TY - JOUR
KW - Adult
KW - Buprenorphine/therapeutic use
KW - Cohort Studies
KW - Delivery of Health Care
KW - Emergency Service, Hospital
KW - Female
KW - Humans
KW - Male
KW - Opioid-Related Disorders/drug therapy
KW - prescriptions
KW - Retrospective Studies
AU - T. Le
AU - P. Cordial
AU - M. Sankoe
AU - C. Purnode
AU - A. Parekh
AU - T. Baker
AU - B. Hiestand
AU - W. F. Peacock
AU - J. Neuenschwander
A1 - 
AB - 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.
AD - Case Western Reserve University School of Medicine, Cleveland, Ohio.; The Ohio State University College of Medicine, Columbus, Ohio.; Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio.; Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio.; The Ohio State University, Columbus, Ohio.; Genesis Healthcare System, Department of Emergency Medicine, Zanesville, Ohio.; Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina.; Baylor College of Medicine, Department of Emergency Medicine, Houston, Texas.; The Ohio State University College of Medicine, Columbus, Ohio.; Genesis Healthcare System, Department of Emergency Medicine, Zanesville, Ohio.
BT - The western journal of emergency medicine
C5 - Education & Workforce; Financing & Sustainability; Opioids & Substance Use
CP - 6
DO - 10.5811/westjem.2021.6.51306
IS - 6
JF - The western journal of emergency medicine
LA - eng
M1 - Journal Article
N2 - 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.
PY - 2021
SN - 1936-9018; 1936-900X; 1936-900X
SP - 1270
EP - 1275
EP - 
T1 - Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
T2 - The western journal of emergency medicine
TI - Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
U1 - Education & Workforce; Financing & Sustainability; Opioids & Substance Use
U2 - 34787550
U3 - 10.5811/westjem.2021.6.51306
VL - 22
VO - 1936-9018; 1936-900X; 1936-900X
Y1 - 2021
Y2 - Sep 24
ER -