Identifying unique barriers to implementing rural emergency department-based peer services for opioid use disorder through qualitative comparison with urban sites.
Addict Sci Clin Pract
; 17(1): 41, 2022 07 28.
Article
em En
| MEDLINE
| ID: mdl-35902890
ABSTRACT
BACKGROUND:
In an effort to address the current opioid epidemic, a number of hospitals across the United States have implemented emergency department-based interventions for engaging patients presenting with opioid use disorder. The current study seeks to address gaps in knowledge regarding implementation of a sub-type of such interventions, emergency department-based peer support services, in rural areas by comparing implementation of rural and urban programs that participated in Indiana's Recovery Coach and Peer Support Initiative (RCPSI).METHODS:
We conducted a secondary analysis of qualitative semi-structured implementation interviews collected as part of an evaluation of 10 programs (4 rural and 6 urban) participating in the RCPSI. We conducted interviews with representatives from each program at 3 time points over the course of the first year of implementation. Our deductive coding process was guided by the Consolidated Framework for Implementation Research (CFIR) and an external context taxonomy.RESULTS:
We identified key differences for rural programs corresponding to each of the 5 primary constructs in the coding scheme. (1) Intervention characteristics rural sites questioned intervention fit with their context, required more adaptations, and encountered unexpected costs. (2) External context rural sites were not appropriately staffed to meet patient needs, encountered logistical and legal barriers regarding patient privacy, and had limited patient transportation options. (3) Innersetting:
rural sites lacked strong mechanisms for internal communication and difficulties integrating with pre-existing culture and climate. (4) Characteristics of individuals some rural providers resisted working with peers due to pre-existing attitudes and beliefs. (5) Implementation process rural sites spent more time identifying external partners and abandoned more components of their initial implementation plans.CONCLUSIONS:
Findings demonstrate how rural programs faced greater challenges implementing emergency department-based peer services over time. These challenges required flexible adaptations to originally intended plans. Rural programs likely require flexibility to adapt interventions that were developed in urban settings to ensure success considering local contextual constraints that were identified by our analysis.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Contexto em Saúde:
11_ODS3_cobertura_universal
/
2_ODS3
/
8_ODS3_consumo_sustancias_psicoactivas
Problema de saúde:
11_delivery_arrangements
/
2_sustancias_psicoativas
/
8_opioid_abuse
Assunto principal:
Atenção Primária à Saúde
/
Transtornos Relacionados ao Uso de Opioides
Tipo de estudo:
Prognostic_studies
/
Qualitative_research
Aspecto:
Implementation_research
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Addict Sci Clin Pract
Assunto da revista:
TRANSTORNOS RELACIONADOS COM SUBSTANCIAS
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Estados Unidos