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Buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments
OBJECTIVES: Opioid use disorder is a major public health concern that accounts for a high number of potential years of life lost. Buprenorphine/naloxone is a recommended treatment for opioid use disorder that can be started in the emergency department (ED). We developed an ED-based program to initia...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225037/ https://www.ncbi.nlm.nih.gov/pubmed/37245202 http://dx.doi.org/10.1007/s43678-023-00520-3 |
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author | Stone, Kayla D. Scott, Ken Holroyd, Brian R. Lang, Eddy Yee, Karen Taghizadeh, Niloofar Deol, Janjeevan Dong, Kathryn Fanaeian, Josh Ghosh, Monty Low, Keysha Ross, Marshall Tanguay, Robert Faris, Peter Day, Nathaniel McLane, Patrick |
author_facet | Stone, Kayla D. Scott, Ken Holroyd, Brian R. Lang, Eddy Yee, Karen Taghizadeh, Niloofar Deol, Janjeevan Dong, Kathryn Fanaeian, Josh Ghosh, Monty Low, Keysha Ross, Marshall Tanguay, Robert Faris, Peter Day, Nathaniel McLane, Patrick |
author_sort | Stone, Kayla D. |
collection | PubMed |
description | OBJECTIVES: Opioid use disorder is a major public health concern that accounts for a high number of potential years of life lost. Buprenorphine/naloxone is a recommended treatment for opioid use disorder that can be started in the emergency department (ED). We developed an ED-based program to initiate buprenorphine/naloxone for eligible patients who live with opioid use disorder, and to provide unscheduled, next-day follow-up referrals to an opioid use disorder treatment clinic (in person or virtual) for continuing patient care throughout Alberta. METHODS: In this quality improvement initiative, we supported local ED teams to offer buprenorphine/naloxone to eligible patients presenting to the ED with suspected opioid use disorder and refer these patients for follow-up care. Process, outcome, and balancing measures were evaluated over the first 2 years of the initiative (May 15, 2018–May 15, 2020). RESULTS: The program was implemented at 107 sites across Alberta during our evaluation period. Buprenorphine/naloxone initiations in the ED increased post-intervention at most sites with baseline data available (11 of 13), and most patients (67%) continued to fill an opioid agonist prescription at 180 days post-ED visit. Of the 572 referrals recorded at clinics, 271 (47%) attended their first follow-up visit. Safety events were reported in ten initiations and were all categorized as no harm to minimal harm. CONCLUSIONS: A standardized provincial approach to initiating buprenorphine/naloxone in the ED for patients living with opioid use disorder was spread to 107 sites with dedicated program support staff and adjustment to local contexts. Similar quality improvement approaches may benefit other jurisdictions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43678-023-00520-3. |
format | Online Article Text |
id | pubmed-10225037 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-102250372023-05-30 Buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments Stone, Kayla D. Scott, Ken Holroyd, Brian R. Lang, Eddy Yee, Karen Taghizadeh, Niloofar Deol, Janjeevan Dong, Kathryn Fanaeian, Josh Ghosh, Monty Low, Keysha Ross, Marshall Tanguay, Robert Faris, Peter Day, Nathaniel McLane, Patrick CJEM Quality Improvement and Patient Safety (QIPS) OBJECTIVES: Opioid use disorder is a major public health concern that accounts for a high number of potential years of life lost. Buprenorphine/naloxone is a recommended treatment for opioid use disorder that can be started in the emergency department (ED). We developed an ED-based program to initiate buprenorphine/naloxone for eligible patients who live with opioid use disorder, and to provide unscheduled, next-day follow-up referrals to an opioid use disorder treatment clinic (in person or virtual) for continuing patient care throughout Alberta. METHODS: In this quality improvement initiative, we supported local ED teams to offer buprenorphine/naloxone to eligible patients presenting to the ED with suspected opioid use disorder and refer these patients for follow-up care. Process, outcome, and balancing measures were evaluated over the first 2 years of the initiative (May 15, 2018–May 15, 2020). RESULTS: The program was implemented at 107 sites across Alberta during our evaluation period. Buprenorphine/naloxone initiations in the ED increased post-intervention at most sites with baseline data available (11 of 13), and most patients (67%) continued to fill an opioid agonist prescription at 180 days post-ED visit. Of the 572 referrals recorded at clinics, 271 (47%) attended their first follow-up visit. Safety events were reported in ten initiations and were all categorized as no harm to minimal harm. CONCLUSIONS: A standardized provincial approach to initiating buprenorphine/naloxone in the ED for patients living with opioid use disorder was spread to 107 sites with dedicated program support staff and adjustment to local contexts. Similar quality improvement approaches may benefit other jurisdictions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43678-023-00520-3. Springer International Publishing 2023-05-28 2023 /pmc/articles/PMC10225037/ /pubmed/37245202 http://dx.doi.org/10.1007/s43678-023-00520-3 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Quality Improvement and Patient Safety (QIPS) Stone, Kayla D. Scott, Ken Holroyd, Brian R. Lang, Eddy Yee, Karen Taghizadeh, Niloofar Deol, Janjeevan Dong, Kathryn Fanaeian, Josh Ghosh, Monty Low, Keysha Ross, Marshall Tanguay, Robert Faris, Peter Day, Nathaniel McLane, Patrick Buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments |
title | Buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments |
title_full | Buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments |
title_fullStr | Buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments |
title_full_unstemmed | Buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments |
title_short | Buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments |
title_sort | buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban alberta emergency departments |
topic | Quality Improvement and Patient Safety (QIPS) |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225037/ https://www.ncbi.nlm.nih.gov/pubmed/37245202 http://dx.doi.org/10.1007/s43678-023-00520-3 |
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