A 3 year follow-up of HCV infection in opioid use disorder patients in treatment

Abstract

Aims: In response to the opioid overdose epidemic, a safety net hospital implemented a policy to ensure emergency department (ED) patients at risk for opioid overdose are offered naloxone rescue kits (NRKs). Study aims are to: (1) determine the extent of implementation, (2) describe barriers and facilitators to adoption. Methods: Mixed methods for formative evaluation: electronic medical record (EMR) query to identify patients at risk and rate of NRK provision, and qualitative interviews with diverse ED staff analyzed via grounded theory to identify barriers and facilitators. Results: The policy supports 3 methods of NRK provision: (1) distribution by Licensed Alcohol and Drug Counselors (LADCs), (2) outpatient pharmacy prescriptions, (3) inpatient pharmacy distribution by ED staff (when LADCs unavailable). In the first 7 months, 1241 ED patients were at risk; of these 12% (n=150) received NRK (142 via LADCs, 5 outpatient prescriptions, 3 ED staff). Interview results indicate support for policy and implementation barriers. Patient barriers: population often not receptive to NRK, not accompanied toEDbyasupportiveother. Staff barriers:unfamiliaritywith policy, lack of clarity regarding responsibility for distribution, lack of consensus on patients appropriate. Process barriers: method of obtaining kit unclear, confusion around standing verbal order, not integrated into EMR. Staff suggestions to improve uptake include: simplifying process, targeted training, role clarification, integration into EMR. Conclusions: ED staff support provision of NRKs andmany barriers aremodifiable. Findingsmay have applications for integrating the intervention into other ED settings. Financial support: Boston University School of Public Health Pilot Grant Program.