Background: EDs nationwide are expanding their roles in the care of patients with opioid use disorder (OUD), and many have begun ED-MAT programs. In May of 2018, our ED instituted an ED-MAT protocol. Since then, we have identified multiple behavioral barriers, affecting both providers and patients, that have limited wide-scale early adoption of our protocol. The lessons learned from our innovative program may be useful as other hospitals plan their own MAT programs.
Objective: While greater than 90% of our attending physicians now have DEA-X waivers and are able to prescribe buprenorphine, there remains opportunity to increase the rate of MAT initiation in our ED. This is consistent with previous findings that many providers who obtain their waivers underutilize them. We set out to examine the behavioral barriers to providers’ use of our MAT initiation protocol and patients’ willingness to seek help in obtaining OUD treatment in our ED.
Methods: A behavioral map was created to outline the decisions and actions required for ED providers to follow the MAT initiation protocol. Semi-structured interviews were conducted with 21 medical providers from our ED: 7 attending physicians, 5 residents, 4 physician assistants, 4 nurse practitioners, and 1 registered nurse. Along with the provider interviews, we also conducted interviews with 10 patients with OUD to better understand their barriers to treatment in our ED
Outcomes: Four behavioral barriers impacting adherence to the MAT initiation protocol by providers were identified, specifically: time pressure, a lack of cues to ask about opioid misuse, uncertainty with treatment protocols, and a lack of clarity around who is responsible for the treatment of OUD. Behavioral barriers identified by patients included: a focus on the present rather than the future, the necessity for important life events to pursue treatment, stigma, and mistrust of the health system.