The following article is a part of conference coverage from the 2021 American Association of Nurse Practitioners National Conference (AANP 2021), held virtually from June 15 to June 20, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading NPs. Check back for more from AANP 2021.
An NIDA-funded project designed to build a partnership between emergency department (ED) and primary care providers in the management of patients with opioid use disorder was described by Laurel Hallock-Koppelman, DNP, FNP-C, APRN, in a poster presented at the 2021 American Association of Nurse Practitioners National Conference (AANP 2021).
Although EDs do have the capacity to treat overdoses, EDs cannot treat underlying substance use disorders (SUDs). System-level factors in both EDs and outpatient settings contribute to breakdowns in transitions of care for patients with SUDs discharged from EDs, according to Dr Hallock-Koppelman, who is assistant professor of family medicine at Oregon Health and Science University (OHSU).
Currently, OHSU does not provide medication-assisted treatment in the ED setting, Dr Hallock-Koppelman noted. Rather, patients must wait between 4 and 6 weeks to begin this treatment.
“One of the biggest problems is providing immediate referral for medication-assisted treatment,” agreed AANP 2021 attendee Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, clinical assistant professor at Stony Brook University School of Nursing, Stony Brook, New York. “Patients are detoxed in the ED and then discharged without adequate referrals because the treatment is just not available,” she said in an interview. “It is only a matter of time before these patients arrive back in the ED for resuscitation or they might not make it back at all because the next overdose could be fatal.”
The Solution: Faster Referral to MAT
OHSU Primary Care Clinic, Richmond, is a 2-site Federally Qualified Health Center in southeast Portland, Oregon. Oregon has the second highest rate of nonmedical use of prescription opioids in the United States (5.4%), and this clinic serves a community with heroin and opioid overdose death rates “well over the Oregon statewide rates.”
OHSU Primary Care Clinic, Richmond, has recently expanded its medication-assisted therapy program for opioid use disorder (OUD), serving 310 patients taking buprenorphine with 21 certified prescribers (nurse practitioners and physicians).
A key goal of Dr. Hallock-Koppelman’s project is to create a protocol for expediting transitions of care from EDs to medication-assisted treatment program. Patients with SUDs in need of treatment will have a fast-tracked entry to primary care, instead of waiting 6 weeks for an appointment.
Additionally, the project will collect evidence-based research on similar programs, adapt materials for the “unique” healthcare landscape in Oregon, and form the first emergency department-primary care provider alliance in Oregon.
“Providing medication-assisted treatment immediately in the ER sends the patient back out with tools to help manage the substance use disorder right away. More primary care providers including NPs can order MAT but getting an appointment can be weeks away from that ED visit. Changing this paradigm to that of an ED visit that will provide MAT buys the time needed to wait to get a primary care visit and has the potential to save countless lives as well as expended dollars for repeated ED visits,” Dr. Koslap-Petraco said.
Dr Hallock-Koppelman identified potential challenges to project implementation, including the inadequate number of providers with a medication-assisted therapy prescribing waiver. Potential solutions include providing medication-assisted therapy training recommendations for ED staff, collaborative meetings between ED and primary care staff, and provision of shadowing opportunities and opportunities to work with patients receiving medication-assisted therapy.
Success benchmarks include completion of stakeholder interviews, 35% survey completion of ED needs assessment surveys, determination of the number of eligible substance use disorder providers, and verbal acceptance of project parameters from departmental leadership.
Visit Clinical Advisor’s meetings section for complete coverage of AANP 2021. All conference sessions are available to registered attendees through August 31, 2021.
Hallock-Koppelman L. Rapid response: substance use disorder treatment from ED to PCP. Poster presented at: American Association of Nurse Practitioners National Conference (AANP 2021; June 15-20, 2021. Poster 62.