在急诊科开始使用丁丙诺啡:急诊临床医生调查。

IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE Western Journal of Emergency Medicine Pub Date : 2024-07-01 DOI:10.5811/westjem.18029
Ariana Barkley, Laura Lander, Brian Dilcher, Meghan Tuscano
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引用次数: 0

摘要

简介:美国急诊医师学会支持在急诊科(ED)使用丁丙诺啡治疗阿片类药物使用障碍(OUD),并证明这种治疗方法是有益的。然而,这种做法在很大程度上未得到充分利用:为了评估急诊科临床医生对在急诊科启动丁丙诺啡治疗的态度和准备情况,我们对一家三甲医院的临床医生(主治医师、住院医师和非医师临床医生)进行了一次横断面电子调查。我们的调查旨在评估急诊临床医生对在急诊室启用丁丙诺啡的态度和意愿,并确定临床医生认为的促进因素和障碍。我们的调查是在 IMPACT(启动用药、同行访问和连接治疗)项目启动后进行的:结果:我们的调查结果表明,对丁丙诺啡处方属于急诊医生执业范围的认同程度与平均执业年限成反比(R2 = 0.93)。接受过 X-waiver 培训的临床医生表示,他们认为自己在急诊室使用丁丙诺啡的准备程度更高(R2 = 0.93)。然而,他们并不更有可能报告在过去三个月内曾在急诊室订购过丁丙诺啡或纳洛酮。那些报告有家庭成员或亲密朋友患有药物使用障碍 (SUD) 的临床医生并不更有可能同意启动丁丙诺啡治疗属于临床医生的执业范围(P = 0.91),也不更有可能获得 X 豁免(P = 0.58)或报告在过去三个月内为急诊室患者订购过丁丙诺啡或纳洛酮(P = 0.65,P = 0.77)。临床医生认为,药剂师、住院病人/门诊病人转诊资源和支持人员(同伴康复支持专家和护理经理)的可用性是启动丁丙诺啡治疗的主要促进因素。无法确保随访、对可用资源缺乏了解以及教育/准备不足是 ED 丁丙诺啡使用的主要障碍。83%的临床医生表示,他们对有关 OUD 治疗的额外教育感兴趣:我们的数据表明,新一代急诊临床医生在急诊室启动丁丙诺啡治疗时可能不会那么犹豫。假以时日,这可能意味着有更多的 OUD 患者可以获得治疗。了解临床医生认为启动丁丙诺啡治疗的促进因素和障碍可以更好地分配资源。临床医生可能会进一步受益于有关阿片类药物使用障碍 (MOUD) 药物、可用资源和随访统计的更多教育。
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Initiation of Buprenorphine in the Emergency Department: A Survey of Emergency Clinicians.

Introduction: Initiation of buprenorphine for opioid use disorder (OUD) in the emergency department (ED) is supported by the American College of Emergency Physicians and is shown to be beneficial. This practice, however, is largely underutilized.

Methods: To assess emergency clinicians' attitudes and readiness to initiate buprenorphine in the ED we conducted a cross-sectional, electronic survey of clinicians (attendings, residents, and non-physician clinicians) in a single, academic ED of a tertiary-care hospital, which serves a rural population. Our survey aimed to assess emergency clinicians' attitudes toward and readiness to initiate buprenorphine in the ED and identify clinician-perceived facilitators and barriers. Our survey took place after the initiation of the IMPACT (Initiation of Medication, Peer Access, and Connection to Treatment) project.

Results: Our results demonstrated the level of agreement that buprenorphine prescribing is within the emergency clinician's scope of practice was inversely correlated to average years in practice (R2 = 0.93). X-waivered clinicians indicated feeling more prepared to administer buprenorphine in the ED R2 = 0.93. However, they were not more likely to report ordering buprenorphine or naloxone in the ED within the prior three months. Those who reported having a family member or close friend with substance use disorder (SUD) were not more likely to agree buprenorphine initiation is within the clinician's scope of practice (P = 0.91), nor were they more likely to obtain an X-waiver (P = 0.58) or report ordering buprenorphine or naloxone for patients in the ED within the prior three months (P = 0.65, P = 0.77). Clinicians identified availability of pharmacists, inpatient/outpatient referral resources, and support staff (peer recovery support specialists and care managers) as primary facilitators to buprenorphine initiation. Inability to ensure follow-up, lack of knowledge of available resources, and insufficient education/preparedness were primary barriers to ED buprenorphine initiation. Eighty-three percent of clinicians indicated they would be interested in additional education regarding OUD treatment.

Conclusion: Our data suggests that newer generations of emergency clinicians may have less hesitancy initiating buprenorphine in the ED. In time, this could mean increased access to treatment for patients with OUD. Understanding clinician-perceived facilitators and barriers to buprenorphine initiation allows for better resource allocation. Clinicians would likely further benefit from additional education regarding medications for opioid use disorder (MOUD), available resources, and follow-up statistics.

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来源期刊
Western Journal of Emergency Medicine
Western Journal of Emergency Medicine Medicine-Emergency Medicine
CiteScore
5.30
自引率
3.20%
发文量
125
审稿时长
16 weeks
期刊介绍: WestJEM focuses on how the systems and delivery of emergency care affects health, health disparities, and health outcomes in communities and populations worldwide, including the impact of social conditions on the composition of patients seeking care in emergency departments.
期刊最新文献
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