As opioid-associated deaths and emergency department (ED) visits for opioid overdose continue to rise, improving access to effective treatments for opioid use disorder (OUD) such as buprenorphine has become increasingly critical. What do patients with OUD in the ED feel they need? To better understand the experiences of patients with OUD on receiving care in the ED and to identify opportunities to improve care, Yale researchers led a collaboration with New York University, John’s Hopkins University, University of Cincinnati, Mount Sinai Hospital in New York, and the University of Washington. Between June 2018 and January 2019. They conducted focus groups with ED patients across six academic, community, and public safety net EDs in Baltimore, MD, Cincinnati, OH, New York City, NY, Seattle, WA and Claremont, NH, as part of two NIDA Clinical Trials Network studies. These studies, ED CONNECT, co-led by lead author of this study, Dr. Kathryn Hawk, Yale Assistant Professor Emergency Medicine and Public Health and Dr. Ryan McCormack, Assistant Professor of Emergency Medicine in the NYU Grossman School of Medicine, and Project ED Health, led by Yale University’s Gail D’Onofrio, Albert E. Kent Professor of Emergency Medicine and Public Health, and David Fiellin, Professor of Medicine, Emergency Medicine and Public Health and Director of Program of the Yale Program in Addiction Medicine, focused on promoting the uptake of ED-initiated buprenorphine for the treatment of OUD across a variety of ED settings.
The study, published in JAMA Network Open, Perspectives About Emergency Department Care Encounters Among Adults With Opioid Use Disorder | Emergency Medicine | JAMA Network Open | JAMA Network used an implementation science framework to identify key elements about the evidence (perspectives on ED care), context (ED setting) and facilitation (what is needed to promote practice change) to inform implementation of improved ED care for patients with OUD. Patients reported that they experienced stigma related to their opioid use and that their complaints of pain and medical issues were not taken seriously. Patients reported that their readiness to initiate treatment for OUD was complex, related to multiple internal and external factors and time sensitive. Opportunities to improve care also included a need for on-demand OUD treatment and ED staff training on addiction.
“Our study shows that there are specific ways we can improve the care of ED patients with OUD and know that one of the most effective ways to do this is to partner with patients and incorporate their perspectives, experiences and needs into how we deliver and improve care,” said Hawk. “It is critically important that we listen to patients and partner with them to improve outcomes together.”
This study highlighted a clear need for improved care of ED patients with OUD, especially with escalating overdose deaths during the COVID-19 pandemic. “Applying the information we garnered talking with individuals with lived experiences”, said D’Onofrio, “is a powerful facilitator to improve the care of patients with OUD in EDs across the country.”