJECTIVE: Emergency medicine clinicians are uniquely positioned to deliver interventions to enhance linkage to evidence-based treatment for opioid use disorder (OUD) in the acute overdose period, yet little is known about patient perspectives to effectively engage patients immediately following opioid overdose. Our objective was to explore patients' perspectives on substance use treatment, perceived needs, and contextual factors that shape the choice of patients seen in the emergency department (ED) to engage with treatment and other patient support services in the acute post-opioid overdose period. METHODS: We administered a brief quantitative survey and conducted semistructured interviews with 24 adult ED patients receiving care after an acute opioid overdose between June 2016 and August 2017 in an urban, academic ED. We used constant comparison method and thematic analysis to identify themes across four levels of a modified social ecologic model (individual, interpersonal, organizational, and structural). RESULTS: The mean (±SD) age of the sample was 33.5 (±9.33) years; 83% were White and 12% were Black; 67% were male; and 83% were diagnosed with OUD, with a mean (±SD) of 3.25 (±2.64) self-reported lifetime opioid overdoses. Eight themes were identified as influencing participants' consideration of OUD treatment and other services: (1) perceptions about control of drug use, (2) personal experience with substance use treatment, (3) role of interpersonal relationships, (4) provider communication skills, (5) stigma, (6) availability of ED resources, (7) impact of treatment policies, and (8) support for unmet basic needs. CONCLUSIONS: Patients receiving ED care following overdose in our ED are willing to discuss their opioid use and its treatment in the ED and report a variety of unmet needs. This work supports a role for ED-based research evaluating a patient-oriented approach to engage patients after opioid overdose.
OBJECTIVE: Emergency medicine clinicians are uniquely positioned to deliver interventions to enhance linkage to evidence-based treatment for opioid use disorder (OUD) in the acute overdose period, yet little is known about patient perspectives to effectively engage patients immediately following opioid overdose. Our objective was to explore patients' perspectives on substance use treatment, perceived needs, and contextual factors that shape the choice of patients seen in the emergency department (ED) to engage with treatment and other patient support services in the acute post-opioid overdose period. METHODS: We administered a brief quantitative survey and conducted semistructured interviews with 24 adult ED patients receiving care after an acute opioid overdose between June 2016 and August 2017 in an urban, academic ED. We used constant comparison method and thematic analysis to identify themes across four levels of a modified social ecologic model (individual, interpersonal, organizational, and structural). RESULTS: The mean (±SD) age of the sample was 33.5 (±9.33) years; 83% were White and 12% were Black; 67% were male; and 83% were diagnosed with OUD, with a mean (±SD) of 3.25 (±2.64) self-reported lifetime opioid overdoses. Eight themes were identified as influencing participants' consideration of OUD treatment and other services: (1) perceptions about control of drug use, (2) personal experience with substance use treatment, (3) role of interpersonal relationships, (4) provider communication skills, (5) stigma, (6) availability of ED resources, (7) impact of treatment policies, and (8) support for unmet basic needs. CONCLUSIONS: Patients receiving ED care following overdose in our ED are willing to discuss their opioid use and its treatment in the ED and report a variety of unmet needs. This work supports a role for ED-based research evaluating a patient-oriented approach to engage patients after opioid overdose.
Authors: Joanne E Brady; Charles J DiMaggio; Katherine M Keyes; John J Doyle; Lynne D Richardson; Guohua Li Journal: Ann Epidemiol Date: 2015-04-02 Impact factor: 3.797
Authors: George E Woody; Douglas Bruce; P Todd Korthuis; Sumedha Chhatre; Sabrina Poole; Maureen Hillhouse; Petra Jacobs; James Sorensen; Andrew J Saxon; David Metzger; Walter Ling Journal: J Acquir Immune Defic Syndr Date: 2014-07-01 Impact factor: 3.731
Authors: Teri Browne; Mary Ann Priester; Stephanie Clone; Aidyn Iachini; Dana DeHart; Robert Hock Journal: J Rural Health Date: 2015-07-15 Impact factor: 4.333
Authors: Alister Martin; Nathan Kunzler; Jun Nakagawa; Benjamin Lee; Sarah Wakeman; Scott Weiner; Ali S Raja Journal: Ann Emerg Med Date: 2019-07-02 Impact factor: 5.721
Authors: Rachel P Winograd; Claire A Wood; Erin J Stringfellow; Ned Presnall; Alex Duello; Phil Horn; Tim Rudder Journal: J Subst Abuse Treat Date: 2019-06-26
Authors: Sarah E Wakeman; Marc R Larochelle; Omid Ameli; Christine E Chaisson; Jeffrey Thomas McPheeters; William H Crown; Francisca Azocar; Darshak M Sanghavi Journal: JAMA Netw Open Date: 2020-02-05
Authors: P Todd Korthuis; Mary Jo Tozzi; Vijay Nandi; David A Fiellin; Linda Weiss; James E Egan; Michael Botsko; Angela Acosta; Marc N Gourevitch; David Hersh; Jeffrey Hsu; Joshua Boverman; Frederick L Altice Journal: J Acquir Immune Defic Syndr Date: 2011-03-01 Impact factor: 3.731
Authors: Elizabeth M Schoenfeld; Lauren M Westafer; Samantha A Beck; Benjamin G Potee; Sravanthi Vysetty; Caty Simon; Jillian M Tozloski; Abigail L Girardin; William E Soares Journal: Acad Emerg Med Date: 2022-05-16 Impact factor: 5.221
Authors: Kathryn Hawk; Ryan McCormack; E Jennifer Edelman; Edouard Coupet; Nicolle Toledo; Phoebe Gauthier; John Rotrosen; Marek Chawarski; Shara Martel; Patricia Owens; Michael V Pantalon; Patrick O'Connor; Lauren K Whiteside; Ethan Cowan; Lynne D Richardson; Michael S Lyons; Richard Rothman; Lisa Marsch; David A Fiellin; Gail D'Onofrio Journal: JAMA Netw Open Date: 2022-01-04
Authors: Krista Glowacki; Madelyn Whyte; Jade Weinstein; Kirsten Marchand; David Barbic; Frank Scheuermeyer; Steve Mathias; Skye Barbic Journal: BMC Health Serv Res Date: 2022-05-07 Impact factor: 2.908
Authors: Margaret Lowenstein; Hareena K Sangha; Anthony Spadaro; Jeanmarie Perrone; M Kit Delgado; Anish K Agarwal Journal: Harm Reduct J Date: 2022-08-26