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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
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.
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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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