Breaking Down Barriers to Treatment in the Emergency Department - NIH HEAL Initiative Webinar

Many Americans turn to the emergency department for care, knowing they will not be turned away based on their insurance status, race, or the language they speak. Still, certain groups, including Black children and individuals with opioid use disorder, face disparities in the quality of care they receive. To highlight research designed to address these disparities, HEAL held its first webinar of the HEAL Headliners webinar series titled “Breaking Down Barriers to Treatment in the Emergency Department.” Monika Goyal, M.D. and Gail D’Onofrio, M.D., two HEAL Principal Investigators, presented.

Working With Patients and Emergency Department Providers to Tackle Stigma

Two presentations explored barriers to emergency department care from different perspectives. In their study titled PAINED: Project Addressing Inequities in the Emergency Department, Goyal and her team are developing interventions to improve inequities in pain management for children who go to the emergency department with a long bone fracture or appendicitis.

Although understudied, racial and ethnic disparities in children’s health and health care are extensive, pervasive, and persistent. Previous work by Goyal and her team found that compared to White children, Black children who visit the emergency department for appendicitis or long bone fractures are less likely to receive optimal pain treatment. Provider bias is one of several factors that contribute to this disparity. Goyal spotlighted research from other groups suggesting that pediatric residents often have a pro-White, anti-Black bias, and that the bias may worsen during particularly stressful shifts.

There is a tremendous amount of research focused on documenting disparities and understanding the factors that contribute to care inequities. According to Goyal, “Equity scientists need to start focusing on developing evidence-informed interventions to mitigate inequities.”

Informed by stakeholders, Goyal’s HEAL research is patient-focused. Quality measurements of pain care are compared with implicit bias measurements to look for effects on quality of pain care. The study will then develop and test Equity Report Cards for providers and electronic health record-embedded clinical decision support tools as an intervention aimed to reduce inequities in pain management and improve patient experience.

In the second presentation, D’Onofrio discussed ED-INNOVATION, which is testing the effectiveness of several different approaches to administering buprenorphine in emergency departments across the United States.

Most people who could benefit from buprenorphine in the emergency department do not get it. Analyses of electronic health records show that less than one-third of individuals who suffer a nonfatal overdose and visit the emergency department receive medications for opioid use disorder. D’Onofrio and her team are developing a clinical decision support tool to help emergency department providers start buprenorphine for opioid use disorder. Providers can access the tool as an application on their smartphone or they can directly embed the tool into electronic health record systems to easily integrate it into their workflow.

Buprenorphine is a safe and effective treatment for opioid use disorder. It alleviates withdrawal symptoms, reduces cravings, and ultimately saves lives. Primary care providers have been prescribing buprenorphine for opioid use disorder for decades. However, many individuals with substance use disorders do not have a primary care provider and instead rely on the emergency department for care.

Like Goyal, D’Onofrio emphasized the importance of community engagement, “We need to integrate clinical support, tailor programs to individual sites, and educate all members of the care team, including emergency department staff, social workers, and recovery coaches.”