The following is a summary of “Impact of an emergency department peer navigator (EDPN) program in improving clinical outcomes and healthcare utilization in an urban setting,” published in the June 2023 issue of Emergency Medicine by Santos, et al.
Emergency Department Peer Navigator Programs (EDPN) have shown promise in improving the prescription of medications for opioid use disorder (MOUD) and enhancing linkage to addiction care. However, the impact of these programs on overall clinical outcomes and healthcare utilization in patients with opioid use disorder (OUD) remained uncertain.
In the retrospective cohort study conducted at a single center, researchers enrolled patients with OUD who participated in the peer navigator program from November 7, 2019, to February 16, 2021. They assessed the follow-up rates in MOUD clinics and examined clinical outcomes in patients utilizing the EDPN program annually. Additionally, they explored the influence of social determinants of health factors (such as race, insurance status, housing status, access to phone/internet, and employment) on clinical outcomes. They reviewed emergency department (ED) and inpatient provider notes to determine the causes of ED visits and hospitalizations in the year before and after enrollment into the program.
The primary clinical outcomes of interest were the number of ED visits for all causes, ED visits for opioid-related causes, hospitalizations for all causes, hospitalizations for opioid-related causes, subsequent urine drug screens, and mortality. They also analyzed demographic and socioeconomic factors (age, gender, race, employment, housing, insurance status, access to phone) to identify any independent associations with clinical outcomes. Death and cardiac arrests were specifically noted. Descriptive statistics were used to describe the clinical outcomes data, and t-tests were employed for comparisons.
A total of 149 patients with OUD were included in the study. Among them, 39.6% presented to the ED with an opioid-related chief complaint at their initial visit. Of the patients, 51.0% had a recorded history of MOUD, and 46.3% had a history of buprenorphine use. In the ED, 31.5% of patients received buprenorphine, with individual doses ranging from 2 to 16 mg, and 46.3% were provided with a buprenorphine prescription. Comparing the average number of ED visits and hospitalizations in pre- and post-enrollment, a significant decrease was observed for all causes and opioid-related complications (P < 0.01). Specifically, ED visits for all causes decreased in 90 (60.40%) patients, remained unchanged in 28 (18.79%) patients, and increased in 31 (20.81%) patients (P < 0.01). Similarly, ED visits for opioid-related complications decreased in 92 (61.74%) patients, remained unchanged in 40 (26.85%) patients, and increased in 17 (11.41%) patients (P < 0.01). Hospitalizations for all causes decreased in 45 (30.20%) patients, remained unchanged in 75 (50.34%) patients, and increased in 29 (19.46%) patients (P < 0.01). Additionally, hospitalizations for opioid-related complications decreased in 31 (20.81%) patients, remained unchanged in 113 (75.84%) patients, and increased in 5 (3.36%) patients (P < 0.01). No socioeconomic factors showed a statistically significant association with clinical outcomes. Two patients (1.2%) died within 1 year after study enrollment.
Implementing an EDPN program was associated with reduced ED visits and hospitalizations for patients with OUD, including visits related to opioid complications. The findings highlighted the potential benefits of EDPN programs in improving clinical outcomes for individuals with opioid use disorder.