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A Resident‐Led Intervention to Increase Initiation of Buprenorphine Maintenance for Hospitalized Patients With Opioid Use Disorder
Author(s) -
Thakrar Ashish P,
Furfaro David,
Keller Sara,
Graddy Ryan,
Buresh Megan,
Feldman Leonard
Publication year - 2021
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.3544
Subject(s) - buprenorphine , medicine , opioid use disorder , emergency medicine , intervention (counseling) , methadone , retention rate , methadone maintenance , opioid , psychiatry , receptor , computer security , computer science
BACKGROUND Hospitalized patients with opioid use disorder (OUD) are rarely started on buprenorphine or methadone maintenance despite evidence that these medications reduce all‐cause mortality, overdoses, and hospital readmissions. OBJECTIVE To assess whether clinician education and a team of residents and hospitalist attendings waivered to prescribe buprenorphine increased the rate of starting patients with OUD on buprenorphine maintenance. DESIGN, SETTING, AND PARTICIPANTS Quality improvement study conducted at a large, urban, academic hospital in Maryland involving hospitalized patients with OUD on internal medicine resident services. INTERVENTION We developed a protocol for initiating buprenorphine maintenance, presented an educational conference, and started the resident‐led Buprenorphine Bridge Team of residents and attendings waivered to prescribe buprenorphine to bridge patients from discharge to follow‐up. MEASUREMENTS The percent of eligible inpatients with OUD initiated on buprenorphine maintenance, 24 weeks before and after the intervention; engagement in treatment after discharge; and resident knowledge and comfort with buprenorphine. RESULTS The rate of starting buprenorphine maintenance increased from 10% (30 of 305 eligible patients) to 24% (64 of 270 eligible patients) after the intervention, with interrupted time series analysis showing a significant increase in rate (14.4%; 95% CI, 3.6%‐25.3%; P = .02). Engagement in treatment after discharge was unchanged (40%‐46% engaged 30 days after discharge). Of 156 internal medicine residents, 89 (57%) completed the baseline survey and 66 (42%) completed the follow‐up survey. Responses demonstrated improved resident knowledge and comfort with buprenorphine. CONCLUSION Internal medicine resident teams were more likely to start patients on buprenorphine maintenance after clinician education and implementation of a Buprenorphine Bridge Team.