Organizational factors associated with practitioners' support for treatment of opioid use disorder in the emergency department.
Adult
Attitude of Health Personnel
Emergency Service, Hospital
/ organization & administration
Evidence-Based Practice
Female
Humans
Male
Middle Aged
Nurses
Opiate Substitution Treatment
Opioid-Related Disorders
/ drug therapy
Optimism
Organizational Culture
Organizational Innovation
Physicians
Practice Guidelines as Topic
Self Efficacy
Social Workers
Stereotyping
Transtheoretical Model
Journal
Addictive behaviors
ISSN: 1873-6327
Titre abrégé: Addict Behav
Pays: England
ID NLM: 7603486
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
07
05
2019
revised:
25
10
2019
accepted:
25
10
2019
pubmed:
22
12
2019
medline:
13
1
2021
entrez:
22
12
2019
Statut:
ppublish
Résumé
Despite the significant increase in emergency room visits for opioid overdose, only few emergency departments (ED) have implemented best practices to treat people with opioid use disorders (OUD). Some implementation gaps may be due to practitioner factors; such as support for medication-assisted treatment (MAT) for OUD in the ED. In this study, we explore the relationship between inner setting characteristics of the EDs (e.g., leadership, readiness for change, organizational climate) and practitioner support for OUD treatment and attitudes towards people with OUD. We surveyed 241 ED practitioners (e.g., physicians, nurses, social workers) at one of the largest EDs in the United States. We used analysis of variance and chi-square global tests to compare responses from ED practitioners in differing roles. We also conducted five multivariate logistic regressions to explore associations between ED inner setting characteristics and five antecedents of implementation; ED practitioner (1) supports MAT for OUD in the ED, (2) supports best practices to treat OUD, (3) has self-efficacy to treat OUD, (4) has stereotypes of people who use drugs, and (5) has optimism to treat people with OUD. We found nurses were more likely than physicians to support MAT for OUD in the ED and delivering other best practices to treat OUD. At the same time, nurses had greater bias than physicians against working with patients suffering from OUD. We also found the ED's climate for innovation and practitioners' readiness for change were positively associated with support for MAT for OUD in the ED and using best practices to treat OUD. Findings suggest that professional roles and some ED inner setting factors play an important role in antecedents of implementation of OUD treatment in the ED. To prepare EDs to effectively respond to the current opioid overdose epidemic, it is critical to further understand the impact of these organizational factors on the implementation of evidence-based OUD treatment practices in the nation.
Sections du résumé
BACKGROUND
Despite the significant increase in emergency room visits for opioid overdose, only few emergency departments (ED) have implemented best practices to treat people with opioid use disorders (OUD). Some implementation gaps may be due to practitioner factors; such as support for medication-assisted treatment (MAT) for OUD in the ED. In this study, we explore the relationship between inner setting characteristics of the EDs (e.g., leadership, readiness for change, organizational climate) and practitioner support for OUD treatment and attitudes towards people with OUD.
METHODS
We surveyed 241 ED practitioners (e.g., physicians, nurses, social workers) at one of the largest EDs in the United States. We used analysis of variance and chi-square global tests to compare responses from ED practitioners in differing roles. We also conducted five multivariate logistic regressions to explore associations between ED inner setting characteristics and five antecedents of implementation; ED practitioner (1) supports MAT for OUD in the ED, (2) supports best practices to treat OUD, (3) has self-efficacy to treat OUD, (4) has stereotypes of people who use drugs, and (5) has optimism to treat people with OUD.
RESULTS
We found nurses were more likely than physicians to support MAT for OUD in the ED and delivering other best practices to treat OUD. At the same time, nurses had greater bias than physicians against working with patients suffering from OUD. We also found the ED's climate for innovation and practitioners' readiness for change were positively associated with support for MAT for OUD in the ED and using best practices to treat OUD.
CONCLUSIONS
Findings suggest that professional roles and some ED inner setting factors play an important role in antecedents of implementation of OUD treatment in the ED. To prepare EDs to effectively respond to the current opioid overdose epidemic, it is critical to further understand the impact of these organizational factors on the implementation of evidence-based OUD treatment practices in the nation.
Identifiants
pubmed: 31862684
pii: S0306-4603(19)30539-8
doi: 10.1016/j.addbeh.2019.106197
pmc: PMC7547528
mid: NIHMS1547082
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
106197Subventions
Organisme : NIMHD NIH HHS
ID : R01 MD014639
Pays : United States
Organisme : NIMH NIH HHS
ID : R25 MH080916
Pays : United States
Organisme : NIDA NIH HHS
ID : R33 DA035634
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Ltd. All rights reserved.
Références
Implement Sci. 2014 Apr 14;9(1):45
pubmed: 24731295
Ann Emerg Med. 2012 Oct;60(4):499-525
pubmed: 23010181
J Am Acad Child Adolesc Psychiatry. 2012 Apr;51(4):423-31
pubmed: 22449648
Annu Rev Public Health. 2015 Mar 18;36:559-74
pubmed: 25581144
Annu Rev Public Health. 2018 Apr 1;39:525-541
pubmed: 29272165
J Pain. 2010 Dec;11(12):1442-50
pubmed: 20627817
JAMA. 2015 Apr 28;313(16):1636-44
pubmed: 25919527
Psychiatr Serv. 2006 Aug;57(8):1162-9
pubmed: 16870968
Int Emerg Nurs. 2009 Jan;17(1):3-14
pubmed: 19135010
Subst Abus. 2013;34(4):363-70
pubmed: 24159907
Adm Policy Ment Health. 2011 Mar;38(2):65-76
pubmed: 20957426
Subst Abus. 2016;37(1):63-9
pubmed: 26566761
Ment Health Serv Res. 2004 Jun;6(2):61-74
pubmed: 15224451
J Stud Alcohol. 1985 Jan;46(1):48-52
pubmed: 3974235
MMWR Morb Mortal Wkly Rep. 2018 Jan 04;67(5152):1419-1427
pubmed: 30605448
BMC Geriatr. 2011 Jul 14;11:35
pubmed: 21752299
Ann Emerg Med. 2018 Jun;71(6):688-690
pubmed: 29523371
Addict Behav. 2010 Mar;35(3):270-2
pubmed: 19897313
Clin Exp Pharmacol Physiol. 1998 Dec;25(12):1032-7
pubmed: 9888002
MMWR Morb Mortal Wkly Rep. 2018 Mar 09;67(9):279-285
pubmed: 29518069