Anjni P Joiner, Jessica Wanthal, Angela N Murrell, José G Cabañas, Gerard Carroll, H Gene Hern, Mike Sasser, Cara Poland, Mary Piscitello Mercer, Melody Glenn
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引用次数: 0
Abstract
Objectives: Emergency Medical Services (EMS) agencies are beginning to provide low-barrier access to treatment for opioid use disorder (OUD) through the development of EMS buprenorphine (EMS-Bupe) programs. However, evidence-based practices for these programs are lacking. Our aim was to review the current literature on EMS and emergency department (ED) based buprenorphine treatment programs to provide consensus recommendations on the EMS-Bupe program development.
Methods: We performed a scoping review of EMS-Bupe programs and ED medication for OUD (MOUD) programs. We searched Ovid MEDLINE(R), Embase.com, Cochrane Central Register of Controlled Trials and Web of Science (Science Citation Index) for English language articles and abstracts. Additional articles/abstracts as identified independently by coauthors were added. Recommendations were generated through consensus based on the findings of the scoping review and other relevant literature.
Results: We identified a total of 9 EMS-Bupe articles/abstracts and 21 ED MOUD abstract, representing 5 EMS-Bupe programs in 4 states. There was significant variability between programs, from infrastructure, medication dosing, and retention rates. Results and recommendations were grouped into 8 categories: EMS program infrastructure, withdrawal classification thresholds, EMS protocol inclusion/exclusion criteria, buprenorphine dosing and adjunct medications, EMS disposition and scene times, EMS clinician training, referrals, and EMS data collection and quality management.
Conclusions: The EMS-Bupe program data are limited but show important variability. In general, we recommend that programs respond to community needs by establishing relationships with local resources. We also favor protocols that increase patient eligibility and treatment retention. Lastly, programs should consider low-barrier, patient-centered strategies aimed at preventing gaps in treatment.
目标：紧急医疗服务（EMS）机构正开始通过制定EMS丁丙诺啡（EMS- bupe）方案，为阿片类药物使用障碍（OUD）提供低障碍治疗。然而，这些项目缺乏基于证据的实践。我们的目的是回顾目前关于EMS和急诊部门（ED）基于丁丙诺啡治疗方案的文献，为EMS- bupe方案的发展提供共识建议。方法：我们对EMS-Bupe方案和ED药物治疗OUD （mod）方案进行了范围审查。我们检索了Ovid MEDLINE(R)、Embase.com、Cochrane Central Register of Controlled Trials和Web of Science（科学引文索引）的英文文章和摘要。添加了由共同作者独立识别的其他文章/摘要。建议是根据范围审查的结果和其他相关文献通过协商一致产生的。结果：我们共识别出9篇EMS-Bupe文章/摘要和21篇ED - mod摘要，代表了4个州的5个EMS-Bupe项目。从基础设施、药物剂量和保留率来看，各项目之间存在显著差异。结果和建议分为8个类别：EMS计划基础设施、退出分类阈值、EMS方案纳入/排除标准、丁丙诺啡剂量和辅助药物、EMS处置和现场时间、EMS临床医生培训、转诊、EMS数据收集和质量管理。结论：EMS-Bupe程序数据有限，但显示出重要的可变性。总的来说，我们建议项目通过与当地资源建立关系来回应社区需求。我们也赞成增加患者资格和治疗保留的方案。最后，项目应该考虑低障碍，以患者为中心的策略，旨在防止治疗中的差距。
期刊介绍：
Prehospital Emergency Care publishes peer-reviewed information relevant to the practice, educational advancement, and investigation of prehospital emergency care, including the following types of articles: Special Contributions - Original Articles - Education and Practice - Preliminary Reports - Case Conferences - Position Papers - Collective Reviews - Editorials - Letters to the Editor - Media Reviews.
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