"This is Part of Emergency Medicine Now" A Qualitative Assessment of Emergency Clinicians' Facilitators of and Barriers to Initiating Buprenorphine
Author Department
Emergency Medicine; Healthcare Quality
Document Type
Article, Peer-reviewed
Publication Date
8-2021
Abstract
Objectives: Despite evidence demonstrating the safety and efficacy of buprenorphine for the treatment of emergency department (ED) patients with opioid use disorder (OUD), incorporation into clinical practice has been highly variable. We explored barriers and facilitators to the prescription of buprenorphine, as perceived by practicing ED clinicians.
Methods: We conducted semi-structured interviews with a purposeful sample of ED clinicians. An interview guide was developed using the Consolidated Framework for Implementation Research and Theoretical Domains implementation science frameworks. Interviews were recorded, transcribed, and analyzed in an iterative process. Emergent themes were identified, discussed, and organized.
Results: We interviewed 25 ED clinicians from eleven states in the United States. Participants were diverse with regard to years in practice and practice setting. While outer setting barriers such as the logistical costs of getting a DEA-X waiver and lack of clear follow-up for patients were noted by many participants, individual-level determinants driven by emotion (stigma), beliefs about consequences and roles, and knowledge predominated. Participants' responses suggested that implementation strategies should address stigma, local culture, knowledge gaps, and logistical challenges, but that a particular order to addressing barriers may be necessary.
Conclusions: While some participants were hesitant to adopt a 'new' role in treating patients with medications for OUD (MOUD), many already had, and gave concrete strategies regarding how to encourage others to embrace their attitude of "this is part of emergency medicine now."
Keywords: MOUD; OUD; barriers; buprenorphine; facilitators; implementation; qualitative.
Recommended Citation
Schoenfeld EM, Soares W, Schaeffer EM, Gitlin J, Burke K, Westafer L. "This is Part of Emergency Medicine Now" A Qualitative Assessment of Emergency Clinicians' Facilitators of and Barriers to Initiating Buprenorphine. Acad Emerg Med. 2021 Aug 9. doi: 10.1111/acem.14369. Epub ahead of print.
PMID
34374466