(76) Facilitators to Patients with Substance Use Disorders Seeking Care in the ED

Background & Introduction: It is well known that the decision to seek care in the emergency department can be a challenging one to make for patients with substance use disorders (SUDs). Prior qualitative research has been conducted with patients with SUDs seeking care in the Emergency Department (ED), including exploring patient experiences in general and specifically with receiving naloxone and post-overdose care in the ED. However, less is known about how care and services in the ED can be changed to help these patients be more willing to seek care in the ED when the need arises. Our aim was to identify actionable changes that can be made to the patient experience in the ED that would facilitate patients with SUDs seeking care in the ED.

Methods: This qualitative research study was conducted at an urban, academic hospital in Philadelphia with a level 1 trauma center. We recruited patients admitted to the hospital and being followed by the addiction medicine consult service, and all interviews were conducted by a trained research assistant during the hospital admission after obtaining informed consent. Semi-structured interviews were used to explore patients’ experiences in the ED and to identify potential changes to the services offered and delivery of care that would make it easier for patients to decide to seek care in the ED. Interviews were audio recorded, transcribed, and analyzed using thematic content analysis.

Results: We have interviewed 18 participants to date, with interviews ongoing. Mean participant age was 43 and participants were majority male (n=15), white (n=13), non-Hispanic (n=10), and undomiciled (n=10). Sixteen participants had a diagnosis of opioid use disorder (OUD), many with additional concurrent SUDs. Participants shared prior negative experiences in the ED and hospital, including receiving stigmatizing or inadequate care. The majority of participants reported feeling respected and not experiencing stigma from hospital staff during their current hospitalization, contrasting this with prior experiences. Many also reported that, while the ED was often very busy, they felt that their providers were committed to promptly addressing their needs as they arose. Several participants reported hearing from their social networks that this hospital was the one to go to for good withdrawal and addiction care, and this word-of-mouth referral created trust and facilitated care seeking at this particular hospital. Some participants also identified challenges related to the ED waiting room, including long wait times and lack of privacy as ongoing challenges. There was also a fear of going into severe withdrawal before being seen by a provider which presented a potential barrier to care seeking.

Conclusion & Discussion: The preliminary results of this study indicate that this hospital has created a culture that helps patients feel safe, welcomed, and well-cared for and that this reputation has begun to spread amongst the community. However, there continues to be pain points in the patient’s experience in the ED that need to be addressed to improve patients’ willingness to seek care in the department, including long wait times, fear of withdrawal, and lack of privacy. The generalizability of this study is limited by the overrepresentation of OUD amongst the study population and that it only included perspectives from patients who were admitted to the hospital. Further work will need to be done to consider what specific changes to policy, procedures, and patient flow can be made to alleviate these pain points. Hospitals can, and should, do more to make the ED a welcoming space for marginalized populations, particularly those with SUDs who have many unique barriers to accessing care. Solutions on how to make seeking care easier for patients with SUDs – including changes to services provided and the patient experience - should come from patients themselves, to center their experience and help ensure success and buy-in with the changes.

References: Hawk, K., Grau, L. E., Fiellin, D. A., Chawarski, M., O'Connor, P. G., Cirillo, N., Breen, C., & D'Onofrio, G. (2021). A qualitative study of emergency department patients who survived an opioid overdose: Perspectives on treatment and unmet needs. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine, 28(5), 542–552. https://doi.org/10.1111/acem.14197

Hawk, K., McCormack, R., Edelman, E. J., Coupet, E., Jr, Toledo, N., Gauthier, P., Rotrosen, J., Chawarski, M., Martel, S., Owens, P., Pantalon, M. V., O'Connor, P., Whiteside, L. K., Cowan, E., Richardson, L. D., Lyons, M. S., Rothman, R., Marsch, L., Fiellin, D. A., & D'Onofrio, G. (2022). Perspectives About Emergency Department Care Encounters Among Adults With Opioid Use Disorder. JAMA network open, 5(1), e2144955. https://doi.org/10.1001/jamanetworkopen.2021.44955

Lowenstein, M., Sangha, H. K., Spadaro, A., Perrone, J., Delgado, M. K., & Agarwal, A. K. (2022). Patient perspectives on naloxone receipt in the emergency department: a qualitative exploration. Harm reduction journal, 19(1), 97. https://doi.org/10.1186/s12954-022-00677-7