Implementation Facilitation to Promote Emergency Department-Initiated Buprenorphine for Opioid Use Disorder

Area of Science:

• Public Health
• Addiction Medicine
• Implementation Science

Background:

• Emergency department (ED) initiation of buprenorphine for opioid use disorder (OUD) is underutilized.
• Effective strategies are needed to increase the provision of ED-initiated buprenorphine and subsequent patient engagement in OUD treatment.

Purpose of the Study:

• To evaluate the impact of an implementation facilitation (IF) strategy on the rate of ED-initiated buprenorphine with referral for OUD.
• To assess the effectiveness of IF in increasing patient engagement in OUD treatment at 30 days post-enrollment.

Main Methods:

• A multicenter, nonrandomized trial compared a 60-minute grand rounds educational session with a multicomponent IF strategy.
• IF involved local champions, protocol development, learning collaboratives, and performance feedback.
• Observational cohorts of ED patients with untreated OUD were analyzed pre- and post-IF implementation (April 2017 - November 2020).

Main Results:

• ED-initiated buprenorphine increased from 0.5% during baseline to 14.6% during the IF period (P < .001).
• Engagement in OUD treatment at 30 days increased from 10.2% to 16.3% (P = .01).
• Patients receiving ED-buprenorphine were more likely to be in treatment at 30 days (35.8% vs 12.9%, P < .001).

Conclusions:

• Implementation facilitation is an effective strategy to increase ED-initiated buprenorphine for OUD.
• The IF strategy significantly improved patient engagement in OUD treatment.
• Findings support the broader adoption of IF to enhance OUD care in emergency departments.