Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study
Abstract Background For many reasons, the emergency department (ED) is a critical venue to initiate OUD interventions. The prevailing culture of the ED has been that substance use disorders are non-emergent conditions better addressed outside the ED where resources are less constrained. This study,...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | Addiction Science & Clinical Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13722-021-00224-y |
| _version_ | 1818557271130505216 |
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| author | Ryan P. McCormack John Rotrosen Phoebe Gauthier Gail D’Onofrio David A. Fiellin Lisa A. Marsch Patricia Novo David Liu E. Jennifer Edelman Sarah Farkas Abigail G. Matthews Caroline Mulatya Dagmar Salazar Jeremy Wolff Randolph Knight William Goodman Kathryn Hawk |
| author_facet | Ryan P. McCormack John Rotrosen Phoebe Gauthier Gail D’Onofrio David A. Fiellin Lisa A. Marsch Patricia Novo David Liu E. Jennifer Edelman Sarah Farkas Abigail G. Matthews Caroline Mulatya Dagmar Salazar Jeremy Wolff Randolph Knight William Goodman Kathryn Hawk |
| author_sort | Ryan P. McCormack |
| collection | DOAJ |
| description | Abstract Background For many reasons, the emergency department (ED) is a critical venue to initiate OUD interventions. The prevailing culture of the ED has been that substance use disorders are non-emergent conditions better addressed outside the ED where resources are less constrained. This study, its rapid funding mechanism, and accelerated timeline originated out of the urgent need to learn whether ED-initiated buprenorphine (BUP) with referral for treatment of OUD is generalizable, as well as to develop strategies to facilitate its adoption across a variety of ED settings and under real-world conditions. It both complements and uses methods adapted from Project ED Health (CTN-0069), a Hybrid Type 3 implementation-effectiveness study of using Implementation Facilitation (IF) to integrate ED-initiated BUP and referral programs. Methods ED-CONNECT (CTN 0079) was a three-site implementation study exploring the feasibility, acceptability, and impact of introducing ED-initiated BUP in rural and urban settings with high-need, limited resources, and different staffing structures. We used a multi-faceted approach to develop, introduce and iteratively refine site-specific ED clinical protocols and implementation plans for opioid use disorder (OUD) screening, ED-initiated BUP, and referral for treatment. We employed a participatory action research approach and use mixed methods incorporating data derived from abstraction of medical records and administrative data, assessments of recruited ED patient-participants, and both qualitative and quantitative inquiry involving staff from the ED and community, patients, and other stakeholders. Discussion This study was designed to provide the necessary, time-sensitive understanding of how to identify OUD and initiate treatment with BUP in the EDs previously not providing ED-initiated BUP, in communities in which this intervention is most needed: high need, low resource settings. Trial registration: The study was prospectively registered on ClinicalTrials.gov (NCT03544112) on June 01, 2018: https://clinicaltrials.gov/ct2/show/NCT03544112 . |
| first_indexed | 2024-12-13T23:57:37Z |
| format | Article |
| id | doaj.art-687b3203f5e24aff9e76b8830f29c202 |
| institution | Directory Open Access Journal |
| issn | 1940-0640 |
| language | English |
| last_indexed | 2024-12-13T23:57:37Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj.art-687b3203f5e24aff9e76b8830f29c2022022-12-21T23:26:28ZengBMCAddiction Science & Clinical Practice1940-06402021-03-0116111410.1186/s13722-021-00224-yImplementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility studyRyan P. McCormack0John Rotrosen1Phoebe Gauthier2Gail D’Onofrio3David A. Fiellin4Lisa A. Marsch5Patricia Novo6David Liu7E. Jennifer Edelman8Sarah Farkas9Abigail G. Matthews10Caroline Mulatya11Dagmar Salazar12Jeremy Wolff13Randolph Knight14William Goodman15Kathryn Hawk16New York University Grossman School of MedicineNew York University Grossman School of MedicineGeisel School of Medicine at Dartmouth CollegeDepartment of Emergency Medicine, Yale School of MedicineDepartment of Emergency Medicine, Yale School of MedicineGeisel School of Medicine at Dartmouth CollegeNew York University Grossman School of MedicineNational Institute on Drug AbuseDepartment of Internal Medicine, Yale School of MedicineNew York University Grossman School of MedicineThe Emmes CompanyThe Emmes CompanyThe Emmes CompanyThe Emmes CompanySpringfield HospitalHoly Family HospitalDepartment of Emergency Medicine, Yale School of MedicineAbstract Background For many reasons, the emergency department (ED) is a critical venue to initiate OUD interventions. The prevailing culture of the ED has been that substance use disorders are non-emergent conditions better addressed outside the ED where resources are less constrained. This study, its rapid funding mechanism, and accelerated timeline originated out of the urgent need to learn whether ED-initiated buprenorphine (BUP) with referral for treatment of OUD is generalizable, as well as to develop strategies to facilitate its adoption across a variety of ED settings and under real-world conditions. It both complements and uses methods adapted from Project ED Health (CTN-0069), a Hybrid Type 3 implementation-effectiveness study of using Implementation Facilitation (IF) to integrate ED-initiated BUP and referral programs. Methods ED-CONNECT (CTN 0079) was a three-site implementation study exploring the feasibility, acceptability, and impact of introducing ED-initiated BUP in rural and urban settings with high-need, limited resources, and different staffing structures. We used a multi-faceted approach to develop, introduce and iteratively refine site-specific ED clinical protocols and implementation plans for opioid use disorder (OUD) screening, ED-initiated BUP, and referral for treatment. We employed a participatory action research approach and use mixed methods incorporating data derived from abstraction of medical records and administrative data, assessments of recruited ED patient-participants, and both qualitative and quantitative inquiry involving staff from the ED and community, patients, and other stakeholders. Discussion This study was designed to provide the necessary, time-sensitive understanding of how to identify OUD and initiate treatment with BUP in the EDs previously not providing ED-initiated BUP, in communities in which this intervention is most needed: high need, low resource settings. Trial registration: The study was prospectively registered on ClinicalTrials.gov (NCT03544112) on June 01, 2018: https://clinicaltrials.gov/ct2/show/NCT03544112 .https://doi.org/10.1186/s13722-021-00224-yBuprenorphineImplementation scienceEmergency serviceOpioid use disorder |
| spellingShingle | Ryan P. McCormack John Rotrosen Phoebe Gauthier Gail D’Onofrio David A. Fiellin Lisa A. Marsch Patricia Novo David Liu E. Jennifer Edelman Sarah Farkas Abigail G. Matthews Caroline Mulatya Dagmar Salazar Jeremy Wolff Randolph Knight William Goodman Kathryn Hawk Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study Addiction Science & Clinical Practice Buprenorphine Implementation science Emergency service Opioid use disorder |
| title | Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study |
| title_full | Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study |
| title_fullStr | Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study |
| title_full_unstemmed | Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study |
| title_short | Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study |
| title_sort | implementation facilitation to introduce and support emergency department initiated buprenorphine for opioid use disorder in high need low resource settings protocol for multi site implementation feasibility study |
| topic | Buprenorphine Implementation science Emergency service Opioid use disorder |
| url | https://doi.org/10.1186/s13722-021-00224-y |
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