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Provider Perceptions of Opioid Safety Measures in VHA Emergency Departments and Urgent Care Centers
Nathalie Dieujuste1, Rachel Johnson-Koenke1, Manuel Celedon1
1is a Research and Project Coordinator, is a Social Work Researcher, and is an Emergency Medicine Physician and Health Service Researcher, all at the Rocky Mountain Regional Veterans Affairs (VA) Medical Center in Aurora, Colorado. is an Assistant Chief of Emergency Medicine, and is an Emergency Medicine Physician, both at the Greater Los Angeles VA Health Care System in California. is an Associate Chief Consultant for VA Pharmacy Benefits Management and the National Director for VA PBM Academic Detailing Service in San Diego, California. is a Pharmacy Benefit Manager for VISN 19 Academic Detailing Service in Denver, Colorado. Rachel Johnson-Koenke is an Assistant Professor at the University of Colorado College of Nursing in Aurora.
Background:
A priority for Veterans Health Administration (VHA) leadership is increasing access to lifesaving treatment, particularly naloxone distribution and medication-assisted treatment (MAT) for opioid use disorder (OUD) for veterans. To date, these practices are not widely done in the VHA emergency departments (ED) and urgent care centers (UCC).
Methods:
The goal of this research was to understand advanced care provider perceptions of barriers and facilitators to naloxone distribution or MAT initiation in VHA ED/UCCs. We developed and disseminated a survey to VHA ED and UCC advanced care providers, including medical doctors (MD/DO), physician assistants (PAs), and nurse practitioners (NPs). Descriptive statistical analysis was conducted.
Results:
There was 16.7% response rate (372 out of 2228 providers) from 103 of 132 sites across all VA regions. The top barrier for ED/UCCs providers to both naloxone and MAT initiation was the feeling that it was beyond their scope of practice (35.2% and 53.2%, respectively). Other reported barriers to MAT initiation included unclear follow-up plan and system for referral of care (50.1%) and feeling uncomfortable using MAT medications (28.8%). Top facilitators for prescribing naloxone included pharmacist who could help prescribe/educate the patient on the medication (44.6%) and patient knowledge of medication options to help overdose (31.7%). The top facilitator for MAT initiation from the ED/UCC was additional VA-based same day treatment options (34.9%).
Conclusions:
Present findings offer a look into possible challenges to address or opportunities to leverage when considering or developing an ED/UCC-based naloxone distribution or MAT-initiation implementation program in VHA facilities.