64 Impact of Substance Use Navigators on Addiction Treatment and Outcomes for Emergency Department Patients in an Integrated Public Health System

IntroductionThere is strong evidence to support emergency department (ED) initiated addiction treatment and continuation of treatment with a warm handoff to a partnered low-threshold ambulatory clinic. To complement this infrastructure many medical systems have chosen to employ dedicated substance use navigators (SUNs) to optimize program effectiveness.Study ObjectiveWe describe patient treatment and linkage outcomes of a mature ED-initiated substance use program vertically integrated with a low-threshold Bridge Clinic under two conditions: (1) when the ED team was operating without a SUN and (2) when a SUN initiated services at the bedside in the ED.MethodsThis was a retrospective cohort study of adult patients discharged from one of three EDs within an integrated public health system between September 1, 2021 through January 2022 with cocaine, methamphetamine, alcohol, and opioid use related diagnoses. The primary outcome was follow-up attendance for substance use treatment within 30 days of ED discharge among patients with and without SUN services in the ED. We used logistic regression and nearest neighbor propensity score matching without replacement to control for confounding effects.ResultsThere were 1,328 patients in the overall cohort, 119 (9.0%) of whom had SUN services; 50.4% of the patients with SUN services and 15.9% of patients without SUN services attended follow-up within 30 days of ED discharge (difference in proportions 34.5%, 95% confidence interval [CI]: 25.3-43.8%). Patients who had SUN services had higher rates of medications administered for addiction treatment (39.5% vs. 16.8%, p<0.001) and higher rates of medications for addiction treatment prescribed at discharge (47.1% vs. 20.7%, p<0.001). SUN services were associated with higher odds of follow-up after ED discharge for patients with alcohol diagnoses (odds ratio [OR] 7.1; 95% CI: 3.4-14.7), opioid diagnoses (OR 2.5; 95% CI: 1.4-4.2), and cocaine diagnoses (OR 16.8; 95% CI: 2.2-125.3); but were not for patients with methamphetamine related diagnoses (OR 2.2; 95% CI: 0.5-10.7). In the multivariable model, SUN services were associated with higher odds of follow-up (aOR 3.7, 95% CI: 2.4-5.8). In the propensity score matched analysis, SUN services were associated with 5.3 higher odds of follow-up (95% CI: 2.9-9.8).ConclusionReceipt of substance use navigation services among ED patients with opioid, stimulant, and alcohol use disorders was strongly associated with improved quality of care and improved follow-up engagement in addiction treatment.No, authors do not have interests to disclose IntroductionThere is strong evidence to support emergency department (ED) initiated addiction treatment and continuation of treatment with a warm handoff to a partnered low-threshold ambulatory clinic. To complement this infrastructure many medical systems have chosen to employ dedicated substance use navigators (SUNs) to optimize program effectiveness. There is strong evidence to support emergency department (ED) initiated addiction treatment and continuation of treatment with a warm handoff to a partnered low-threshold ambulatory clinic. To complement this infrastructure many medical systems have chosen to employ dedicated substance use navigators (SUNs) to optimize program effectiveness. Study ObjectiveWe describe patient treatment and linkage outcomes of a mature ED-initiated substance use program vertically integrated with a low-threshold Bridge Clinic under two conditions: (1) when the ED team was operating without a SUN and (2) when a SUN initiated services at the bedside in the ED. We describe patient treatment and linkage outcomes of a mature ED-initiated substance use program vertically integrated with a low-threshold Bridge Clinic under two conditions: (1) when the ED team was operating without a SUN and (2) when a SUN initiated services at the bedside in the ED. MethodsThis was a retrospective cohort study of adult patients discharged from one of three EDs within an integrated public health system between September 1, 2021 through January 2022 with cocaine, methamphetamine, alcohol, and opioid use related diagnoses. The primary outcome was follow-up attendance for substance use treatment within 30 days of ED discharge among patients with and without SUN services in the ED. We used logistic regression and nearest neighbor propensity score matching without replacement to control for confounding effects. This was a retrospective cohort study of adult patients discharged from one of three EDs within an integrated public health system between September 1, 2021 through January 2022 with cocaine, methamphetamine, alcohol, and opioid use related diagnoses. The primary outcome was follow-up attendance for substance use treatment within 30 days of ED discharge among patients with and without SUN services in the ED. We used logistic regression and nearest neighbor propensity score matching without replacement to control for confounding effects. ResultsThere were 1,328 patients in the overall cohort, 119 (9.0%) of whom had SUN services; 50.4% of the patients with SUN services and 15.9% of patients without SUN services attended follow-up within 30 days of ED discharge (difference in proportions 34.5%, 95% confidence interval [CI]: 25.3-43.8%). Patients who had SUN services had higher rates of medications administered for addiction treatment (39.5% vs. 16.8%, p<0.001) and higher rates of medications for addiction treatment prescribed at discharge (47.1% vs. 20.7%, p<0.001). SUN services were associated with higher odds of follow-up after ED discharge for patients with alcohol diagnoses (odds ratio [OR] 7.1; 95% CI: 3.4-14.7), opioid diagnoses (OR 2.5; 95% CI: 1.4-4.2), and cocaine diagnoses (OR 16.8; 95% CI: 2.2-125.3); but were not for patients with methamphetamine related diagnoses (OR 2.2; 95% CI: 0.5-10.7). In the multivariable model, SUN services were associated with higher odds of follow-up (aOR 3.7, 95% CI: 2.4-5.8). In the propensity score matched analysis, SUN services were associated with 5.3 higher odds of follow-up (95% CI: 2.9-9.8). There were 1,328 patients in the overall cohort, 119 (9.0%) of whom had SUN services; 50.4% of the patients with SUN services and 15.9% of patients without SUN services attended follow-up within 30 days of ED discharge (difference in proportions 34.5%, 95% confidence interval [CI]: 25.3-43.8%). Patients who had SUN services had higher rates of medications administered for addiction treatment (39.5% vs. 16.8%, p<0.001) and higher rates of medications for addiction treatment prescribed at discharge (47.1% vs. 20.7%, p<0.001). SUN services were associated with higher odds of follow-up after ED discharge for patients with alcohol diagnoses (odds ratio [OR] 7.1; 95% CI: 3.4-14.7), opioid diagnoses (OR 2.5; 95% CI: 1.4-4.2), and cocaine diagnoses (OR 16.8; 95% CI: 2.2-125.3); but were not for patients with methamphetamine related diagnoses (OR 2.2; 95% CI: 0.5-10.7). In the multivariable model, SUN services were associated with higher odds of follow-up (aOR 3.7, 95% CI: 2.4-5.8). In the propensity score matched analysis, SUN services were associated with 5.3 higher odds of follow-up (95% CI: 2.9-9.8). ConclusionReceipt of substance use navigation services among ED patients with opioid, stimulant, and alcohol use disorders was strongly associated with improved quality of care and improved follow-up engagement in addiction treatment.No, authors do not have interests to disclose Receipt of substance use navigation services among ED patients with opioid, stimulant, and alcohol use disorders was strongly associated with improved quality of care and improved follow-up engagement in addiction treatment.