107 Improving Transitions of Care for Patients Initiated on Buprenorphine from the Emergency Department

Abstract

Opioid use disorder (OUD) is on the rise nationwide with increasing emergency department (ED) visits and deaths secondary to overdose. Although previous research has shown that patients who are started on buprenorphine in the ED have increased engagement in addiction treatment, access to on-demand medications for OUD is still limited, in part because of the need for outpatient linkages to care. The objective of this study is to describe emergency and outpatient providers’ perception of local barriers to transitions of care for ED-initiated buprenorphine patients. Purposive sampling was used to recruit key stakeholders, who identified as physicians, addiction specialists, and hospital administrators, from 10 EDs and 11 outpatient clinics in King County, Washington. Twenty-one interviews were recorded and transcribed, and then coded by two team members in order to verify accuracy of the thematic analysis. Interview guides and coding were informed by the Consolidated Framework for Implementation Research (CFIR), which provides a structure of domains associated with effective implementation of evidence-based practice. From the 21 interviews with emergency and outpatient providers, four major barriers emerged around transitions of care for ED-initiated buprenorphine patients—stigma, X-waiver shortage, referral incoordination, and loss to follow-up. Interviewees desired a protocolized “standard of care” for the treatment of ED patients with OUD to destigmatize the condition and increase patient self-identification and mission-driven practice. Additionally, participants highlighted the need to increase program capacity through promoting X-waiver training and creating a central repository of outpatient providers in order to streamline referrals. Lastly, interviewees aspired to increase retention of patients in outpatient treatment by having low-barrier scheduling, walk-in appointments, navigation services, and care coordination. There are a number of barriers to translating evidence-based practice around the transitions of care of ED-initiated buprenorphine patients to an urban community setting. Next steps for implementation of this intervention include increasing the number of X-waivered providers, creating a central repository for streamlined referrals and follow-up, and funding navigation services.