Abstract
Emergency departments (EDs) are increasingly initiating treatment for patients with untreated opioid use disorder (OUD) and linking them to ongoing addiction care. To our knowledge, patient perspectives related to their ED visit have not been characterized and may influence their access to and interest in OUD treatment. To assess the experiences and perspectives regarding ED-initiated health care and OUD treatment among US patients with untreated OUD seen in the ED. This qualitative study, conducted as part of 2 studies (Project ED Health and ED-CONNECT), included individuals with untreated OUD who were recruited during an ED visit in EDs at 4 urban academic centers, 1 public safety net hospital, and 1 rural critical access hospital in 5 disparate US regions. Focus groups were conducted between June 2018 and January 2019. Data collection and thematic analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework with evidence (perspectives on ED care), context (ED), and facilitation (what is needed to promote change) elements. A total of 31 individuals (mean [SD] age, 43.4 [11.0] years) participated in 6 focus groups. Twenty participants (64.5%) identified as male and most 13 (41.9%) as White; 17 (54.8%) reported being unemployed. Themes related to evidence included patients' experience of stigma and perceived minimization of their pain and medical problems by ED staff. Themes about context included the ED not being seen as a source of OUD treatment initiation and patient readiness to initiate treatment being multifaceted, time sensitive, and related to internal and external patient factors. Themes related to facilitation of improved care of patients with OUD seen in the ED included a need for on-demand treatment and ED staff training. In this qualitative study, patients with OUD reported feeling stigmatized and minimized when accessing care in the ED and identified several opportunities to improve care. The findings suggest that strategies to address stigma, acknowledge and treat pain, and provide ED staff training should be implemented to improve ED care for patients with OUD and enhance access to life-saving treatment.
Highlights
Themes about context included the emergency department (ED) not being seen as a source of opioid use disorder (OUD) treatment initiation and patient readiness to initiate treatment being multifaceted, time sensitive, and related to internal and external patient factors
Themes related to facilitation of improved care of patients with OUD seen in the ED included a need for on-demand treatment and ED staff training
The findings suggest that strategies to address stigma, acknowledge and treat pain, and provide ED staff training should be implemented to improve ED care for patients with OUD and enhance access to life-saving treatment
Summary
As US opioid-associated fatalities have continued to increase,[1,2] emergency departments (EDs) have been recognized as an important venue for initiating treatment for opioid use disorder (OUD) and providing referrals for ongoing care,[3,4,5] and people seeking treatment for overdose, injection-related infections, withdrawal, and OUD have been increasingly treated in the ED.[6,7,8,9,10,11,12] Emergency department–initiated buprenorphine with treatment referral is cost-effective and associated with increased 30-day treatment engagement rates compared with standard referral.[13,14] The treatment gap between people with OUD and those engaged in treatment[15,16] is associated with stigma, limited patient knowledge about and motivation for treatment, socioeconomic barriers to treatment, and racial and ethnic disparities in access to treatment.[17,18,19,20,21,22,23,24,25,26] These patient-related factors should be considered when designing interventions to engage patients in the ED. We aimed to explore patients’ perspectives on receiving OUD-related care in the ED to inform future implementation efforts to promote OUD treatment initiation and improve patient-centered care in the ED for those with OUD
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