Table 2 Descriptive characteristics of included harm reduction intervention studies
Author and Year of Publication | Setting | # of Subjects | Study detail Inclusion criteria | Supportive Intervention Detail | Supportive Intervention Category | Outcomes | Follow-up Post Intervention |
|---|---|---|---|---|---|---|---|
Cohort studies | |||||||
Alburaih (2018) [33] | ED | 314 | Retrospective multi-centre. Recurrent visits for pain. | ED-based pain contract (opioid treatment plan) | Support for pt. in pain. | # of ED visits | 24-months |
Alexandridis (2018) [34] | ED + Community | 7200 | Statewide database analysis Chronic pain pt. presenting to ED | Diversion control Naloxone policies Community education Provider education Support for pt. in pain Hospital ED policy Addiction treatment | Diversion control Naloxone policies Community education Provider education Support for pt. in pain Hospital ED policy Addiction treatment | Overdose mortality Overdose-related ED visits | 22-months |
Alexandridis (2019) [35] | ED + Community | 7200 | Retrospective Statewide database analysis Chronic pain pt. Subgroup of pt. on buprenorphine therapy | Diversion control Naloxone policies Community education Provider education Support for pt. in pain Hospital ED policy Addiction treatment | Diversion control Naloxone policies Community education Provider education Support for pt. with pain Hospital ED policy Addiction treatment | PDMP-derived counts of opioid prescriptions and buprenorphine | 22-months |
Allen (2016)a [36] | ED + Community | 13 | Retrospective Chart review Pt with > 360 ER visits in 12 months Complex pain syndrome Problematic substance use | Comprehensive pain and addiction strategy referral from ED. | Support for pt. in pain | # of visits to ED Disposition of pt. after ED visit | 52-months |
Fulton-Kehoe (2015) [37] | Statewide | 1809 | Retrospective Statewide database analysis Pt with >= 1 paid claim for opioid Rx from ED. | Statewide Guideline for best practice implementation | Statewide Prescription Policies | Rates of non-methadone associated opioid poisonings | 45-months |
Ghobadi (2018) [38] | ED | 19,751c | Retrospective Chart review Chronic pain (> 50 MEQ/d for >90d as outpatient) | Multi-ED opioid prescribing guidelines implementation | Statewide Prescription Policies | ED parenteral opioids ED oral opioids ED discharge prescription counts | 12-months |
Gugelmann (2013) [39] | ED | 2462b | Prospective Pt receiving opioids in ED Subgroup analysis of pt. with chronic pain. | Multifacted educational program (round presentations, electronic notification, formal ED nursing staff education, journal clubs). | Provider Education | # of opioid discharge packs Change in opioid dispensing in pt. with RF for dependence | 12-months |
Hartung (2018) [40] | Statewide | N/A | Retrospective Medicaid administrative claims and enrollment data Pt with opioid Rx in ED. Stratification by MEQ dispensed. | Prior authorization for opioid Rx > 120 mg/d MEQ implementation. | Statewide Prescription Policies | Probability of opioid prescription above 120 mg MED | 18-months |
Jurecska (2012) [41] | ED | 91 | Retrospective Chart review Pt with > 3 ED visits in prior 3-Mos or 6 or > presentations in 6-Mo with chronic pain (defined as pain > 6 Mos). | Non-narcotic and adherence rates to narcotics policy implementation | Statewide Prescription Policies | Recurrent visits to ED | 36-months |
Kahler (2017) [42] | ED | 243 | Retrospective Chart review Pt with chronic pain Pt with >=6 ED visits per 12 Mo + at least 1 visit identified as primarily opioid-seeking behavior + case management for ED misuse. | Referral to free outpatient taper-to-abstinence pain management clinic. | Support for pt. in pain | # of ED visits # of PDMP opioid prescriptions # of individual opioid prescribers # of diagnostic tests | 12-months |
Maughan (2015) [43] | ED | N/A | Retrosepctive Database analysis through DAWN (Drug Abuse Monitoring Network) All ED visits involving opioid analgesic related harm (abuse or accidental) | Implementation of prescription drug monitoring program (PDMP) | Electronic Alert System | Rates of ED visits | 84-months |
Olsen (2016) [44] | ED | 46 | Retrospective + prospective Chart review Pt with > 3 ED visits in prior 6-Mo or > 6 ED visits in prior 12-Mo for a chronic painful condition. Inappropriate opioid prescription management | ED opioid prescription drug treatment plan in cooperation with primary care provider. | Support for pt. in pain | # fo ED visits # of opioid pills prescribed | 6-months |
Pace (2017) [45] | ED | 529 | Retrospective Chart review Acute pain Chronic pain (> 3 Mo) | Opioid prescribing pathway with framework for opioid prescription | Hospital ED policy | MEQ dose administered in ED # of IV/IM prescrpitions # of opioid prescriptions at discharge | 6-months |
Svenson (2007) [46] | ED | 15 | Prospective Chart review Pt with > 10 ED visits in prior 12-Mo for chronic non cancer pain. | ED organized care with non-opioid Rx and referral to primary care provider for opioid management. | Support for pt. in pain | # of ED visits # of outpatient clinic visits # of outpatient opioid prescriptions | 12-months |
Whiteside (2017) [47] | ED | 29 | Prospective open Feasibility study Subgroup analysis of ED pt. screened positive for risk of Rx opioid misuse in prior 6-Mo | ED-LINC: Emergency department longitudinal integrated care. Multidisciplinary case management: active care coordination and linkage, opioid guidelines, PDMP usage. | Support for pt. in pain Electronic Alert System Hospital ED policy | Feasibility of intervention Substance use and mental health scores # of ED visits | 6-months |
Randomized Controlled Trials | |||||||
Murphy (2017)d [48] | ED | 165 | Multi-centric Non-blinded Pt with 5 or > ED visits in prior 12-Mo with > pain complaints or drug-seeking behavior. ED presentation > 50% related to pain. Economic evaluation (same cohort as Neven 2016) | Multidisciplinary case management with organized follow-up by case manager. | Support for pt. in pain | Total treatment cost differential | 12-months |
Neven (2016) [49] | ED | 165 | Multi-centric Non-blinded Pt with 5 or > ED visits in prior 12-Mo with > pain complaints or drug-seeking behavior. ED presentation > 50% related to pain. | Multidisciplinary case management with organized follow-up by case manager. | Support for pt. in pain | # of ED visits Odds of receiving an opioid prescription at ED discharge MEQ of opioid dispensed | 12-months |
Rathlev (2016) [50] | ED | 40 | Multi-centric Non-blinded Pt with 4 or > ED visits in prior 12-Mo with opioid use disorder (OUD) identified via SMS billing codes ED presentation related to acute pain. | Multidisciplinary case management development | Support for pt. in pain | MEQ prescribed at discharge MEQ administered in ED or inpatient Total medical charges # of ED visits # of ED visits with advanced imaging # of inpatient admission | 12-months |
Ringwalt (2015) [51] | ED | 411 | Pt with 11 or > ED visits in prior 12-Mo and chronic noncancer pain determined via chart & Rx review | Care linkage to primary care provider with plan for non-opioid based pain management. | Support for pt. in pain | # of prescriptions received from ED. # of ED visits | 12-months |