Abstract: Organizational Capacity in Emergency Care to Respond to the Opioid Epidemic (Society for Social Work and Research 23rd Annual Conference - Ending Gender Based, Family and Community Violence)

Schedule:

Saturday, January 19, 2019: 11:15 AM

Golden Gate 5, Lobby Level (Hilton San Francisco)

* noted as presenting author

Erick Guerrero, PhD, Associate Professor, University of Southern California, Los Angeles, CA

Welmoed Van Deen, MD, PhD, Assistant Professor, University of Southern California, Los Angeles, CA

Yinfei Kong, PhD, Assistant Professor, California State University, Los Angeles, Fullerton, CA

Rebecca Trotzky-Sirr, MD, Director, University of Southern California, Los Angeles, CA

Background and purpose: To date, there is limited research on the organizational capacity of emergency departments (EDs) to implement medication-assisted treatment for substance use disorders. In this article, we examine the inner context of the ED to understand the extent to which organizational capacity—including readiness for change (preparation and willingness for change), climate for innovation (perceived priority with and value in innovation), psychological safety (willing to try new practices, not afraid of making mistakes), and implementation leadership (leader who is perceived as responsive, persistent, supportive of implementation) —is associated with attitudes toward implementation of opioid use disorder treatment practices. Findings can advance health services research in implementation science and build on health care integration models to respond to the opioid epidemic.

Methods: We collected survey data from December 2016 to August 2017 among practitioners at one of the largest EDs in the United States. Our sampling frame included the 430 ED practitioners (physicians, nurses, and social workers). We used analysis of variance and chi-square global tests to compare responses from ED practitioners in differing roles. Specifically, we compared responses of ED managers, physicians (resident or attending), nurses, and social workers). We also used the multivariate logistic regression processes in Stata/SE Version 12 to conduct five regressions, one per outcome.

Results: We found nurses were more likely than physicians to support initiating OUD treatment in the ED and implement best OUD-treatment practices. At the same time, nurses had greater bias than physicians towards working with patients suffering from OUD. We also found ED’s climate for innovation and providers’ readiness for change were positively associated with initiating OUD treatment and using best OUD-treatment practices.

Conclusion and Implications: Findings suggest that interventions should target practitioners’ attitudes about opioid users and workplace context to support preparation for and openness to implementing evidence-based OUD treatment practices. Implications for identifying and testing implementation strategies to implementing OUD treatment practices in EDs to reduce the burden of the opioid epidemic are discussed.