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A new study from the Perelman School of Medicine at University of Pennsylvania shows that a new study aimed at increasing the emergency department’s treatment of buprenorphine (buprenorphine) for patients with opioid use disorders The initial plan resulted in a six-fold increase in the use of buprenorphine in three Pennsylvania Medical College hospitals
.
By adopting various strategies in the three acute care centers—from financial incentives for doctors to train doctors in the treatment of opioid use disorder, to automatic contact with fellow rehabilitation experts—the project not only improved the treatment of buprenorphine initially Rate, and maintain these changes
"We adopted a behavioral design approach to make the implementation of evidence-based treatment simple, attractive, social and timely
.
Although we initially focused on the prescription itself, we realized that we still need to overcome other obstacles, such as Identify and involve patients in care," said Margaret Lowenstein, assistant professor of medicine and lead author of the study
Buprenorphine is a drug that stabilizes opioid withdrawal and soothes cravings
.
Its use can increase long-term participation in the care of opioid use disorders and reduce drug overdose deaths and other complications
In order for patients to receive this potentially life-saving drug, researchers must first make it easier to prescribe buprenorphine by increasing the proportion of clinicians who are allowed to prescribe buprenorphine
.
Clinicians need to be authorized to prescribe buprenorphine by completing specific training courses-"x exemption"
In order to better promote the drug treatment of opioid use disorders, a clinical team led by Dr.
Jeanmarie Perrone adopted several strategies
.
Dr.
Being able to prescribe medication is the first step
.
The next step is to identify the patient and then connect them to the ongoing treatment
The data of the program from March 2017 to July 2020, covering an extension of 18 months before and after the program is in place, showing improvement: The speed of opioid use in patients receiving buprenorphine in the emergency department only increased by 3%.
To 23%
.
This explains the 25% increase in the likelihood of patients receiving buprenorphine treatment during the emergency department
These findings are not temporary: even one year after the changes took effect, the usage rate continues to rise
.
Most importantly, the number of doctors who have prescribed buprenorphine at least once rose from 7% to 70%
However, the authors found that there are large differences in the rate at which some doctors implement this treatment
.
In the most extreme case, some doctors prescribe buprenorphine for 61% of patients with opioid use disorders they encounter
.
Other doctors never prescribe, even if they are exempted
.
"In fact, some doctors in our group are able to provide this kind of evidence-based treatment to more than half of the patients when others are capable of doing so, but it does not show that there is more work to be done to push clinicians to provide this kind of treatment as a default process," Senior author M.
Kit Delgado, MD, said that he is an assistant professor of emergency medicine and epidemiology and an associate director of the Medical Nudge Group at the University of Pennsylvania
.
This huge difference was the motivation for the research team to conduct another study, which involved 29 emergency doctors and nurses participating in the focus group of the program
.
The results of this study were published in the New England Journal of Medicine Catalyst
.
One of the main conclusions is the identification of patients: the automated process described in the first study did not find all patients eligible to start treatment because the algorithm did not achieve the required specificity or sensitivity
.
The study also found that all emergency department team members support nurses' involvement in the traditional triage process to identify patients through universal screening
.
Automation can still play a role, but after the patient is identified, it will provide doctors, nurses and fellow rehabilitation experts with active screen trigger prompts to guide care
.
Although they have seen the benefits, the team also knows that it is important to continue to expand their influence
.
Delgado said: "In the future, we will test different methods to better ensure that patients discharged from the hospital taking the buprenorphine prescription drug have a warm handover and participate in the ongoing addiction treatment
.
" "Start taking it .
" This drug is the best first step, but there are many more on the road to long-term recovery after they are discharged from the hospital
.
"
Journal Reference :
Margaret Lowenstein, Jeanmarie Perrone, Ruiying A.
Xiong, Christopher K.
Snider, Nicole O’Donnell, Davis Hermann, Roy Rosin, Julie Dees, Rachel McFadden, Utsha Khatri, Zachary F.
Meisel, Nandita Mitra, M.
Kit Delgado.
Sustained Implementation of a Multicomponent Strategy to Increase Emergency Department-Initiated Interventions for Opioid Use Disorder .
Annals of Emergency Medicine , 2021; DOI: 10.
1016/j.
annemergmed.
2021.
10.
012
