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Barriers and facilitators to implementing medications for opioid use disorder and naloxone distribution in Veterans Affairs emergency departments.
Sasson, Comilla; Dieujuste, Nathalie; Klocko, Robert; Basrai, Zahir; Celedon, Manuel; Hsiao, Jonie; Himstreet, Julianne; Hoffman, Jonathan; Pfaff, Cassidy; Malmstrom, Robert; Smith, Jason; Holstein, Ariel; Johnson-Koenke, Rachel.
Afiliação
  • Sasson C; VA Eastern Colorado Health Care System, Veterans Health Administration, Aurora, Colorado, USA.
  • Dieujuste N; University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
  • Klocko R; VA Eastern Colorado Health Care System, Veterans Health Administration, Aurora, Colorado, USA.
  • Basrai Z; VA Eastern Colorado Health Care System, Veterans Health Administration, Aurora, Colorado, USA.
  • Celedon M; VA Greater Los Angeles Health Care System, Department of Emergency Medicine, Veterans Health Administration, Los Angeles, California, USA.
  • Hsiao J; VA Greater Los Angeles Health Care System, Department of Emergency Medicine, Veterans Health Administration, Los Angeles, California, USA.
  • Himstreet J; VA Greater Los Angeles Health Care System, Department of Emergency Medicine, Veterans Health Administration, Los Angeles, California, USA.
  • Hoffman J; National Academic Detailing Services, Veterans Health Administration, Aurora, Colorado, USA.
  • Pfaff C; VISN 19 Academic Detailing, Veterans Health Administration, Denver, Colorado, USA.
  • Malmstrom R; VISN 19 Academic Detailing, Veterans Health Administration, Denver, Colorado, USA.
  • Smith J; National Academic Detailing Services, Veterans Health Administration, Aurora, Colorado, USA.
  • Holstein A; VISN 19 Academic Detailing, Veterans Health Administration, Denver, Colorado, USA.
  • Johnson-Koenke R; Pitkin County Public Health, Aspen, Colorado, USA.
Acad Emerg Med ; 30(4): 289-298, 2023 04.
Article em En | MEDLINE | ID: mdl-36757683
OBJECTIVES: Safer opioid prescribing patterns, naloxone distribution, and medications for opioid use disorder (M-OUD) are an important part of decreasing opioid-related adverse events. Veterans are more likely to experience these adverse events compared to the general population. Despite treatment guidelines and ED-based opioid safety programs implemented throughout Veterans Affairs (VA) Medical Centers, many Veterans with OUD do not receive these harm reduction interventions. Prior research in other health care settings has identified barriers to M-OUD initiation and naloxone distribution; however, little is known about how this may be similar or different for health care professionals in VA ED and urgent care centers. METHODS: We conducted qualitative interviews with VA health care professionals and staff using a semistructured interview guide. We analyzed the data addressing barriers and facilitators to M-OUD treatment in the ED and naloxone distribution using descriptive matrix analysis, followed by team consensus. RESULTS: We interviewed 19 VA staff in various roles. Respondent concerns and considerations regarding the initiation of M-OUD in the ED included M-OUD initiation falling outside of ED's scope of providing acute treatment, lack of VA-approved M-OUD protocols and follow-up procedures, staffing concerns, and educational gaps. Respondents reported that naloxone was important but lacked clarity on who should prescribe it. Some respondents stated that an automated system to prescribe naloxone would be helpful, and others felt that it would not offer needed support and education to patients. Some respondents reported that naloxone would not address opioid misuse, which other respondents felt was a belief due to stigma around substance use and lack of education about treatment options. CONCLUSIONS: Our VA-based research highlights similarities of barriers and facilitators, seen in other health care settings, when implementing opioid safety initiatives. Education and training, destigmatizing substance use disorder care, and leveraging technology are important facilitators to increasing access to lifesaving therapies for OUD treatment and harm reduction.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Veteranos / Transtornos Relacionados ao Uso de Opioides Tipo de estudo: Guideline / Qualitative_research Limite: Humans País/Região como assunto: America do norte Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Veteranos / Transtornos Relacionados ao Uso de Opioides Tipo de estudo: Guideline / Qualitative_research Limite: Humans País/Região como assunto: America do norte Idioma: En Ano de publicação: 2023 Tipo de documento: Article