Alexandra B Collins1, Francesca L Beaudoin2, Elizabeth A Samuels3, Rachel Wightman3, Janette Baird4. 1. Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States. Electronic address: alexandra_collins1@brown.edu. 2. Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States; Department of Emergency Medicine, Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, United States; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States. 3. Department of Emergency Medicine, Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, United States. 4. Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States.
Abstract
BACKGROUND: Emergency departments (EDs) in the US have increasingly incorporated interventions that seek to reduce opioid-related morbidity and mortality. However, many of these interventions are underutilized. This study examined ED provider-identified barriers and facilitators to policy-prescribed service provision for patients treated for an opioid overdose in Rhode Island EDs, and opportunities to improve care delivery. METHODS: Semi-structured qualitative interviews were conducted with 55 ED providers (management and clinical staff) across Rhode Island EDs from November 2019 to July 2020. Thematic analysis of interviews focused on gaps and best practices in post-overdose care delivery, including social and structural factors driving access to, and uptake of, services. RESULTS: Participants highlighted how automatic service delivery (opt out vs. opt in) and the integration of peer-based services enhanced post-overdose service provision. However, social and structural factors (e.g. insurance barriers, limited outpatient treatment resources) and gaps in provider knowledge of medications for opioid use disorder created barriers to care. Addressing long ED wait times and establishing dedicated care teams for patients following an overdose were seen as critical to improving ED service delivery. CONCLUSION: Our findings suggest that post-overdose service delivery within EDs is a useful approach for connecting patients to services, particularly when peer support specialists are involved. However, standardizing service delivery approaches and improving provider education of harm reduction services must be prioritized alongside state-level policy changes to improve access to care for ED patients.
BACKGROUND: Emergency departments (EDs) in the US have increasingly incorporated interventions that seek to reduce opioid-related morbidity and mortality. However, many of these interventions are underutilized. This study examined ED provider-identified barriers and facilitators to policy-prescribed service provision for patients treated for an opioid overdose in Rhode Island EDs, and opportunities to improve care delivery. METHODS: Semi-structured qualitative interviews were conducted with 55 ED providers (management and clinical staff) across Rhode Island EDs from November 2019 to July 2020. Thematic analysis of interviews focused on gaps and best practices in post-overdose care delivery, including social and structural factors driving access to, and uptake of, services. RESULTS: Participants highlighted how automatic service delivery (opt out vs. opt in) and the integration of peer-based services enhanced post-overdose service provision. However, social and structural factors (e.g. insurance barriers, limited outpatient treatment resources) and gaps in provider knowledge of medications for opioid use disorder created barriers to care. Addressing long ED wait times and establishing dedicated care teams for patients following an overdose were seen as critical to improving ED service delivery. CONCLUSION: Our findings suggest that post-overdose service delivery within EDs is a useful approach for connecting patients to services, particularly when peer support specialists are involved. However, standardizing service delivery approaches and improving provider education of harm reduction services must be prioritized alongside state-level policy changes to improve access to care for ED patients.
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