TY - JOUR
AU - K. L. Sue
AU - M. Chawarski
AU - L. Curry
AU - R. McNeil
AU - E. Coupet Jr.
AU - R. P. Schwartz
AU - C. Wilder
AU - J. I. Tsui
AU - K. F. Hawk
AU - G. D'Onofrio
AU - P. G. O'Connor
AU - D. A. Fiellin
AU - E. J. Edelman
A1 - 
AB - IMPORTANCE: An increasing number of emergency departments (EDs) are initiating buprenorphine for opioid use disorder (OUD) and linking patients to ongoing community-based treatment, yet community-based clinician and staff perspectives regarding this practice have not been characterized. OBJECTIVE: To explore perspectives and experiences regarding ED-initiated buprenorphine among community-based clinicians and staff in geographically distinct regions. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study reports findings from Project ED Health, a hybrid type 3 effectiveness-implementation study designed to evaluate the impact of implementation facilitation on ED-initiated buprenorphine with referral to ongoing medication treatment. Clinicians and staff from community-based treatment programs were identified by urban academic EDs as potential referral sites for ongoing OUD treatment in 4 cities across the US in a formative evaluation as having the capability to continue medication treatment. Focus groups were held from April 1, 2018, to January 11, 2019, to examine community OUD treatment clinician and staff perspectives on accepting patients who have received ED-initiated buprenorphine. Data were analyzed from August 2020 to August 2022. MAIN OUTCOMES AND MEASURES: Data collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework, focusing on domains including evidence, context, and facilitation. RESULTS: A total of 103 individuals (mean [SD] age, 45.3 [12.0] years; 76 female and 64 White) participated in 14 focus groups (groups ranged from 3-22 participants). Participants shared negative attitudes toward buprenorphine and variable attitudes toward ED-initiated buprenorphine. Prominent barriers included the community site treatment capacity and structure as well as payment and regulatory barriers. Perceived factors that could facilitate this model included additional substance use disorder training for ED staff, referrals and communication, greater inclusion of peer navigators, and addressing sociostructural marginalization that patients faced. CONCLUSIONS AND RELEVANCE: In this study of community-based clinicians and staff positioned to deliver OUD treatment, participants reported many barriers to successful linkages for patients who received ED-initiated buprenorphine. Strategies to improve these linkages included educating communities and programs, modeling low-barrier philosophies, and using additional staff trained in addiction as resources to improve transitions from EDs to community partners.
AD - Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.; Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.; Friends Research Institute, Baltimore, Maryland.; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio.; Department of Medicine, University of Washington School of Medicine, Seattle.; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut.
AN - 37163263
BT - JAMA Netw Open
C5 - Opioids & Substance Use; Education & Workforce
CP - 5
DA - May 1
DO - 10.1001/jamanetworkopen.2023.12718
DP - NLM
ET - 20230501
IS - 5
JF - JAMA Netw Open
LA - eng
N2 - IMPORTANCE: An increasing number of emergency departments (EDs) are initiating buprenorphine for opioid use disorder (OUD) and linking patients to ongoing community-based treatment, yet community-based clinician and staff perspectives regarding this practice have not been characterized. OBJECTIVE: To explore perspectives and experiences regarding ED-initiated buprenorphine among community-based clinicians and staff in geographically distinct regions. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study reports findings from Project ED Health, a hybrid type 3 effectiveness-implementation study designed to evaluate the impact of implementation facilitation on ED-initiated buprenorphine with referral to ongoing medication treatment. Clinicians and staff from community-based treatment programs were identified by urban academic EDs as potential referral sites for ongoing OUD treatment in 4 cities across the US in a formative evaluation as having the capability to continue medication treatment. Focus groups were held from April 1, 2018, to January 11, 2019, to examine community OUD treatment clinician and staff perspectives on accepting patients who have received ED-initiated buprenorphine. Data were analyzed from August 2020 to August 2022. MAIN OUTCOMES AND MEASURES: Data collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework, focusing on domains including evidence, context, and facilitation. RESULTS: A total of 103 individuals (mean [SD] age, 45.3 [12.0] years; 76 female and 64 White) participated in 14 focus groups (groups ranged from 3-22 participants). Participants shared negative attitudes toward buprenorphine and variable attitudes toward ED-initiated buprenorphine. Prominent barriers included the community site treatment capacity and structure as well as payment and regulatory barriers. Perceived factors that could facilitate this model included additional substance use disorder training for ED staff, referrals and communication, greater inclusion of peer navigators, and addressing sociostructural marginalization that patients faced. CONCLUSIONS AND RELEVANCE: In this study of community-based clinicians and staff positioned to deliver OUD treatment, participants reported many barriers to successful linkages for patients who received ED-initiated buprenorphine. Strategies to improve these linkages included educating communities and programs, modeling low-barrier philosophies, and using additional staff trained in addiction as resources to improve transitions from EDs to community partners.
PY - 2023
SN - 2574-3805
SP - e2312718
ST - Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department-Initiated Buprenorphine Programs
T1 - Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department-Initiated Buprenorphine Programs
T2 - JAMA Netw Open
TI - Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department-Initiated Buprenorphine Programs
U1 - Opioids & Substance Use; Education & Workforce
U3 - 10.1001/jamanetworkopen.2023.12718
VL - 6
VO - 2574-3805
Y1 - 2023
ER -