Exploratory Analysis on the Role of Video Tools and Multidisciplinary Healthcare Providers to Aid Counselling for Buprenorphine/Naloxone Induction Within the Evaluating Microdosing in the Emergency Department Study.

Introduction: To address the rising deaths and hospitalizations related to opioid toxicity, buprenorphine/naloxone has been provided as a frontline treatment within the emergency department (ED), allowing increased access to opioid agonist therapies (OAT). However, several barriers exist toward initiating patients on buprenorphine/naloxone within the ED, such as shortages in healthcare staff and time limitations in the urgent ED environment. To overcome these barriers, we utilized counselling tools and engaged multidisciplinary healthcare providers to counsel patients for our study, Evaluating Microdosing in the Emergency Department (EMED). The primary objective of this analysis is to describe the proportion of healthcare providers counselling for buprenorphine/naloxone induction within the EMED study, before and after the implementation of a counselling video, and across different time intervals. Additionally, we aim to compare the completion status of enrollment when patients were counselled by different types of healthcare providers. By analyzing these factors, we aim to explore how collaboration with multidisciplinary healthcare providers and the use of video tools can impact buprenorphine/naloxone induction in the ED, thereby increasing accessibility of take-home OAT.

Methods: Data regarding the type of healthcare worker providing counselling for the EMED study was collected at Vancouver General Hospital from July 23, 2021, to December 31, 2023. The EMED study is an open-label, randomized controlled trial comparing microdosing and standard dosing take-home regimens. We analyzed 172 providers involved in counselling patients for the study. We stratified the data by month, week, and day of the week to assess trends in counselling frequencies.

Results: We found a statistically significant increase in the proportion of emergency physicians counselling after the implementation of the counselling video. Specifically, we found there was a statistically significant increase in the evenings. Furthermore, we found that pharmacists completed a greater proportion of counselling for buprenorphine/naloxone induction throughout the study period, and there was no statistically significant difference between the completion status of enrollment when counselled by either provider.

Conclusion: We can improve patient access to buprenorphine/naloxone induction counselling by utilizing an adjunct video tool and distributing workload between emergency physicians and clinical pharmacists. Future sites interested in providing take-home buprenorphine/naloxone kits may benefit from implementing video tools and involving clinical pharmacists to mitigate workflow burdens.