Lauren K Whiteside1, Ly Huynh2, Sophie Morse3, Jane Hall4, William Meurer5, Caleb J Banta-Green6, Hannah Scheuer7, Rebecca Cunningham8, Mark McGovern9, Douglas F Zatzick10. 1. Department of Emergency Medicine & Harborview Injury Prevention and Research Center, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America. Electronic address: laurenkw@u.washington.edu. 2. Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America. Electronic address: lyh4@uw.edu. 3. Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America. Electronic address: scmorse@uw.edu. 4. Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America. Electronic address: janehall@uw.edu. 5. Department of Emergency Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, Ann Arbor, MI 48109-5303, United States of America. Electronic address: wmeurer@med.umich.edu. 6. Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America. Electronic address: calebbg@uw.edu. 7. Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America. Electronic address: hscheuer@uw.edu. 8. Department of Emergency Medicine, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Rd Bldg. 10-G080, Ann Arbor, MI 48109-2800, United States of America. Electronic address: stroh@med.umich.edu. 9. Department of Psychiatry & Behavioral Sciences and Department of Medicine, Stanford University School of Medicine, 1520 Page Mill Road Suite 158, MC 5721, Stanford, CA 94305, United States of America. Electronic address: mpmcg@stanford.edu. 10. Department of Psychiatry & Behavioral Sciences & Harborview Injury Prevention and Research Center, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America. Electronic address: dzatzick@uw.edu.
Abstract
INTRODUCTION: Opioid use disorder (OUD) and related comorbid conditions are highly prevalent among patients presenting to emergency department (ED) settings. Research has developed few comprehensive disease management strategies for at-risk patients presenting to the ED that both decrease illicit opioid use and improve initiation and retention in medication treatment for OUD (MOUD). METHODS: The research team conducted a pilot pragmatic clinical trial that randomized 40 patients presenting to a single ED to a collaborative care intervention (n = 20) versus usual care control (n = 20) conditions. Interviewers blinded to patient intervention and control group status followed-up with participants at 1, 3, and 6 months after presentation to the ED. The 3-month Emergency Department Longitudinal Integrated Care (ED-LINC) collaborative care intervention for patients at risk for OUD included: 1) a Brief Negotiated Interview at bedside, 2) overdose education and facilitation of MOUD, 3) longitudinal proactive care management, 4) utilization of the statewide health information exchange platform for 24/7 tracking of recurrent ED utilization, and 5) weekly caseload supervision that incorporated measurement-based care treatment assessment with stepped-up care for patients with recalcitrant symptoms. RESULTS: Overall, the ED-LINC intervention was feasibly delivered and acceptable to patients. The pilot study achieved >80% follow-up rates at 1, 3, and 6 months. In adjusted longitudinal mixed model regression analyses, no statistically significant differences existed in days of opioid use over the past 30 days for ED-LINC intervention patients when compared to patients receiving usual care (incidence-rate ratio (IRR) 1.50, 95% CI 0.54-4.16). The unadjusted mean number of days of illicit opioid use decreased at the 1-month and 3-month follow-up time points for both groups. ED-LINC intervention patients had increased rates of MOUD initiation compared to control patients (50% versus 30%); intervention versus control comparisons did not achieve statistical significance, although power to detect significant differences in the pilot was limited. CONCLUSIONS: The ED-LINC intervention for patients with OUD can be feasibly implemented and warrants testing in larger scale, adequately powered randomized pragmatic clinical trial investigations. CLINICALTRIALS: gov NCT03699085.
INTRODUCTION: Opioid use disorder (OUD) and related comorbid conditions are highly prevalent among patients presenting to emergency department (ED) settings. Research has developed few comprehensive disease management strategies for at-risk patients presenting to the ED that both decrease illicit opioid use and improve initiation and retention in medication treatment for OUD (MOUD). METHODS: The research team conducted a pilot pragmatic clinical trial that randomized 40 patients presenting to a single ED to a collaborative care intervention (n = 20) versus usual care control (n = 20) conditions. Interviewers blinded to patient intervention and control group status followed-up with participants at 1, 3, and 6 months after presentation to the ED. The 3-month Emergency Department Longitudinal Integrated Care (ED-LINC) collaborative care intervention for patients at risk for OUD included: 1) a Brief Negotiated Interview at bedside, 2) overdose education and facilitation of MOUD, 3) longitudinal proactive care management, 4) utilization of the statewide health information exchange platform for 24/7 tracking of recurrent ED utilization, and 5) weekly caseload supervision that incorporated measurement-based care treatment assessment with stepped-up care for patients with recalcitrant symptoms. RESULTS: Overall, the ED-LINC intervention was feasibly delivered and acceptable to patients. The pilot study achieved >80% follow-up rates at 1, 3, and 6 months. In adjusted longitudinal mixed model regression analyses, no statistically significant differences existed in days of opioid use over the past 30 days for ED-LINC intervention patients when compared to patients receiving usual care (incidence-rate ratio (IRR) 1.50, 95% CI 0.54-4.16). The unadjusted mean number of days of illicit opioid use decreased at the 1-month and 3-month follow-up time points for both groups. ED-LINC intervention patients had increased rates of MOUD initiation compared to control patients (50% versus 30%); intervention versus control comparisons did not achieve statistical significance, although power to detect significant differences in the pilot was limited. CONCLUSIONS: The ED-LINC intervention for patients with OUD can be feasibly implemented and warrants testing in larger scale, adequately powered randomized pragmatic clinical trial investigations. CLINICALTRIALS: gov NCT03699085.
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