Implementation Barriers of Prehospital Buprenorphine Administration Programs in the United States: A Scoping Review.

IF 2.1 3区 医学 Q2 EMERGENCY MEDICINE
Mirinda Ann Gormley, Phillip Moschella, Tina Pham, Victoria Callicott, Kyle Jardim, Austin Madden, Wesley R Wampler, Daniel Schwerin, Shuchin Shukla, David A Miramontes, Parker Bailes, Alain H Litwin, Sarah B Floyd, Gerald Wook Beltran
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引用次数: 0

Abstract

Objectives: Prehospital buprenorphine administration programs (PBAPs) have spread throughout the United States (U.S.) with limited information on their locations or barriers to implementation, posing challenges to emergency medical services (EMS) systems adopting this clinical care model. This scoping review identifies where current PBAPs operate and summarizes commonly reported barriers to PBAP implementation.

Methods: State Offices of EMS were contacted by phone and email and asked if PBAPs operated within the state. After three failed attempts, representative physicians from remaining states were queried through the National Association of EMS Physicians' state membership. Four databases identified PBAPs from manuscripts, popular media, and conference proceedings from each database's inception to 8/25/2024. Programs were included if EMS clinicians administered buprenorphine. Data extraction from academic manuscripts, popular media, and conference proceedings included PBAP location, personnel, protocols, and implementation barriers. Results were reported utilizing Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for Scoping Reviews.

Results: Nineteen states and Washington D.C. reported at least one PBAP, 28 reported none, 3 were pending implementation. Of 977 identified titles, 17 met inclusion criteria. Seven media articles, 4 conference presentations, 3 cohort studies, 2 case series, and 1 scoping review yielded data on 13 unique PBAPs within 8 states. Most PBAPs delivered buprenorphine via 9-1-1 paramedics (61.5%) during an EMS response, or by community paramedics (46.1%) within 24-48 h of an EMS response to a patient who experienced an overdose. Five (33.3%) PBAPs reported at least one patient-related barrier to PBAP implementation, including reasons buprenorphine was not administered, lack of treatment access, and patient loss of follow-up. Four programs reported operational-level barriers, including in-person restrictions due to COVID-19, siloing of outpatient services, lack of outpatient service options, inconsistent education of PBAP staff, inconsistent application of PBAP protocols by EMS clinicians, high turnover, and difficulty procuring buprenorphine.

Conclusions: Whereas 19 states in the U.S. and Washington D.C. reported having at least one PBAP, few are reported in literature, and very few report barriers to PBAP implementation. Developing consensus on metrics assessing PBAP implementation is necessary to inform EMS agencies implementing these novel programs throughout the U.S.

院前丁丙诺啡给药计划在美国的实施障碍:范围审查。
目的:院前丁丙诺啡给药计划(ppap)已经在美国普及,但关于其地点或实施障碍的信息有限,对采用这种临床护理模式的紧急医疗服务(EMS)系统提出了挑战。该范围审查确定了当前PBAP的运行情况,并总结了常见的实施PBAP的障碍。方法:通过电话和电子邮件与州EMS办事处联系,询问pbap是否在州内运行。在三次尝试失败后,来自其余州的代表性医生通过全国急救医师协会的州会员进行了询问。四个数据库从手稿、流行媒体和会议论文集中确定了pbap,从每个数据库建立到2024年8月25日。如果EMS临床医生使用丁丙诺啡,程序也包括在内。从学术论文、大众媒体和会议记录中提取数据,包括PBAP的位置、人员、协议和实施障碍。使用系统评价的首选报告项目和范围评价的扩展元分析来报告结果。结果:19个州和华盛顿特区报告了至少一个PBAP, 28个报告没有,3个有待实施。在977个确定的标题中,17个符合纳入标准。7篇媒体文章、4篇会议报告、3篇队列研究、2篇病例系列研究和1篇范围综述得出了8个州13个独特ppap的数据。大多数ppap在EMS响应期间通过9-1-1护理人员(61.5%)提供丁丙诺啡,或在EMS响应后24-48小时内由社区护理人员(46.1%)提供丁丙诺啡。5个(33.3%)PBAP报告了至少一个与患者相关的PBAP实施障碍,包括未施用丁丙诺啡、缺乏治疗途径和患者失去随访的原因。四个项目报告了运营层面的障碍,包括COVID-19造成的面对面限制、门诊服务的孤立、缺乏门诊服务选择、对PBAP工作人员的教育不一致、EMS临床医生对PBAP协议的应用不一致、人员流失率高、丁丙诺啡采购困难。结论:尽管美国19个州和华盛顿特区报告至少有一个PBAP,但文献报道很少,而且很少报告实施PBAP的障碍。在评估PBAP实施的指标上达成共识是必要的,以告知EMS机构在美国各地实施这些新项目
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来源期刊
Prehospital Emergency Care
Prehospital Emergency Care 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.30
自引率
12.50%
发文量
137
审稿时长
1 months
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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