A Promising Step in Fighting the Opioid Epidemic, Care Plan Implementation for those Presenting to the Emergency Department

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Background: The opioid epidemic has both financial implications and ethical confounders affecting emergency departments across the country. Additionally, patients presenting to the emergency department (ED) seeking opioid administration and prescriptions can be both disruptive and time intensive.
 Objective: To determine long-term effectiveness of ED care plans designed to improve medical care for ED opioid-seeking patients with chronic painful conditions. Methods: A retrospective, cohort observational study.
 Location: a suburban teaching hospital with an annual census of 90,000 patients. The number of ED visits were tallied one year prior (control), and for five consecutive years following initiation. The primary outcome was the number of yearly ED visits in subjects meeting criteria.
 Statistics: Two-tailed Wilcoxon signed-rank test with significance of p<0.05, two tailed. Results: One hundred and twenty patients were enrolled. Twelve were excluded, leaving 108 patients for analysis. Mean yearly ED visits prior to care plan initiation were 7.6 (95% CI 11.9-3.3). Following care plan initiation, mean visits were: one year, 2.3 (95% CI 4.3-0.3); two years, 1.3 (95% CI 2.7-0.0); three years, 1.1(95 % CI 3.1-0.0); four years, 0.8 (95% CI 2.1-0.0); five years, 0.6 (95% CI 1.7-0.0). The five-year total mean reduction in visits was 7.0 (95% CI 8.1- 6.2) (p=0.0001). Conclusions: ED care plans are an effective long-term method to reduce visits in patients with chronic painful conditions who present seeking opioid treatment.