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Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study

INTRODUCTION: Recent studies from urban academic centers have shown the promise of emergency physician-initiated buprenorphine for improving outcomes in opioid use disorder (OUD) patients. We investigated whether emergency physician-initiated buprenorphine in a rural, community setting decreases sub...

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Autores principales: Le, Tinh, Cordial, Parker, Sankoe, Mackenzie, Purnode, Charlotte, Parekh, Ankur, Baker, Thomas, Hiestand, Brian, Peacock, W.F., Neuenschwander, James
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597690/
https://www.ncbi.nlm.nih.gov/pubmed/34787550
http://dx.doi.org/10.5811/westjem.2021.6.51306
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author Le, Tinh
Cordial, Parker
Sankoe, Mackenzie
Purnode, Charlotte
Parekh, Ankur
Baker, Thomas
Hiestand, Brian
Peacock, W.F.
Neuenschwander, James
author_facet Le, Tinh
Cordial, Parker
Sankoe, Mackenzie
Purnode, Charlotte
Parekh, Ankur
Baker, Thomas
Hiestand, Brian
Peacock, W.F.
Neuenschwander, James
author_sort Le, Tinh
collection PubMed
description INTRODUCTION: Recent studies from urban academic centers have shown the promise of emergency physician-initiated buprenorphine for improving outcomes in opioid use disorder (OUD) patients. We investigated whether emergency physician-initiated buprenorphine in a rural, community setting decreases subsequent healthcare utilization for OUD patients. METHODS: We performed a retrospective chart review of patients presenting to a community hospital emergency department (ED) who received a prescription for buprenorphine from June 15, 2018–June 15, 2019. Demographic and opioid-related International Classification of Diseases, 10th Revision, (ICD-10) codes were documented and used to create a case-matched control cohort of demographically matched patients who presented in a similar time frame with similar ICD-10 codes but did not receive buprenorphine. We recorded 12-month rates of ED visits, all-cause hospitalizations, and opioid overdoses. Differences in event occurrences between groups were assessed with Poisson regression. RESULTS: Overall 117 patients were included in the study: 59 who received buprenorphine vs 58 controls. The groups were well matched, both roughly 90% White and 60% male, with an average age of 33.4 years for both groups. Controls had a median two ED visits (range 0–33), median 0.5 hospitalizations (range 0–8), and 0 overdoses (range 0–3), vs median one ED visit (range 0–8), median 0 hospitalizations (range 0–4), and median 0 overdoses (range 0–3) in the treatment group. The incidence rate ratio (IRR) for counts of ED visits was 0.61, 95% confidence interval (CI), 0.49, 0.75, favoring medication-assisted treatment (MAT). For hospitalizations, IRR was 0.34, 95% CI, 0.22, 0.52 favoring MAT, and for overdoses was 1.04, 95% CI, 0.53, 2.07. CONCLUSION: Initiation of buprenorphine by ED providers was associated with lower 12-month ED visit and all-cause hospitalization rates with comparable overdose rates compared to controls. These findings show the ED’s potential as an initiation point for medication-assisted treatment in OUD patients.
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spelling pubmed-85976902021-11-22 Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study Le, Tinh Cordial, Parker Sankoe, Mackenzie Purnode, Charlotte Parekh, Ankur Baker, Thomas Hiestand, Brian Peacock, W.F. Neuenschwander, James West J Emerg Med Behavioral Health INTRODUCTION: Recent studies from urban academic centers have shown the promise of emergency physician-initiated buprenorphine for improving outcomes in opioid use disorder (OUD) patients. We investigated whether emergency physician-initiated buprenorphine in a rural, community setting decreases subsequent healthcare utilization for OUD patients. METHODS: We performed a retrospective chart review of patients presenting to a community hospital emergency department (ED) who received a prescription for buprenorphine from June 15, 2018–June 15, 2019. Demographic and opioid-related International Classification of Diseases, 10th Revision, (ICD-10) codes were documented and used to create a case-matched control cohort of demographically matched patients who presented in a similar time frame with similar ICD-10 codes but did not receive buprenorphine. We recorded 12-month rates of ED visits, all-cause hospitalizations, and opioid overdoses. Differences in event occurrences between groups were assessed with Poisson regression. RESULTS: Overall 117 patients were included in the study: 59 who received buprenorphine vs 58 controls. The groups were well matched, both roughly 90% White and 60% male, with an average age of 33.4 years for both groups. Controls had a median two ED visits (range 0–33), median 0.5 hospitalizations (range 0–8), and 0 overdoses (range 0–3), vs median one ED visit (range 0–8), median 0 hospitalizations (range 0–4), and median 0 overdoses (range 0–3) in the treatment group. The incidence rate ratio (IRR) for counts of ED visits was 0.61, 95% confidence interval (CI), 0.49, 0.75, favoring medication-assisted treatment (MAT). For hospitalizations, IRR was 0.34, 95% CI, 0.22, 0.52 favoring MAT, and for overdoses was 1.04, 95% CI, 0.53, 2.07. CONCLUSION: Initiation of buprenorphine by ED providers was associated with lower 12-month ED visit and all-cause hospitalization rates with comparable overdose rates compared to controls. These findings show the ED’s potential as an initiation point for medication-assisted treatment in OUD patients. Department of Emergency Medicine, University of California, Irvine School of Medicine 2021-11 2021-09-24 /pmc/articles/PMC8597690/ /pubmed/34787550 http://dx.doi.org/10.5811/westjem.2021.6.51306 Text en Copyright: © 2021 Le et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/)
spellingShingle Behavioral Health
Le, Tinh
Cordial, Parker
Sankoe, Mackenzie
Purnode, Charlotte
Parekh, Ankur
Baker, Thomas
Hiestand, Brian
Peacock, W.F.
Neuenschwander, James
Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
title Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
title_full Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
title_fullStr Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
title_full_unstemmed Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
title_short Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
title_sort healthcare use after buprenorphine prescription in a community emergency department: a cohort study
topic Behavioral Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597690/
https://www.ncbi.nlm.nih.gov/pubmed/34787550
http://dx.doi.org/10.5811/westjem.2021.6.51306
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