Effects of Emergency Department Training on Buprenorphine Prescribing and Opioid Use Disorder-Associated ED Revisits: Retrospective Cohort Study

TL;DR

A training program for emergency physicians increased buprenorphine prescriptions but did not reduce ED revisits for opioid use disorder complications.

Contribution

Demonstrates the effectiveness of ED training in increasing buprenorphine prescribing without reducing ED reutilization for OUD.

Findings

The proportion of physicians who could prescribe buprenorphine increased from 37% to 88%.

Buprenorphine prescriptions for referred patients rose from 50% to 92% over 16 months.

No significant changes were observed in ED reutilization or other secondary outcomes.

Abstract

Prescribing patients buprenorphine from the emergency department (ED) is recommended by multiple organizations. However, it is unclear how best to encourage physicians to prescribe buprenorphine from the ED. Our objectives in this study were to examine the effects of a departmental-wide training initiative for emergency physicians to prescribe buprenorphine, increase buprenorphine prescribing, and decrease ED re-utilization for opioid use disorder (OUD) complications.

We performed this retrospective cohort study at an academic medical center. Beginning May 1, 2018, the ED started a buprenorphine-education initiative and tracked the proportion of clinicians who obtained buprenorphine-prescribing certification over the following 16 months. We identified adult patients referred to an addiction clinic from the ED during this period. Our primary outcome was the proportion of patients who received a buprenorphine prescription from the ED. Secondary outcomes included ED re-utilization for OUD complications and buprenorphine refills, as well as follow-up in the bridge clinic within 30 days.

The proportion of physicians eligible to prescribe buprenorphine increased from 37% to 88% over the study period, and 430 patients were referred to an addiction clinic. The proportion of patients referred to a bridge program who received a buprenorphine prescription increased from 50% during the first month compared to 92% during month 16 (odds ratio 1.14, 95% confidence interval 1.08–1.21 per month). There were no statistically significant changes in any secondary outcomes.

Our intervention increased buprenorphine prescribing by emergency physicians. It did not decrease ED reutilization for complications related to opioid use disorder.

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