Organizational culture, clinician training and support, the ability to link patients to ongoing treatment, and the ability to tailor implementation to each clinical site were key determinants of successful implementation of an intervention to promote buprenorphine initiation in emergency departments, according to a qualitative study conducted as part of the EMBED pragmatic clinical trial.
The study’s findings were published recently in Implementation Science Communications.
EMBED, an NIH Collaboratory Trial, was a cluster randomized trial across 21 emergency departments in 5 healthcare systems in the United States. The trial tested the effectiveness of a clinical decision support tool integrated into the electronic health record in improving rates of buprenorphine initiation in the emergency department for the treatment of opioid use disorder. The intervention led to a modest increase in buprenorphine initiation and little impact on patient outcomes.
A secondary aim of the study was to identify determinants of adopting, implementing, and maintaining the clinical decision support tool at the trial sites. Among the key determinants were:
- establishing buprenorphine initiation as a cultural norm within healthcare organizations;
- organizational commitment to implementing and sustaining the intervention;
- clinician training and support on opioid use disorder and buprenorphine initiation in emergency departments;
- availability of referral resources to link patients who were initiated on buprenorphine in the emergency to ongoing treatment; and
- the ability to tailor the intervention to clinic workflows that fit the resources and characteristics of the local clinic.
EMBED was supported within the NIH Collaboratory by a cooperative agreement from the National Institute on Drug Abuse and received logistical and technical support from the NIH Collaboratory Coordinating Center. Read more about EMBED in the Living Textbook, and learn about the other NIH Collaboratory Trials.