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Variability in Practice of Buprenorphine Treatment by Emergency Department Operational Characteristics
Grant Comstock1, Natalia Truszczynski2, Sean S Michael3
1Medical College of Wisconsin, Department of Emergency Medicine, Division of Medical Toxicology, Milwaukee, Wisconsin.
The Western Journal of Emergency Medicine
|July 19, 2024
Summary
Emergency department buprenorphine treatment for opioid use disorder varies by hospital size and admission rates. Larger departments with higher admission rates showed increased buprenorphine treatment, contrary to fears of negative operational impacts.
Area of Science:
- Emergency Medicine
- Addiction Medicine
- Health Services Research
Background:
- Opioid use disorder (OUD) is a significant public health crisis.
- Buprenorphine is an effective medication for OUD treatment.
- Variability in buprenorphine treatment exists within emergency departments (EDs).
Purpose of the Study:
- To describe variability in ED buprenorphine treatment rates.
- To examine the relationship between ED operational characteristics and buprenorphine treatment.
- To identify factors influencing buprenorphine administration in the ED.
Main Methods:
- Retrospective cohort study of adult patients with OUD discharged from 12 hospital-based EDs.
- Analysis of buprenorphine treatment rates based on ED operational characteristics (census, admission rates, LOS, boarding time).
- Secondary outcomes included ED LOS and 30-day return rates.
Main Results:
- 10.2% of 7,469 OUD encounters received buprenorphine.
- Higher buprenorphine treatment rates were observed in larger EDs and those with higher hospital/ICU admission rates.
- No consistent association found between ED LOS, 30-day return rates, and buprenorphine treatment.
Conclusions:
- ED buprenorphine treatment rates are influenced by departmental operational characteristics.
- Concerns about negative impacts on operational metrics were not consistently observed.
- Increased funding and resource allocation are recommended to improve access to buprenorphine.
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