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1.
Annals of Emergency Medicine ; 80(4 Supplement):S19, 2022.
Article in English | EMBASE | ID: covidwho-2176217

ABSTRACT

Background: To enhance dissemination of resources promoting evidence-based care of emergency department (ED) patients with opioid use disorder (OUD) and assess practices related to OUD care in EDs with a range of characteristics and resources, we developed the ACEP Emergency Medicine Quality Network (E-QUAL) Opioid Initiative. This national ED-focused practice-based learning network seeks to increase provision of naloxone and medication for the treatment of OUD (MOUD) by supporting local quality improvement (QI) through a curated toolkit with webinars and resources, a QI chart review to assess and benchmark ED care, and the dissemination of best practices. Method(s): In March of 2021, participating EDs were requested to complete a structured chart review of 30 randomly selected ED visits between September 2020 - February 2021 (baseline) with ICD-10 codes for opioid overdose or OUD, and to report on the following measures: substance use evaluation in the ED, naloxone offer/provision, MOUD administration (methadone or buprenorphine) in the ED, buprenorphine prescription at discharge, documented overdose prevention or harm reduction provision, and referral to OUD treatment. In November 2021, EDs were requested to review and submit metrics from an additional 30 charts for visits between July 2021- October 2021 (follow-up). Descriptive statistics and student's t tests were used to evaluate differences. Result(s): Among the 385 EDs participating in the 2021 E-QUAL Opioid Initiative learning collaborative, the median annual ED visit volume for adults was 14,552, with 138 (36%) classified as rural and 43 (11%) as critical access. Chart review data were submitted for 4,877 ED visits during the baseline period and 5,629 visits during follow-up. Between the baseline and follow-up periods, documented substance use evaluation in the ED increased from 89% to 93% (p<0.001) and OUD referral rate increased from 63% to 84% (p<0.001). Overall, the discussion or provision of naloxone (34% to 27%;p<0.001) and the documentation of overdose prevention and harm reduction counseling (67% to 60%;p<0.001) decreased across the two time points, although among the subset of patients with opioid overdose, naloxone discussion/provision increased (36% to 43%;p<0.001). Provision of buprenorphine and methadone in the ED (1% to 4%;p<0.001) and provision of an outpatient prescription of buprenorphine (2% to 3%;p<0.05) increased as well. Conclusion(s): EDs participating in a national practice-based learning network demonstrated improvement in several measures of ED OUD care. This study represents the first feasibility assessment of collection of measures from a nationwide sample including rural and community EDs for this purpose. Although improvements are modest, improved rates of OUD evaluation, treatment referral and MOUD treatment provision after participation in an online learning collaborative amidst the COVID-19 pandemic demonstrate the importance and potential for ongoing education and quality improvement. Yes, authors have interests to disclose Disclosure: Foundation for Opioid Response (FORE) Foundation Grant Support Foundation for Opioid Response (FORE) Foundation Copyright © 2022

2.
Annals of Emergency Medicine ; 78(4):S89-S90, 2021.
Article in English | EMBASE | ID: covidwho-1748261

ABSTRACT

Study Objectives: To identify changes in emergency department (ED) visits for opioid-related diagnoses, opioid overdose, and the use of buprenorphine in EDs during the SARS-CoV-2 pandemic. Methods: Electronic health data was collected from 14 geographically distinct emergency departments for ED visits between August 31, 2019 and August 30, 2020. Variables collected include age, sex, race, ICD-10 discharge codes, buprenorphine administrations, buprenorphine prescriptions and SARS-CoV-2 hospital admission rate. The category of opioid-related diagnoses included ED visits with ICD-10 codes for opioid use disorder, opioid dependence, opioid withdrawal, opioid overdose and/or opioid-related infection. Opioid-related infection visits were tabulated as ED visits with ICD-10 code for abscess, cellulitis, endocarditis or osteomyelitis and concurrent ICD-10 code of opioid-related diagnosis for the current ED visit or in the medical history. We used descriptive statistics and paired t-test to evaluate for differences in ED visits for opioid-related diagnoses, opioid overdose and rate of buprenorphine administrations and/or prescriptions between in visit with opioid-related diagnosis between August 31, 2019-February 29, 2020 and March 1, 2020-August 30, 2020. Spearman correlation was used to assess the association of outcomes with hospital SARS-CoV-2 burden from January 1, 2020 through August 30, 2020. Results: We collected information on a total of 911,738 ED visits between August 31, 2019- August 30, 2020 from 14 EDs Total ED visits with opioid-related diagnoses by ICD-10 code were 9,788, including 3,198 for opioid overdose, 1,745 for opioid withdrawal, and 431 for opioid-related infection (Figure 1). Between August 31, 2019-February 29, 2020 and March 1, 2020-August 30, 2020 (N = 13 sites), there was an increase in ED visits for OUD-related visits per 10,000 visits (130.8 (SE: 24.2) vs 101.8 (SE: 21.8);p=0.002) and an increase in ED visits for opioid overdose per 10,000 ED visits (40.8 (SE: 10.3) vs 27.4 (SE: 6.1);p=0.02). No change was detected in the rate of buprenorphine administration and/or prescriptions: 25.8 (SE: 5.3) vs 25.1 (5.5);p=0.80. From January to August 2020, significant correlations were observed between inpatient hospital SARS-CoV-2 rates and ED visits with a positive correlation between opioid-related diagnoses per 10,000 (Spearman r=0.92, p= <0.0001) and opioid overdose per 10,000 visits (r=0.90, p=<0.0001);a negative correlation was found for the rate of ED administration and/or prescription of buprenorphine (r=-0.37, p=0.03). Conclusions: ED visits for opioid-related diagnoses and opioid overdose per 10,000 ED visits increased in EDs between March 1, 2020 – August 30, 2020 compared to the preceding 6 months and correlated with inpatient SARS-CoV-2 burden. Although the overall rate of buprenorphine administered and/or prescribed from the ED highlights a significant practice change in EDs over recent years, buprenorphine provision in EDs did not increase despite likely treatment service disruptions during this period of SARS-CoV-2. [Formula presented]

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