219 A Non-Inferiority Trial of Peer Recovery Coaches for Screening, Brief Intervention and Referral to Treatment for Substance Use Disorders via In-Person versus Telehealth Interviews

Abstract

Screening, Brief Intervention, and Referral to Treatment (SBIRT) has become an impactful method of addressing at risk/problematic substance use in the emergency department (ED). However, employing full-time peer recovery coaches (PRCs) may be challenging for some EDs. Additionally, it is unclear whether telehealth serves as a constructive medium for PRCs to deliver brief interventions (BI) and provide linkage to treatment. This study assessed the effectiveness of PRC evaluation and intervention via in-person versus telehealth interaction for patients screening positive at ED triage for at risk/problematic substance use. A prospective cohort study was conducted from July 1, 2020 to February 28, 2021 between two free-standing EDs in Maryland, one with an annual volume of 28,000 visits and one with an annual volume of 32,000 visits. Patients who arrived at the ED and received a BI were enrolled in our study. Since not all BI are eligible for referral, we further defined a subgroup of “high-risk” BI, excluding those BI performed exclusively for marijuana use or those who triggered positive at ED triage but did not have a specific substance identified, to evaluate the proportion of high-risk BI that were provided referral to treatment. A research assistant collected demographic and clinical information from the electronic medical record including modality of PRC interaction-in-person, tele-video, and telephone-referral to treatment, and confirmation of linkage to substance use treatment post-referral. Patients under the age of 18, prisoners, pregnant women, and patients who had received a referral without ED BI were excluded. BI provided and referral versus linkage to treatment for in-person versus telehealth PRC interactions were compared using a test of proportions and non-inferiority was defined by a fixed margin of less than -0.1. In the 8-month enrollment period, 1,144 patients had a positive ED triage screening and received a BI. In-person BI received had a proportion of 0.70 (±0.46) compared to telehealth BI with a proportion of 0.64 (±0.48), with an absolute risk difference of 0.06 (95% CI -0.03-0.08 p<0.05). Of the 331 patients who received a high-risk BI, 57 patients were referred to treatment, with a proportion of 0.61 (±0.08) of patients who received in-person and 0.52 (±0.11) received a telehealth high-risk BI that linked to treatment, with an absolute risk difference of 0.09 (95% CI 0.18-0.35 p=0.52). Our study demonstrated non-inferiority for patients with at risk behavior/problematic substance use to receive PRC BI via in-person versus telehealth. Non-inferiority was not demonstrated for linkage to treatment amongst the high-risk BI referral group, though non-inferiority would have been achieved for this cohort for a fixed margin of less than -0.2. Additional research with a larger sample is needed to corroborate these observations; however, this study suggests some EDs could consider implementing SBIRT with a hybrid PRC model or isolated telehealth staffing to assist in the care of patients with substance use disorder.