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A program meant to encourage the use of a drug that can help people overcome opioid addiction led to dramatic increases in its use in emergency rooms, researchers report.
Buprenorphine is a medication that stabilizes opioid withdrawal and soothes cravings. Using it can help people with opioid use disorder stay engaged with care, while reducing overdose deaths and other complications of drug use.
The program designed by researchers from the University of Pennsylvania worked both to give doctors incentives to train to treat opioid use disorder, as well as to develop and improve the connection between patients and peer recovery specialists.
Designed to increase initiation of the use of buprenorphine treatment for opioid use disorder in emergency rooms, the program was tested at three Penn Medicine hospitals and led to a sixfold increase in the treatment at these locations.
"We used a behavioral design approach to make implementation of evidence-based treatment easy, attractive, social and timely. While we concentrated initially on prescribing itself, we realized we also needed to overcome other barriers, such as identifying and engaging patients in care," lead study author and assistant professor of medicine Dr. Margaret Lowenstein said in a university news release.
This medication can be lifesaving for patients. To help make it easier for them to get it, researchers first needed to make it easier to prescribe by helping more clinicians become authorized prescribers.
The physicians in the study needed something called an X-waiver that required training, but those restrictions were later loosened in 2021. To prescribe the drug, physicians still need to register in advance on a government website.
The clinical team used a financial incentive system that rewarded doctors for the training, increasing their numbers from 6% to 90% in six weeks.
The researchers also developed a system to identify patients through electronic health records and connect them immediately with peer recovery specialists while they were in the hospital and during early recovery.
For the study, data was collected from March 2017 until July 2020, 18 months before and after the start of the program. It found that the rate of patients with opioid addiction who received buprenorphine in emergency departments climbed from 3% before the study to 23% by the end of the study period.
The patients sustained their use of the drug and increased it, even a year after the changes went into effect, though the study found that not all doctors prescribed it at the same rates. Some doctors prescribed buprenorphine to 61% of their patients with opioid use disorders, while others never wrote a prescription, even if they were authorized.
“The fact that some physicians in our group were able to provide this evidence-based treatment to more than half of their patients while others had the ability to do so, but never did, showed there was much more work to be done to nudge clinicians and make offering this treatment a default process,” said senior study author Dr. M. Kit Delgado, an assistant professor of emergency medicine and epidemiology.
This information led the team to conduct a focus group of 29 emergency department doctors or nurses. They learned that the automated process wasn't finding all eligible patients because the algorithm needed more specificity.
"Moving forward, we're going to test different ways to better ensure that patients we're discharging with buprenorphine prescriptions have a warm handoff and engagement with ongoing addiction treatment," Delgado said in the release. "Starting this medication is the best first step, but there are many more on the long-term path to recovery once they leave the hospital."
The findings were published Dec. 23 in the Annals of Emergency Medicine.
SOURCE: University of Pennsylvania School of Medicine, news release, Dec. 23, 2021
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