Certified peer recovery support specialists and substance use related emergency department visits: A mixed methods study of the patient experience.

Introduction: Emergency department (ED) peer-delivered interventions have been implemented across the country to improve outcomes for people who use drugs. In this study we describe what elements patients believe led to a positive interaction with a certified peer recovery support specialist (CPRSS) in the ED and discuss implications when those elements were missing.

Methods: This is a qualitatively driven mixed methods study embedded within a larger longitudinal study. Using a close and open-ended question interview guide, we interviewed 26 participants from 2018 to 2023 who met with a CPRSS in a Nevada ED for a substance use related concern. Interviews were recorded and transcribed verbatim. Thematic analysis was used to code the transcripts and generate themes. Quantitative data (satisfaction, therapeutic alliance, and social support) were analyzed using student-t, Fisher's exact, and one-way ANOVA tests.

Results: Participants described numerous elements that they believed contributed to being satisfied with their CPRSS interaction, which we grouped into three categories: 1) how the CPRSS interaction felt, 2) how the CPRSS services were delivered, and 3) patient factors that influenced the interaction with a CPRSS. Elements that contributed to their satisfaction, including whether the CPRSS adapted to their current circumstances, if they received personalized referrals, and how their own mental and physical state impacted their receptivity to services.

Conclusions: Our findings highlight areas to optimize implementation and increase program uptake for future ED-based CPRSS-delivered interventions, including training CPRSS in the philosophy of harm reduction, following up with the patient post-ED, and tailoring services to the patients' immediate needs.