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Improving transitions of care for patients initiated on buprenorphine for opioid use disorder from the emergency departments in King County, Washington

STUDY OBJECTIVE: Opioid use disorder (OUD) is on the rise nationwide with increasing emergency department (ED) visits and deaths secondary to overdose. Although previous research has shown that patients who are started on buprenorphine in the ED have increased engagement in addiction treatment, acce...

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Autores principales: Fockele, Callan Elswick, Duber, Herbert C., Finegood, Brad, Morse, Sophie C., Whiteside, Lauren K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987236/
https://www.ncbi.nlm.nih.gov/pubmed/33778807
http://dx.doi.org/10.1002/emp2.12408
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author Fockele, Callan Elswick
Duber, Herbert C.
Finegood, Brad
Morse, Sophie C.
Whiteside, Lauren K.
author_facet Fockele, Callan Elswick
Duber, Herbert C.
Finegood, Brad
Morse, Sophie C.
Whiteside, Lauren K.
author_sort Fockele, Callan Elswick
collection PubMed
description STUDY OBJECTIVE: Opioid use disorder (OUD) is on the rise nationwide with increasing emergency department (ED) visits and deaths secondary to overdose. Although previous research has shown that patients who are started on buprenorphine in the ED have increased engagement in addiction treatment, access to on‐demand medications for OUD is still limited, in part because of the need for linkages to outpatient care. The objective of this study is to describe emergency and outpatient providers’ perception of local barriers to transitions of care for ED‐initiated buprenorphine patients. METHODS: Purposive sampling was used to recruit key stakeholders, identified as physicians, addiction specialists, and hospital administrators, from 10 EDs and 11 outpatient clinics in King County, Washington. Twenty‐one interviews were recorded and transcribed and then coded using an integrated deductive and inductive content analysis approach by 2 team members to verify accuracy of the analysis. Interview guides and coding were informed by the Consolidated Framework for Implementation Research (CFIR), which provides a structure of domains and constructs associated with effective implementation of evidence‐based practice. RESULTS: From the 21 interviews with emergency and outpatient providers, this study identified 4 barriers to transitions of care for ED‐initiated buprenorphine patients: scope of practice, prescribing capacity, referral incoordination, and loss to follow‐up. CONCLUSION: Next steps for implementation of this intervention in a community setting include establishing a standard of care for treatment and referral for ED patients with OUD, increasing buprenorphine prescribing capacity, creating a central repository for streamlined referrals and follow‐up, and supporting low‐barrier scheduling and navigation services.
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spelling pubmed-79872362021-03-25 Improving transitions of care for patients initiated on buprenorphine for opioid use disorder from the emergency departments in King County, Washington Fockele, Callan Elswick Duber, Herbert C. Finegood, Brad Morse, Sophie C. Whiteside, Lauren K. J Am Coll Emerg Physicians Open Health Policy STUDY OBJECTIVE: Opioid use disorder (OUD) is on the rise nationwide with increasing emergency department (ED) visits and deaths secondary to overdose. Although previous research has shown that patients who are started on buprenorphine in the ED have increased engagement in addiction treatment, access to on‐demand medications for OUD is still limited, in part because of the need for linkages to outpatient care. The objective of this study is to describe emergency and outpatient providers’ perception of local barriers to transitions of care for ED‐initiated buprenorphine patients. METHODS: Purposive sampling was used to recruit key stakeholders, identified as physicians, addiction specialists, and hospital administrators, from 10 EDs and 11 outpatient clinics in King County, Washington. Twenty‐one interviews were recorded and transcribed and then coded using an integrated deductive and inductive content analysis approach by 2 team members to verify accuracy of the analysis. Interview guides and coding were informed by the Consolidated Framework for Implementation Research (CFIR), which provides a structure of domains and constructs associated with effective implementation of evidence‐based practice. RESULTS: From the 21 interviews with emergency and outpatient providers, this study identified 4 barriers to transitions of care for ED‐initiated buprenorphine patients: scope of practice, prescribing capacity, referral incoordination, and loss to follow‐up. CONCLUSION: Next steps for implementation of this intervention in a community setting include establishing a standard of care for treatment and referral for ED patients with OUD, increasing buprenorphine prescribing capacity, creating a central repository for streamlined referrals and follow‐up, and supporting low‐barrier scheduling and navigation services. John Wiley and Sons Inc. 2021-03-23 /pmc/articles/PMC7987236/ /pubmed/33778807 http://dx.doi.org/10.1002/emp2.12408 Text en © 2021 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Health Policy
Fockele, Callan Elswick
Duber, Herbert C.
Finegood, Brad
Morse, Sophie C.
Whiteside, Lauren K.
Improving transitions of care for patients initiated on buprenorphine for opioid use disorder from the emergency departments in King County, Washington
title Improving transitions of care for patients initiated on buprenorphine for opioid use disorder from the emergency departments in King County, Washington
title_full Improving transitions of care for patients initiated on buprenorphine for opioid use disorder from the emergency departments in King County, Washington
title_fullStr Improving transitions of care for patients initiated on buprenorphine for opioid use disorder from the emergency departments in King County, Washington
title_full_unstemmed Improving transitions of care for patients initiated on buprenorphine for opioid use disorder from the emergency departments in King County, Washington
title_short Improving transitions of care for patients initiated on buprenorphine for opioid use disorder from the emergency departments in King County, Washington
title_sort improving transitions of care for patients initiated on buprenorphine for opioid use disorder from the emergency departments in king county, washington
topic Health Policy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987236/
https://www.ncbi.nlm.nih.gov/pubmed/33778807
http://dx.doi.org/10.1002/emp2.12408
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