Article Authors: Erick Guerrero, Allison Ober, Daniel Howard, Tenie Khachikian, Yinfei Kong, Welmoed van Deen, Avelardo Valdez, Rebecca Trotzky-Sirr, and Michael Menchine.

Article Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547528/

Write-up by IRIS team members: Yali Deng

Patients with opioid use disorders (OUD) often seek emergency department (ED) services to treat opioid use-related health emergencies, especially overdose. Some best practices for ED practitioners’ response within opioid-related visits include screening for OUD, initiating medication-assisted treatment (MAT) for OUD, and providing referrals to treatment. However, there are external and internal barriers to implementing these practices in EDs. The ED practitioners’ attitudes towards patients with OUD and treatment of OUD are critical in implementing these practices.  

This article explored the extent to which organizational factors such as perceived organizational climate for innovation, attitudes toward change in workplaces, and attitudes toward evidence-based practice (EBP) predict ED practitioners’ attitudes toward OUD treatment in five domains. These five domains were (1) their supports for MAT for OUD in the ED, (2) supports for best practices to treat OUD, (3) self-efficacy to treat OUD, (4) stereotypes of people who use drugs, and (5) optimism to treat people with OUD. This study surveyed 241 ED practitioners (including managers, physicians, nurses, and social workers) at a large ED in Los Angeles County.   

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Results of this study indicate that practitioners’ readiness for change was associated with increased support for MAT for OUD. Also, a greater organizational climate for innovation was associated with increased support for best practice to treat OUD. In addition, practitioners who have higher openness towards EBPs have greater self-efficacy to treat OUD. However, practitioners who tend to disregard EBP (e.g., “will not use manualized interventions”) are less optimistic in treating people with OUD, while practitioners who see EBP as a requirement (e.g., “agency required use of EBP”) are less supportive of MAT for OUD.   

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Based on these findings, the author suggested that ED leaders support a climate of innovation and change within their organizations. Also, instead of just mandating the use of EBP, some trainings are critical to prepare partitioners with a better understanding of the chronic nature of OUD and the rationale behind MAT as well as other best practices to treat OUD. 

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Since 2006, the Mosaic Group Reverse the Cycle (RTC) program has been used in EDs across the country to facilitate effective overdose response by use of MAT, peer recovery coaches, staff trainings, and other supports. A pilot study funded by IRIS investigated how involvement in RTC predicts ED staff’s attitudes towards patients with OUD. Results indicated that greater exposure to this innovative program was associated with more positive ED practitioners’ attitudes. You can find further details about this study here.