Biosurveillance and the Opioid Crisis in Emergency Medicine: Qualitative Study of Physician Perspectives.

BACKGROUND

In 2017, the US Department of Health and Human Services declared a national opioid crisis. In 2022, an estimated 81,806 overdose deaths involved an opioid. Emergency departments are critical in the pathway of care for providing resources and linkages to services. Studies investigating emergency medicine (EM) physicians' perspectives on the opioid crisis have largely focused on prescribing.

OBJECTIVES

To investigate EM physicians' perspectives on response strategies to the opioid crisis of biosurveillance and linkages to care. A secondary objective was to map reported challenges and recommendations using a sequential intercept model as an actionable framework.

METHODS

This is a qualitative study. Six EM physicians in an academic health care system were interviewed through semi-structured interviews. Interviews were transcribed, then thematically coded and analyzed to identify cross-sector settings and barriers to care with corresponding recommendations. Settings and recommendations were mapped as a sequential intercept model.

RESULTS

EM physicians identified 9 key settings as crucial touch points in the opioid crisis: home setting, emergency medical services, patient care, clinically relevant data and information, prescriptions and pain management, predischarge coordination, outpatient resources, biosurveillance sample collection, and the external partner and administrative environment. Biosurveillance challenges included concerns about collecting biological materials for state and regional monitoring, as well as the time burden for sample collection. Linkage to care challenges included social determinants of health and limited outpatient care access. Recommendations were specific to each setting and included care coordination and fostering cross-sector partnerships. A patient-centered approach and better integration of community resources were emphasized.

CONCLUSIONS

The service delivery culture is of acute and episodic care but needs to more seamlessly address care across its fragmented multicomponent complex system. EM physicians face systemic challenges and provide actionable recommendations to promote comprehensive care to patients presenting to the emergency department with opioid-related complaints.