The following is a summary of “Peer recovery coaches and emergency department utilization in patients with substance use disorders,” published in the July 2023 issue of Emergency Medicine by Lukacs et al.

Although Emergency Departments (ED) frequently provide care for patients with substance use disorders (SUD), there are numerous obstacles to connecting these patients with appropriate long-term treatment. The Peer Recovery Coach (PRC) is one method for reducing risk in this population. PRCs are individuals with first-hand knowledge of the rehabilitation process; they are a powerful resource for bridging this care divide by engaging patients and their families and providing system navigation, self-empowerment for behavior change, and harm reduction strategies. This initiative aims to describe an ED-based PRC program and evaluate its viability and effectiveness. This was a quality improvement initiative conducted retrospectively at three suburban hospitals.

All patients presenting to the ED were screened with a brief questionnaire during triage, and if they consented, high-risk patients were referred to a PRC. If feasible, the PRC met with the patient at the ED bedside. Members of the PRC program gathered prospective data on patient engagement with the PRC 30, 60, and 90 days after their ED visit. Using the EMR, the researchers determined the number of subsequent ED visits 30, 60, and 90 days after the index PRC visit (for medical and substance use disorder-related visits). Between January 1, 2019, and June 30, 2020, 448 individuals were identified and included in this analysis, of which 292 (66%) were male, and the mean age was 44 (range: 18–80). Most patients (289, 65%) reported alcohol as their predominant substance of abuse, followed by heroin/opiates (20%). At 30, 60, and 90 days, 110 (25%), 79 (18%), and 71 (16%) patients, respectively, were still actively participating in the program. 

The cohort had no difference in the mean number of visits before and after the PRC engagement visit. Among patients who had at least one prior ED visit, however, there were significant differences in mean visits across all visit types: for patients with 1 last ED visit, the 90-day mean decrease in visits was 1.0 (95% CI: 0.7–1.2), whereas, for patients with 5+ prior ED visits, the 90-day mean reduction of visits was 3.6 (95% CI: 2.4–4.8). They describe implementing a PRC program based in the emergency department for patients with substance use disorders. While they demonstrated that the PRC could engage the patient in the ED, outpatient program follow-up was inadequate. For patients with at least one previous SUD visit to the ED, there was a statistically significant reduction in ED utilization after engaging with a PRC in the ED, suggesting that this population could be targeted to link patients to long-term care and reduce repeated ED utilization.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001559