Factors associated with frequent buprenorphine / naloxone initiation in a national survey of Canadian emergency physicians.

Autor: MacKinnon N; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.; Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada., Lane D; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada., Scheuermeyer F; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.; Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.; Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada., Kaczorowski J; Université de Montréal, Montreal, Quebec, Canada., Dong K; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada., Orkin AM; Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada., Daoust R; Université de Montréal, Montreal, Quebec, Canada.; Centre de Recherche de l'Hôpital Sacré-Coeur de Montréal, Montreal, Quebec, Canada., Moe J; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada., Andolfatto G; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada., Klaiman M; Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Yan J; Division of Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada., Koh JJ; Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada., Crowder K; Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada., Atkinson P; Department of Emergency Medicine, Dalhousie University, St. John, New Brunswick, Canada., Savage D; Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada., Stempien J; Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada., Besserer F; Department of Emergency Medicine, University of British Columbia, Prince George, British Columbia, Canada., Wale J; Department of Emergency Medicine, University of British Columbia, Victoria, British Columbia, Canada., Kestler A; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.; Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.; Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Feb 05; Vol. 19 (2), pp. e0297084. Date of Electronic Publication: 2024 Feb 05 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0297084
Abstrakt: Objective: To identify individual and site-related factors associated with frequent emergency department (ED) buprenorphine/naloxone (BUP) initiation. BUP initiation, an effective opioid use disorder (OUD) intervention, varies widely across Canadian EDs.
Methods: We surveyed emergency physicians in 6 Canadian provinces from 2018 to 2019 using bilingual paper and web-based questionnaires. Survey domains included BUP-related practice, demographics, attitudes toward BUP, and site characteristics. We defined frequent BUP initiation (the primary outcome) as at least once per month, high OUD prevalence as at least one OUD patient per shift, and high OUD resources as at least 3 out of the following 5 resources: BUP initiation pathways, BUP in ED, peer navigators, accessible addiction specialists, and accessible follow-up clinics. We excluded responses from sites with <50% participation (to minimize non-responder bias) and those missing the primary outcome. We used univariate analysis to identify associations between frequent BUP initiation and factors of interest, stratifying by OUD prevalence.
Results: We excluded 3 responses for missing BUP initiation frequency and 9 for low response rate at one ED. Of the remaining 649 respondents from 34 EDs, 374 (58%) practiced in metropolitan areas, 384 (59%) reported high OUD prevalence, 312 (48%) had high OUD resources, and 161 (25%) initiated BUP frequently. Age, gender, board certification and years in practice were not associated with frequent BUP initiation. Site-specific factors were associated with frequent BUP initiation (high OUD resources [OR 6.91], high OUD prevalence [OR 4.45], and metropolitan location [OR 2.39],) as were individual attitudinal factors (willingness, confidence, and responsibility to initiate BUP.) Similar associations persisted in the high OUD prevalence subgroup.
Conclusions: Individual attitudinal and site-specific factors were associated with frequent BUP initiation. Training to increase physician confidence and increasing OUD resources could increase BUP initiation and benefit ED patients with OUD.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 MacKinnon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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