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Emergency Department Buprenorphine Quality Improvement and Emergency Physician Knowledge, Attitudes, and Self-Efficacy. | LitMetric

AI Article Synopsis

  • Buprenorphine is an effective treatment for opioid use disorder but is often underused in emergency departments (EDs), prompting a study to assess how an initiative affects emergency physician knowledge and confidence.
  • A survey conducted before and after the quality improvement (QI) initiative showed that physician confidence and knowledge about buprenorphine significantly increased, and more physicians began prescribing it post-initiative.
  • Despite the increase in prescribing and confidence, attitudes and self-efficacy remained unchanged, with increased confidence linked to greater likelihood of prescribing buprenorphine.

Article Abstract

Objective: Buprenorphine is an evidence-based treatment for opioid use disorder that is underused in the emergency department (ED). In this study we evaluated changes in emergency physician knowledge, confidence, and self-efficacy regarding buprenorphine prescribing and working with patients who use drugs after implementation of an ED buprenorphine quality improvement (QI) initiative.

Methods: An anonymous, online survey was administered to emergency physicians staffing four EDs in New England in 2019 and 2020 before and after an ED QI initiative. Survey questions included novel and previously validated questions to assess confidence, knowledge, self-efficacy, and attitudes about buprenorphine and working with patients who use drugs. Confidence, self-efficacy, and attitude responses were assessed on a Likert scale. Participants received a gift card for survey completion. We analyzed pre- and post- survey responses descriptively and compared them using -tests. Using logistic regression we evaluated the factors associated with buprenorphine prescribing.

Results: Of 95 emergency physicians, 56 (58.9% response rate) completed the pre-intervention survey and 60 (63.2%) completed the post-survey. There was an increase in the number of X-waivered adult emergency physicians and ED buprenorphine prescribing after program implementation. Physician confidence increased from a mean of 3.4 ( 0.8) to 3.9 ( 0.7; scale 1-5,  < 0.01). Knowledge about buprenorphine increased from a mean score of 1.4 ( 0.7) to 1.7 ( 0.5,  < 0.01). Physician attitudes and self-efficacy did not change. Post-initiative, increased confidence was associated with higher odds of buprenorphine prescribing (odds ratio 4.4; 95% confidence interval 1.07-18.4).

Conclusion: After an ED QI initiative, buprenorphine prescribing in the ED increased, as did both physician confidence in working with patients who use drugs and their knowledge of buprenorphine. Increased confidence was associated with higher odds of buprenorphine prescribing and should be a focus of future, buprenorphine implementation strategies in the ED.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10754198PMC
http://dx.doi.org/10.5811/westjem.59477DOI Listing

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