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(69) Buprenorphine Linked To Significant Reductions in Emergency Department Utilization


Authors:

Brian Dawson, MD – Attending Physician, Ideal Option

Bryce Kelly, BS – Chief Operating Officer, Ideal Option

Jeffrey Allgaier, MD, FACEP – President, Ideal Option

Andrea G. Barthwell, MD, DFASAM – Director and Founder, Two Dreams

Abstract:

Introduction: The economic burden of the opioid epidemic in the United States is staggering.  According to the Council of Economic Advisors, in 2015, the economic cost of the opioid crisis was $504.0 billion, or 2.8 percent of GDP that year (1). There are substantial data to conclude that decreased utilization of the ED is associated with significant decreases in the economic burden of healthcare (2,3). There are also some data to conclude that evidence-based medication assisted treatment (MAT) for patients with opioid use disorder (OUD) is associated with decreased healthcare costs in this population (4,5).
Methods: Ideal Option (“The Practice) is a multi-site addiction medicine practice focused on MAT for OUD. The Practice submitted a patient demographics report into the Emergency Department Information Exchange (EDIE) system database for patients prescribed buprenorphine by practitioners within The Practice. This database contains data from all Emergency Departments (EDs) visited by a patient in Washington and Oregon as well as some in Alaska and California. This allowed us to identify all ED encounters in the database for these patients from January 1st of 2015 through December 31st of 2017. Primary outcomes measured were the change in number of ED visits that occurred after entrance into The Practice using the following before and after time-intervals: 30, 60, 90, 180 and 365 days. Initial engagement was defined as having had at least one initial evaluation with The Practice. The hypothesis was that engagement and further treatment with office based buprenorphine would result in decreased ED utilization.
Results: The total number of ED encounters within the measurement period before engagement along with the total number of ED encounters within the measurement period after engagement were collected.  1,438 unique patients had at least one ED encounter either 29 days before the engagement date or 29 days after the engagement date, 2,091 patients from 0-59 days, 2,480 patients from 0-89 days, 3,200 patients from 0-179 days, and 3,861 patients from 0-364 days. Overall ED utilization after engagement date decreased across all measurement periods.  Most notably, the ED utilization decreased by 43.13% after engagement within the 0-29 day measurement period (1,558 total ED visits prior to engagement compared to 886 after engagement). Further, as days in the measurement period expanded, the percentage decrease in ED utilization decreased: 35% decrease in 0-59 day (2,611 before, 1,693 after), 32% decrease in 0-89 day, (3,455 before, 2,364 after), 30% decrease in 0-189 day (5,203 before, 3,658 after), and 27% decrease in 0-365 day measurement periods (6,773 before, 4,927 after).  
Conclusion: This study shows a strong association between office based buprenorphine treatment and decreased ED utilization. This data adds to our existing body of literature that suggests office based buprenorphine treatment for OUD results in decreased overall healthcare costs.

 

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