Ryan P McCormack1, John Rotrosen2, Phoebe Gauthier3, Gail D'Onofrio4, David A Fiellin4,5, Lisa A Marsch3, Patricia Novo2, David Liu6, E Jennifer Edelman5, Sarah Farkas2, Abigail G Matthews7, Caroline Mulatya7, Dagmar Salazar7, Jeremy Wolff7, Randolph Knight8, William Goodman9, Kathryn Hawk4. 1. New York University Grossman School of Medicine, 227 E 30th St, Ground Floor, EM Research, New York, NY, 10016, USA. Ryan.mccormack@nyulangone.org. 2. New York University Grossman School of Medicine, 227 E 30th St, Ground Floor, EM Research, New York, NY, 10016, USA. 3. Geisel School of Medicine at Dartmouth College, Hanover, NH, USA. 4. Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA. 5. Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. 6. National Institute on Drug Abuse, Rockville, MD, USA. 7. The Emmes Company, Rockville, MD, USA. 8. Springfield Hospital, Springfield, VT, USA. 9. Holy Family Hospital, Methuen, MA, USA.
Abstract
BACKGROUND: For many reasons, the emergency department (ED) is a critical venue to initiate OUD interventions. The prevailing culture of the ED has been that substance use disorders are non-emergent conditions better addressed outside the ED where resources are less constrained. This study, its rapid funding mechanism, and accelerated timeline originated out of the urgent need to learn whether ED-initiated buprenorphine (BUP) with referral for treatment of OUD is generalizable, as well as to develop strategies to facilitate its adoption across a variety of ED settings and under real-world conditions. It both complements and uses methods adapted from Project ED Health (CTN-0069), a Hybrid Type 3 implementation-effectiveness study of using Implementation Facilitation (IF) to integrate ED-initiated BUP and referral programs. METHODS: ED-CONNECT (CTN 0079) was a three-site implementation study exploring the feasibility, acceptability, and impact of introducing ED-initiated BUP in rural and urban settings with high-need, limited resources, and different staffing structures. We used a multi-faceted approach to develop, introduce and iteratively refine site-specific ED clinical protocols and implementation plans for opioid use disorder (OUD) screening, ED-initiated BUP, and referral for treatment. We employed a participatory action research approach and use mixed methods incorporating data derived from abstraction of medical records and administrative data, assessments of recruited ED patient-participants, and both qualitative and quantitative inquiry involving staff from the ED and community, patients, and other stakeholders. DISCUSSION: This study was designed to provide the necessary, time-sensitive understanding of how to identify OUD and initiate treatment with BUP in the EDs previously not providing ED-initiated BUP, in communities in which this intervention is most needed: high need, low resource settings. TRIAL REGISTRATION: The study was prospectively registered on ClinicalTrials.gov (NCT03544112) on June 01, 2018: https://clinicaltrials.gov/ct2/show/NCT03544112 .
BACKGROUND: For many reasons, the emergency department (ED) is a critical venue to initiate OUD interventions. The prevailing culture of the ED has been that substance use disorders are non-emergent conditions better addressed outside the ED where resources are less constrained. This study, its rapid funding mechanism, and accelerated timeline originated out of the urgent need to learn whether ED-initiated buprenorphine (BUP) with referral for treatment of OUD is generalizable, as well as to develop strategies to facilitate its adoption across a variety of ED settings and under real-world conditions. It both complements and uses methods adapted from Project ED Health (CTN-0069), a Hybrid Type 3 implementation-effectiveness study of using Implementation Facilitation (IF) to integrate ED-initiated BUP and referral programs. METHODS: ED-CONNECT (CTN 0079) was a three-site implementation study exploring the feasibility, acceptability, and impact of introducing ED-initiated BUP in rural and urban settings with high-need, limited resources, and different staffing structures. We used a multi-faceted approach to develop, introduce and iteratively refine site-specific ED clinical protocols and implementation plans for opioid use disorder (OUD) screening, ED-initiated BUP, and referral for treatment. We employed a participatory action research approach and use mixed methods incorporating data derived from abstraction of medical records and administrative data, assessments of recruited ED patient-participants, and both qualitative and quantitative inquiry involving staff from the ED and community, patients, and other stakeholders. DISCUSSION: This study was designed to provide the necessary, time-sensitive understanding of how to identify OUD and initiate treatment with BUP in the EDs previously not providing ED-initiated BUP, in communities in which this intervention is most needed: high need, low resource settings. TRIAL REGISTRATION: The study was prospectively registered on ClinicalTrials.gov (NCT03544112) on June 01, 2018: https://clinicaltrials.gov/ct2/show/NCT03544112 .
Entities:
Keywords:
Buprenorphine; Emergency service; Implementation science; Opioid use disorder
Authors: H A Navaline; E C Snider; C J Petro; D Tobin; D Metzger; A I Alterman; G E Woody Journal: AIDS Res Hum Retroviruses Date: 1994 Impact factor: 2.205
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