Implementation
Science Progam
Atlantic and Quebec
Nodes Facilitation
Expanding Buprenorphine and Naloxone Rapid Access in Emergency Departments
Objectifs
The purpose of this thematic area is to enhance access to opioid agonist treatment (OAT) in emergency departments by reviewing the current landscape of this intervention and by developing educational resources to address the gaps, attitudes, knowledge, and skills of emergency physicians in providing quality care to people who use opioids.
Project Components
with Opioid Dependence: A Rapid Systematic Review
Given the recent interest in OAT initiation in emergency departments to address the opioid crisis in Canada, we identified and synthesized the existing literature to better understand this intervention and to provide critical information to audiences engaged in harm reduction research, practice, and policy.
emergency physician groups: a cross-sectional survey
While the opioid crisis is a complex issue, there are several steps emergency physicians can take to assist patients at risk, including initiating OAT in the emergency department. However, the level of comfort and willingness of emergency physicians to initiate OAT remains unclear. A survey was administered to emergency physicians across British Columbia, Alberta, Ontario, and Quebec. Objectives include:
Identify emergency physicians’ attitudes towards initiating OAT in emergency departments.
Identify current prescribing patterns amongst emergency physicians (i.e. frequency of prescribing buprenorphine/naloxone), identify emergency physicians’ perceived barriers and facilitators in initiating OAT.
Identify emergency physicians’ awareness of resources (published guidelines, accessing addictions specialist, etc.) to ensure appropriate management and provision of OAT.
in the emergency department: A qualitative study
Differing views, attitudes, and accessibility of OAT have resulted in different stages of implementation across Canadian emergency departments. To support and facilitate emergency departments in their implementation process, we conducted phone interviews with emergency physicians across Canada who were interested in OAT implementation. The phone interviews included discussions of the preliminary results of the emergency physician groups survey. The results describe the current context surrounding the implementation of OAT in emergency departments nationally and provide key recommendations for consideration.
to improve care for people who use opioids: a modified Delphi study
Emergency departments play a critical role in identifying and initiating treatment for people who use opioids, but emergency department care for these patients varies widely across Canada. Our modified Delphi study aimed to develop a consensus-based checklist of good practices for this group at high-risk of short-term mortality post-discharge. We recruited panelists from a Canada-wide collaborator meeting on the initiation of OAT in emergency departments to participate in two Delphi consensus rounds. Our final 13-item checklist has received preliminary support from the Addictions Committee of the Canadian Association of Emergency Physicians (CAEP).
More information on the Delphi study and the final 13-item checklist:
We have selected ten emergency departments across Canada to receive $10,000 to conduct implementation and evaluation activities. These emergency departments will pilot the best practices checklist and will provide baseline and post-implementation data on OUD services provided. They will also receive logistical support from CRISM and expert advice from the CAEP/CRISM team. The following emergency departments are participating in our checklist implementation initiative:
- Centre hospitalier de l’Université de Montréal (Montréal, QC)
- Fort St. John Hospital (Fort St. John, BC)
- Kingston Health Sciences Centre (Kingston, ON)
- Mount Sinai Hospital (Toronto, ON)
- Northumberland Hills Hospital (Cobourg, ON)
- Peter Lougheed Centre (Calgary, AB)
- Queen Elizabeth II Health Sciences Centre (Halifax, NS)
- Sechelt | shíshálh Hospital (Sechelt, BC)
- St. Boniface Hospital and Health Sciences Centre (Winnipeg, MB)
- St. Joseph’s Health Centre (Toronto, ON)
- St. Michael’s Hospital (Toronto, ON)
- Woodstock Hospital (Woodstock, ON)