{"pk":17671,"title":"Emergency Department Buprenorphine Quality Improvement and Emergency Physician Knowledge, Attitudes, and Self-Efficacy","subtitle":null,"abstract":"Objective: \nBuprenorphine is an evidence-based treatment for opioid use disorder that is underused in the emergency department (ED). In this study we evaluated changes in emergency physician knowledge, confidence, and self-efficacy regarding buprenorphine prescribing and working with patients who use drugs after implementation of an ED buprenorphine quality improvement (QI) initiative.\nMethods:\n An anonymous, online survey was administered to emergency physicians staffing four EDs in New England in 2019 and 2020 before and after an ED QI initiative. Survey questions included novel and previously validated questions to assess confidence, knowledge, self-efficacy, and attitudes about buprenorphine and working with patients who use drugs. Confidence, self-efficacy, and attitude responses were assessed on a Likert scale. Participants received a gift card for survey completion. We analyzed pre- and post- survey responses descriptively and compared them using t-tests. Using logistic regression we evaluated the factors associated with buprenorphine prescribing.\nResults:\n Of 95 emergency physicians, 56 (58.9% response rate) completed the pre-intervention survey and 60 (63.2%) completed the post-survey. There was an increase in the number of X-waivered adult emergency physicians and ED buprenorphine prescribing after program implementation. Physician confidence increased from a mean of 3.4 (SD 0.8) to 3.9 (SD 0.7; scale 1–5, p < 0.01). Knowledge about buprenorphine increased from a mean score of 1.4 (SD 0.7) to 1.7 (SD 0.5, p < 0.01). Physician attitudes and self-efficacy did not change. Post-initiative, increased confidence was associated with higher odds of buprenorphine prescribing (odds ratio 4.4; 95% confidence interval 1.07–18.4).\nConclusion:\n After an ED QI initiative, buprenorphine prescribing in the ED increased, as did both physician confidence in working with patients who use drugs and their knowledge of buprenorphine. Increased confidence was associated with higher odds of buprenorphine prescribing and should be a focus of future, buprenorphine implementation strategies in the ED.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"opioid use disorder"},{"word":"opioid overdose"},{"word":"Theory of Planned Behavior"},{"word":"buprenorphine"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/49g5k4vr","frozenauthors":[{"first_name":"Michelle","middle_name":"L.","last_name":"Myles","name_suffix":"","institution":"Brown University, Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island","department":"None"},{"first_name":"Kelli","middle_name":"","last_name":"Scott","name_suffix":"","institution":"Northwestern University, Feinberg School of Medicine, Center for Dissemination and Implementation Science, Chicago, Illinois","department":"None"},{"first_name":"Hannah","middle_name":"N.","last_name":"Ziobrowski","name_suffix":"","institution":"Brown University, School of Public Health, Department of Epidemiology, Providence, Rhode Island","department":"None"},{"first_name":"Sarah","middle_name":"A.","last_name":"Helseth","name_suffix":"","institution":"Northwestern University, Feinberg School of Medicine, Center for Dissemination and Implementation Science, Chicago, Illinois","department":"None"},{"first_name":"Sara","middle_name":"","last_name":"Becker","name_suffix":"","institution":"Northwestern University, Feinberg School of Medicine, Center for Dissemination and Implementation Science, Chicago, Illinois","department":"None"},{"first_name":"Elizabeth","middle_name":"A.","last_name":"Samuels","name_suffix":"","institution":"Brown University, Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island; Brown University, School of Public Health, Department of Epidemiology, Providence, Rhode Island; University of California Los Angeles, Department of Emergency Medicine, Los Angeles, California","department":"None"}],"date_submitted":"2022-11-22T01:15:17+01:00","date_accepted":"2022-11-22T01:15:17+01:00","date_published":"2023-09-14T22:36:35+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17671/galley/9023/download/"}]}