Making initiation of buprenorphine easy and timely was associated with a 25 percent increase in the likelihood of its use of treatment in emergency departments.
A program designed to increase initiation of buprenorphine treatment for opioid use disorder in the emergency department led to a sixfold increase in its use at three Penn Medicine hospitals, according to new research from the Perelman School of Medicine at the University of Pennsylvania. By using various tactics in three acute care centers — ranging from financial incentives for doctors to train to treat opioid use disorder to an automated connection to peer recovery specialists — the program was not only able to boost buprenorphine treatment rates initially, but it sustained the changes.
«We used a behavioral design approach to make implementation of evidence-based treatment easy, attractive, social and timely. While we concentrated initially on prescribing itself, we realized we also needed to overcome other barriers, such as identifying and engaging patients in care,» said Margaret Lowenstein, MD, an assistant professor of Medicine and the lead author of the research, published in Annals of Emergency Medicine. «So much of our work focused on helping providers better identify treatment opportunities, reducing the friction related to prescribing, and supporting patient engagement and care linkage.»
Buprenorphine is a medication that stabilizes opioid withdrawal and soothes cravings. Its use can increase long-term engagement with opioid use disorder care and reduce overdose death and other complications of drug use.
To get this potentially lifesaving medication to patients, the researchers first had to make it easy to prescribe buprenorphine through increasing the proportion of clinicians authorized to prescribe it. Clinicians needed to obtain the authority to prescribe buprenorphine — an «X-waiver» — through the completion of specific training courses. Prior to the loosening of these requirements in 2021, all prescribers had to undergo trainings — and the process still requires advance registration on a government website.
To better promote medication treatment for opioid use disorder, several strategies were employed by a clinical team led by Jeanmarie Perrone, MD,a study co-author and a professor of Emergency Medicine, as well as the director of the Penn Medicine Center for Addiction Medicine and Policy. A financial-incentive system rewarding doctors for the training resulted in X-waivered providers climbing from 6 to 90 percent in just six weeks. Additionally, the team increased motivation and influenced social norms to prescribe buprenorphine regularly by sharing patient success stories and publicly congratulating clinicians for initiating the treatment.
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Materials provided by University of Pennsylvania School of Medicine. Note: Content may be edited for style and length.