Enhancing Outcomes: Impact of an EDPN Program in Urban Healthcare Settings

Jul 12, 2023

Photo Credit: Pornpak Khunatorn

The following is a summary of “Improving Outcomes: Emergency Department Peer Navigator Program in Urban Healthcare,” published in the June 2023 issue of Emergency Medicine by Cynthia et al.

It has been demonstrated that Emergency Department Peer Navigator Programs (EDPN) increase prescribing of medications for opioid use disorder (MOUD) and enhance linkage to addiction treatment. However, whether it can improve overall clinical outcomes and healthcare utilization among OUD patients is still being determined. This is a retrospective, single-center, IRB-approved cohort study of OUD patients enrolled in their peer navigator program between 11/7/19 and 2/16/21. Annually, the researchers determined the MOUD clinic follow-up rates and clinical outcomes for EDPN patients. They also examined the social determinants of health (e.g., race, medical insurance status, lack of accommodation, phone and internet access, employment, etc.) that influence the clinical outcomes of their patients. Before and after enrollment in the program, ED and inpatient provider notes were reviewed to ascertain the causes of ED visits and hospitalizations one year before and after registration.

Number of ED visits from all causes, number of ED visits from opioid-related causes, number of hospitalizations from all causes, and number of hospitalizations from opioid-related causes one year after enrollment in their EDPN program, subsequent urine drug screens, and mortality were the clinical outcomes of interest. Also analyzed were demographic and socioeconomic factors (age, gender, race, employment, housing, insurance status, and phone access) to determine if any were independently associated with clinical outcomes. There were deaths and cardiac arrests noted. Data on clinical outcomes were characterized with descriptive statistics and contrasted with t-tests. They included 149 OUD patients in their investigation. At the index ED visit, 39.6% of patients had an opioid-related chief complaint; 51.0% had a documented history of MOUD, and 46.3% had a history of buprenorphine use. Individual doses of buprenorphine administered in the ED ranged from 2 to 16 mg, and 46.3% of patients were prescribed buprenorphine.

The average number of ED visits one year before enrollment was 3.09 versus 2.20 (P< 0.01); for opioid-related complications, it was 1.80 versus 0.72 (P <0.01). One year before and after enrollment, the average number of hospitalizations for all causes was 0.83 versus 0.60 (P = 0.05); for opioid-related complications, 0.39 versus 0.09 (P< 0.01). All-cause ED visits decreased in 90 (60.40%) patients, remained unchanged in 28 (18.79%) patients, and rose in 31 (20.81%) patients (P <0.01). Visiting the ED due to opioid-related complications decreased in 92 (61.74%) patients, remained the same in 40 (26.85%) patients, and increased in 17 (11.41%) patients (P< 0.01). All-cause hospitalizations decreased in 45 (30.20%) patients, remained unchanged in 75 (50.34%) patients, and increased in 29 (19.46%) patients (P< 0.01). Hospitalizations due to opioid-related complications decreased in 31 (20.81%) patients, remained the same in 113 (75.84%) patients, and increased in 5 (3.36%) patients (P<0.01). There was no statistically significant association between socioeconomic factors and clinical outcomes. Two patients (1.2%) died within one year of enrollment in the investigation. Their study found a correlation between implementing an EDPN program and reducing ED visits and hospitalizations for opioid-related complications and for all causes among patients with opioid use disorder.