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A Qualitative Assessment of an Electronic Health Record-Embedded Intervention to Increase In-Hospital Opioid Use
Susan L Calcaterra1,2, Steven Lockhart3, Ingrid A Binswanger4,5,6,7
1Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA. susan.calcaterra@cuanschutz.edu.
Background:
In-hospital initiation of medications for opioid use disorder (MOUD) remains low despite their effectiveness to reduce opioid-related mortality. We implemented an in-hospital OUD intervention across 12 hospitals to increase OUD treatment provision.
Objective:
Understand factors impacting adoption and implementation of a non-interruptive electronic health record-embedded intervention which provided OUD treatment guidance.
Design And Participants:
We conducted focus groups and key informant interviews involving hospital-based physicians and advanced practice professionals (APPs), nurses, social workers, and pharmacists working in one large Colorado health system at 6 and 12 months following the intervention's implementation.
Approach:
We employed both a deductive and inductive approach, based on a directed content analysis, to analyze qualitative data.
Key Results:
Sixty-one professionals participated representing the three hospital regions across Colorado (northern, southern, central): 24 hospital-based clinicians, 19 nurses, 12 social workers, and 6 pharmacists. We identified five themes related to challenges and barriers to the adoption of the OUD intervention: (1) despite access to educational sessions and MOUD initiation protocols, discomfort treating OUD persisted; (2) inconsistent health system messaging and communication across hospitals resulted in variable use of the OUD intervention; (3) differential access to addiction expertise impacted MOUD initiation; (4) increased emphasis on opioid withdrawal severity assessment and documentation led to unexpected benefits and challenges; and (5) challenges were identified associated with the complexity of caring for patients with OUD in busy hospital practices.
Conclusion:
Various challenges were identified that impacted in-hospital OUD treatment provision after the intervention. Emergent themes informed opportunities that health system leaders could implement to expand in-hospital OUD treatment provision including frequent and cohesive messaging from leadership highlighting health system priorities and goals for OUD treatment, addiction specialist support with outpatient referral resources for OUD treatment linkage, ongoing education with reinforcement on MOUD initiation, and stigma training.
