Barriers, facilitators and perceived impact of initiation of buprenorphine–naloxone in the emergency department
| Characteristic | No. of respondents | % of respondents (95% CI) | Range across physician groups, %* |
|---|---|---|---|
| Barriers rated as “very significant”† | |||
| Lack of adequate training (n = 631) | 367 | 58.2 (54.3–62.0) | 14.0–95.2 |
| Lack of time during clinical encounter (n = 625) | 345 | 55.2 (51.2–59.1) | 37.7–79.3 |
| Lack of physical care space for initiation (n = 601) | 298 | 49.6 (45.6–53.6) | 0.0–69.4 |
| Lack of adequate outpatient follow-up options (n = 598) | 252 | 42.1 (38.2–46.1) | 0.0–96.6 |
| Lack of hospital or ED administrative support (n = 602) | 220 | 36.5 (32.7–40.4) | 0.0–89.3 |
| Limited knowledge of research (n = 607) | 207 | 34.1 (30.3–37.9) | 4.7–58.3 |
| Facilitators rated as having “strong impact”‡ | |||
| Availability of specialized staff (n = 630) | 589 | 93.5 (91.6–95.4) | 75.0–100.0 |
| Availability of clinical pathways (n = 624) | 573 | 91.8 (89.7–94.0) | 75.0–95.5 |
| ED BUP initiation is common local practice (n = 628) | 541 | 86.1 (83.4–88.9) | 58.8–100.0 |
| Evidence that BUP decreases overdose mortality (n = 623) | 535 | 85.9 (83.1–88.6) | 64.3–100.0 |
| Timely access to addictions specialist (n = 627) | 532 | 84.9 (82.0–87.7) | 64.3–100.0 |
| Supportive recommendations from professional organization (n = 626) | 507 | 81.0 (77.9–84.1) | 53.3–100.0 |
| Support from ED nursing staff (n = 628) | 511 | 81.4 (78.3–84.4) | 58.3–100.0 |
| Local leaders who recommend ED BUP intitiation (n = 616) | 456 | 74.0 (70.6–77.5) | 41.7–96.2 |
| Perceived public health effect of ED BUP initiation§ | |||
| Decrease in deaths from opioid overdose (n = 634) | 506 | 79.8 (76.7–82.9) | 56.3–96.3 |
| Decrease in 911 calls for opioid overdose (n = 632) | 387 | 61.2 (57.4–65.0) | 36.8–85.0 |
| Decrease in ED visits for opioid overdose (n = 634) | 379 | 59.8 (56.0–63.6) | 36.0–92.3 |
| Decrease in overall opioid use (n = 632) | 324 | 51.3 (47.4–55.2) | 21.7–69.2 |
Note: BUP = buprenorphine–naloxone, CI = confidence interval, ED = emergency department.
↵* Range from the ED group with the lowest positive response rate to the ED group with the highest positive response rate.
↵† “Very significant” is a score of at least 4 on a 1–5 scale.
↵‡ “Strong impact” is a score of at least 7 on a 1–10 scale.
↵§ “Decrease” is a score of at least 4 on a 1–5 scale.