Emergency department buprenorphine program: staff concerns and recommended implementation strategies

Area of Science:

• Implementation Science
• Addiction Medicine
• Emergency Medicine

Background:

• Emergency Departments (EDs) are suitable settings for initiating buprenorphine treatment for opioid use disorder.
• Despite proven efficacy, buprenorphine initiation in EDs is underutilized, with suboptimal clinician participation.
• Hospitals require data to standardize national implementation of ED buprenorphine programs.

Purpose of the Study:

• Investigate ED providers' concerns regarding buprenorphine programs in the ED.
• Assess ED providers' willingness to prescribe buprenorphine in the ED setting.
• Identify implementation strategies to overcome barriers to ED buprenorphine programs.

Main Methods:

• Consolidated Framework for Implementation Research (CFIR)-informed interviews were conducted with 11 ED staff.
• Transcripts were analyzed using a six-step thematic approach.
• Results were organized within CFIR domains: inner setting, outer setting, intervention characteristics, and individual characteristics.

Main Results:

• Physicians found EDs suitable for buprenorphine prescribing but noted concerns.
• Concerns included information gaps, patient outcomes beyond the ED, buprenorphine effectiveness, timing, and provider competence.
• Lack of support, physician experience, and anxiety about opioid withdrawal were also cited.

Conclusions:

• Physicians view ED buprenorphine programs as appropriate but have concerns.
• Implementation strategies addressing multiple levels can increase physician willingness and program uptake.
• Addressing provider concerns is crucial for successful buprenorphine program implementation in EDs.