Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study

Introduction: Recent studies from urban academic centers have shown the promise of emergency physician-initiated buprenorphine for improving outcomes in opioid use disorder (OUD) patients. We investigated whether emergency physician-initiated buprenorphine in a rural, community setting decreases sub...

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Autores principales:	Tinh Le, Parker Cordial, Mackenzie Sankoe, Charlotte Purnode, Ankur Parekh, Thomas Baker, Brian Hiestand, W.F. Peacock, James Neuenschwander
Formato:	article
Lenguaje:	EN
Publicado:	eScholarship Publishing, University of California 2021
Materias:	Medicine R Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/9c76d77c6e2642129ed65d92c95de366
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spelling	oai:doaj.org-article:9c76d77c6e2642129ed65d92c95de3662021-11-17T15:19:27ZHealthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study1936-901810.5811/westjem.2021.6.51306https://doaj.org/article/9c76d77c6e2642129ed65d92c95de3662021-09-01T00:00:00Zhttps://escholarship.org/uc/item/2242b26vhttps://doaj.org/toc/1936-9018Introduction: Recent studies from urban academic centers have shown the promise of emergency physician-initiated buprenorphine for improving outcomes in opioid use disorder (OUD) patients. We investigated whether emergency physician-initiated buprenorphine in a rural, community setting decreases subsequent healthcare utilization for OUD patients. Methods: We performed a retrospective chart review of patients presenting to a community hospital emergency department (ED) who received a prescription for buprenorphine from June 15, 2018–June 15, 2019. Demographic and opioid-related International Classification of Diseases, 10th Revision, (ICD-10) codes were documented and used to create a case-matched control cohort of demographically matched patients who presented in a similar time frame with similar ICD-10 codes but did not receive buprenorphine. We recorded 12-month rates of ED visits, all-cause hospitalizations, and opioid overdoses. Differences in event occurrences between groups were assessed with Poisson regression. Results: Overall 117 patients were included in the study: 59 who received buprenorphine vs 58 controls. The groups were well matched, both roughly 90% White and 60% male, with an average age of 33.4 years for both groups. Controls had a median two ED visits (range 0–33), median 0.5 hospitalizations (range 0–8), and 0 overdoses (range 0–3), vs median one ED visit (range 0–8), median 0 hospitalizations (range 0–4), and median 0 overdoses (range 0–3) in the treatment group. The incidence rate ratio (IRR) for counts of ED visits was 0.61, 95% confidence interval (CI), 0.49, 0.75, favoring medication-assisted treatment (MAT). For hospitalizations, IRR was 0.34, 95% CI, 0.22, 0.52 favoring MAT, and for overdoses was 1.04, 95% CI, 0.53, 2.07. Conclusion: Initiation of buprenorphine by ED providers was associated with lower 12-month ED visit and all-cause hospitalization rates with comparable overdose rates compared to controls. These findings show the ED’s potential as an initiation point for medication-assisted treatment in OUD patients.Tinh LeParker CordialMackenzie SankoeCharlotte PurnodeAnkur ParekhThomas BakerBrian HiestandW.F. PeacockJames NeuenschwandereScholarship Publishing, University of CaliforniaarticleMedicineRMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENWestern Journal of Emergency Medicine, Vol 22, Iss 6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medicine R Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Tinh Le Parker Cordial Mackenzie Sankoe Charlotte Purnode Ankur Parekh Thomas Baker Brian Hiestand W.F. Peacock James Neuenschwander Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
description	Introduction: Recent studies from urban academic centers have shown the promise of emergency physician-initiated buprenorphine for improving outcomes in opioid use disorder (OUD) patients. We investigated whether emergency physician-initiated buprenorphine in a rural, community setting decreases subsequent healthcare utilization for OUD patients. Methods: We performed a retrospective chart review of patients presenting to a community hospital emergency department (ED) who received a prescription for buprenorphine from June 15, 2018–June 15, 2019. Demographic and opioid-related International Classification of Diseases, 10th Revision, (ICD-10) codes were documented and used to create a case-matched control cohort of demographically matched patients who presented in a similar time frame with similar ICD-10 codes but did not receive buprenorphine. We recorded 12-month rates of ED visits, all-cause hospitalizations, and opioid overdoses. Differences in event occurrences between groups were assessed with Poisson regression. Results: Overall 117 patients were included in the study: 59 who received buprenorphine vs 58 controls. The groups were well matched, both roughly 90% White and 60% male, with an average age of 33.4 years for both groups. Controls had a median two ED visits (range 0–33), median 0.5 hospitalizations (range 0–8), and 0 overdoses (range 0–3), vs median one ED visit (range 0–8), median 0 hospitalizations (range 0–4), and median 0 overdoses (range 0–3) in the treatment group. The incidence rate ratio (IRR) for counts of ED visits was 0.61, 95% confidence interval (CI), 0.49, 0.75, favoring medication-assisted treatment (MAT). For hospitalizations, IRR was 0.34, 95% CI, 0.22, 0.52 favoring MAT, and for overdoses was 1.04, 95% CI, 0.53, 2.07. Conclusion: Initiation of buprenorphine by ED providers was associated with lower 12-month ED visit and all-cause hospitalization rates with comparable overdose rates compared to controls. These findings show the ED’s potential as an initiation point for medication-assisted treatment in OUD patients.
format	article
author	Tinh Le Parker Cordial Mackenzie Sankoe Charlotte Purnode Ankur Parekh Thomas Baker Brian Hiestand W.F. Peacock James Neuenschwander
author_facet	Tinh Le Parker Cordial Mackenzie Sankoe Charlotte Purnode Ankur Parekh Thomas Baker Brian Hiestand W.F. Peacock James Neuenschwander
author_sort	Tinh Le
title	Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
title_short	Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
title_full	Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
title_fullStr	Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
title_full_unstemmed	Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
title_sort	healthcare use after buprenorphine prescription in a community emergency department: a cohort study
publisher	eScholarship Publishing, University of California
publishDate	2021
url	https://doaj.org/article/9c76d77c6e2642129ed65d92c95de366
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Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study

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