Evaluation of a Medication for Opioid Use Disorder Initiation Program in the Emergency Department

Abstract

Medication for opioid use disorder (MOUD) is the standard evidence-based treatment option for patients with opioid use disorder (OUD). Initiating MOUD in the emergency department (ED) may help patients start the treatment and lead to greater success in sustaining recovery from OUD. Programs have been introduced in EDs to support the initiation of MOUD, but little is known about the implementation facilitators and challenges that impact these programs. The objective of this study was to explore key partners' perspectives about the facilitators and challenges of implementing and operating an ED-based MOUD program in a large, Midwestern academic medical center.

BACKGROUND

Medication for opioid use disorder (MOUD) is the standard evidence-based treatment option for patients with opioid use disorder (OUD). Initiating MOUD in the emergency department (ED) may help patients start the treatment and lead to greater success in sustaining recovery from OUD. Programs have been introduced in EDs to support the initiation of MOUD, but little is known about the implementation facilitators and challenges that impact these programs. The objective of this study was to explore key partners' perspectives about the facilitators and challenges of implementing and operating an ED-based MOUD program in a large, Midwestern academic medical center.Interviews were conducted in April and May 2019 with physicians, nurses, social workers, pharmacists, and administrators who were involved in implementing the ED MOUD initiation program. Verbatim transcripts were analyzed both deductively and inductively to identify themes related to the facilitators and challenges of program implementation, and suggestions about factors that contributed to program success.

METHODS

Interviews were conducted in April and May 2019 with physicians, nurses, social workers, pharmacists, and administrators who were involved in implementing the ED MOUD initiation program. Verbatim transcripts were analyzed both deductively and inductively to identify themes related to the facilitators and challenges of program implementation, and suggestions about factors that contributed to program success.We found subthemes related to each of these 3 major themes. First, facilitators of program implementation included institutional buy-in, community support, involvement of an interdisciplinary team, availability of ongoing training, and public awareness of the opioid epidemic. Second, program implementation challenges included inadequate staffing and training, complications in treatment linkage, uncertainty in prescribing, unclear workflow, and culture change. Identified success factors for program implementation included provider, community, and patient education, data availability, and provider buy-in.

RESULTS

We found subthemes related to each of these 3 major themes. First, facilitators of program implementation included institutional buy-in, community support, involvement of an interdisciplinary team, availability of ongoing training, and public awareness of the opioid epidemic. Second, program implementation challenges included inadequate staffing and training, complications in treatment linkage, uncertainty in prescribing, unclear workflow, and culture change. Identified success factors for program implementation included provider, community, and patient education, data availability, and provider buy-in.Our study results suggest that attention to factors such as buy-in, the need for the right training and education, and establishing key relationships with community organizations can help ED-based MOUD programs fill a critical gap in care for patients with OUD.

CONCLUSION

Our study results suggest that attention to factors such as buy-in, the need for the right training and education, and establishing key relationships with community organizations can help ED-based MOUD programs fill a critical gap in care for patients with OUD.