Table 3.
Barriers and facilitators to offering specific substance use disorder-related services
| Variable | n | % |
|---|---|---|
| Screening | ||
| What barriers does your ED face related to screening patients for substance use disorder? a | ||
| Need to triage competing medical problems | 36 | 42% |
| Lack of clinical knowledge/training in administering substance use disorder screening | 33 | 39% |
| Screening patients for substance use disorder is not part of the ED protocol | 32 | 38% |
| Lack of adequate substance use disorder screening tools | 30 | 35% |
| Screening is not embedded within the EMR | 30 | 35% |
| Lack of time | 25 | 29% |
| Lack of training in what to do with a positive screen | 25 | 29% |
| Nowhere to refer patients with a positive screen | 23 | 27% |
| Patient privacy concerns (e.g., family member or significant other will not leave the room) | 23 | 27% |
| Some staff are uncomfortable screening patients for substance use disorder | 12 | 14% |
| Other | 10 | 12% |
| What factors make it easier to screen patients for substance use disorder? (n = 37)a, b | ||
| Substance use disorder screening is embedded in the EMR | 31 | 84% |
| Substance use disorder screening is part of the ED protocol | 18 | 49% |
| Providers have clinical knowledge/training in administering substance use disorder screening | 12 | 32% |
| Providers know how/where to refer patients with a positive screen | 11 | 30% |
| Providers are comfortable administering substance use disorder screenings | 10 | 27% |
| Providers are trained in what to do with a positive screen | 9 | 24% |
| ED has a champion who has led education efforts about screening for substance use disorder | 4 | 11% |
| Other | 2 | 5% |
| MOUD | ||
| Rank your level of agreement with the following statement: Patients with opioid use disorder in the ED can receive buprenorphine in a timely manner. | ||
| Strongly disagree | 6 | 7% |
| Disagree | 6 | 7% |
| Neither agree nor disagree | 24 | 28% |
| Agree | 26 | 31% |
| Strongly agree | 13 | 15% |
| Not Applicable | 10 | 12% |
| What barriers are there to prescribing take-home buprenorphine? a | ||
| Lack of providers that have/had an X-waiver to prescribe buprenorphine c | 56 | 66% |
| Lack of clinician willingness to prescribe buprenorphine | 44 | 52% |
| Lack of clinician knowledge in how to induct patients on buprenorphine | 41 | 48% |
| Clinicians often will not prescribe buprenorphine unless patients are connected to counseling or treatment | 36 | 42% |
| Lack of knowledge that patients can receive take-home buprenorphine from X-waivered providers | 30 | 35% |
| No community providers to continue prescriptions after take-home supply runs out | 29 | 34% |
| Lack of time to follow up with patient when they leave the ED | 28 | 33% |
| Pharmacy does not stock buprenorphine or maintain adequate supplies | 21 | 25% |
| Lack of patient interest | 9 | 11% |
| Limited access to pharmacy or long wait times | 9 | 11% |
| Other | 8 | 9% |
aSelect all that apply question, percentages may exceed 100%
bOnly among hospitals with a screening protocol
cThe X-waiver requirement was removed while the survey was being fielded