TY - JOUR
KW - Adult
KW - Emergency Service, Hospital
KW - Female
KW - Focus Groups
KW - Humans
KW - Male
KW - Opioid-Related Disorders/psychology
KW - Patient Acceptance of Health Care/psychology
KW - Qualitative Research
KW - Social Stigma
KW - Stereotyping
KW - United States
AU - K. Hawk
AU - R. McCormack
AU - E. J. Edelman
AU - E. Coupet Jr
AU - N. Toledo
AU - P. Gauthier
AU - J. Rotrosen
AU - M. Chawarski
AU - S. Martel
AU - P. Owens
AU - M. V. Pantalon
AU - P. O'Connor
AU - L. K. Whiteside
AU - E. Cowan
AU - L. D. Richardson
AU - M. S. Lyons
AU - R. Rothman
AU - L. Marsch
AU - D. A. Fiellin
AU - G. D'Onofrio
A1 - 
AB - IMPORTANCE: Emergency departments (EDs) are increasingly initiating treatment for patients with untreated opioid use disorder (OUD) and linking them to ongoing addiction care. To our knowledge, patient perspectives related to their ED visit have not been characterized and may influence their access to and interest in OUD treatment. OBJECTIVE: To assess the experiences and perspectives regarding ED-initiated health care and OUD treatment among US patients with untreated OUD seen in the ED. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study, conducted as part of 2 studies (Project ED Health and ED-CONNECT), included individuals with untreated OUD who were recruited during an ED visit in EDs at 4 urban academic centers, 1 public safety net hospital, and 1 rural critical access hospital in 5 disparate US regions. Focus groups were conducted between June 2018 and January 2019. MAIN OUTCOMES AND MEASURES: Data collection and thematic analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework with evidence (perspectives on ED care), context (ED), and facilitation (what is needed to promote change) elements. RESULTS: A total of 31 individuals (mean [SD] age, 43.4 [11.0] years) participated in 6 focus groups. Twenty participants (64.5%) identified as male and most 13 (41.9%) as White; 17 (54.8%) reported being unemployed. Themes related to evidence included patients' experience of stigma and perceived minimization of their pain and medical problems by ED staff. Themes about context included the ED not being seen as a source of OUD treatment initiation and patient readiness to initiate treatment being multifaceted, time sensitive, and related to internal and external patient factors. Themes related to facilitation of improved care of patients with OUD seen in the ED included a need for on-demand treatment and ED staff training. CONCLUSIONS AND RELEVANCE: In this qualitative study, patients with OUD reported feeling stigmatized and minimized when accessing care in the ED and identified several opportunities to improve care. The findings suggest that strategies to address stigma, acknowledge and treat pain, and provide ED staff training should be implemented to improve ED care for patients with OUD and enhance access to life-saving treatment.
AD - Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.; Yale School of Public Health, New Haven, Connecticut.; Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Emergency Medicine, NYU Grossman School of Medicine, New York.; Yale School of Public Health, New Haven, Connecticut.; Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.; Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.; Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire.; Department of Psychiatry, NYU Grossman School of Medicine, New York.; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.; Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.; Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut.; Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Emergency Medicine, University of Washington School of Medicine, Seattle.; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.; Institute for Health Equity Research, Icahn School of Medicin(TRUNCATED)
BT - JAMA network open
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 1
DO - 10.1001/jamanetworkopen.2021.44955
IS - 1
JF - JAMA network open
LA - eng
M1 - Journal Article
N2 - IMPORTANCE: Emergency departments (EDs) are increasingly initiating treatment for patients with untreated opioid use disorder (OUD) and linking them to ongoing addiction care. To our knowledge, patient perspectives related to their ED visit have not been characterized and may influence their access to and interest in OUD treatment. OBJECTIVE: To assess the experiences and perspectives regarding ED-initiated health care and OUD treatment among US patients with untreated OUD seen in the ED. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study, conducted as part of 2 studies (Project ED Health and ED-CONNECT), included individuals with untreated OUD who were recruited during an ED visit in EDs at 4 urban academic centers, 1 public safety net hospital, and 1 rural critical access hospital in 5 disparate US regions. Focus groups were conducted between June 2018 and January 2019. MAIN OUTCOMES AND MEASURES: Data collection and thematic analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework with evidence (perspectives on ED care), context (ED), and facilitation (what is needed to promote change) elements. RESULTS: A total of 31 individuals (mean [SD] age, 43.4 [11.0] years) participated in 6 focus groups. Twenty participants (64.5%) identified as male and most 13 (41.9%) as White; 17 (54.8%) reported being unemployed. Themes related to evidence included patients' experience of stigma and perceived minimization of their pain and medical problems by ED staff. Themes about context included the ED not being seen as a source of OUD treatment initiation and patient readiness to initiate treatment being multifaceted, time sensitive, and related to internal and external patient factors. Themes related to facilitation of improved care of patients with OUD seen in the ED included a need for on-demand treatment and ED staff training. CONCLUSIONS AND RELEVANCE: In this qualitative study, patients with OUD reported feeling stigmatized and minimized when accessing care in the ED and identified several opportunities to improve care. The findings suggest that strategies to address stigma, acknowledge and treat pain, and provide ED staff training should be implemented to improve ED care for patients with OUD and enhance access to life-saving treatment.
PY - 2022
SN - 2574-3805; 2574-3805
T1 - Perspectives About Emergency Department Care Encounters Among Adults With Opioid Use Disorder
T2 - JAMA network open
TI - Perspectives About Emergency Department Care Encounters Among Adults With Opioid Use Disorder
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 35076700
U3 - 10.1001/jamanetworkopen.2021.44955
VL - 5
VO - 2574-3805; 2574-3805
Y1 - 2022
Y2 - Jan 4
ER -