Peer providers and linkage with buprenorphine care after hospitalization: A retrospective cohort study

Abstract

Background: People with opioid use disorder (OUD) are increasingly started on buprenorphine in the hospital, yet many patients do not attend outpatient buprenorphine care after discharge. Peer providers, people in recovery themselves, are a growing part of addiction care. We examine whether patients who received a low-intensity, peer-delivered intervention during hospitalization had a greater rate of linking with outpatient buprenorphine care relative to those not seen by a peer. Methods: This was a retrospective cohort study of adults with OUD who were started on buprenorphine during hospitalization. The primary outcome was receipt of a buprenorphine prescription within 30 days of discharge. Secondary outcomes included attendance at a follow-up visit with a buprenorphine provider within 30 days and hospital readmission within 90 days. Modified Poisson regression analyses tested for differences in the rate ratios (RR) of each binary outcome for patients who were versus were not seen by a peer provider. Peer notes in the electronic health record were reviewed to characterize peer activities. Results: 111 patients met the study inclusion criteria, 31.5% of whom saw a peer provider. 55.0% received a buprenorphine prescription within 30 days of hospital discharge. Patients with versus without peer provider encounters did not significantly differ in the rates of receiving a buprenorphine prescription (RR = 1.06, 95% CI: 0.74-1.51), hospital readmission (RR = 1.45, 95% CI: 0.80-2.64), or attendance at a buprenorphine follow-up visit (RR = 1.03, 95% CI: 0.68-1.57). Peers most often listened to or shared experiences with patients (68.6% of encounters) and helped facilitate medical care (60.0% of encounters). Conclusions: There were no differences in multiple measures of buprenorphine follow-up between patients who received this low-intensity peer intervention and those who did not. There is need to investigate what elements of peer provider programs contribute to patient outcomes and what outcomes should be assessed when evaluating peer programs.

Keywords:

• Buprenorphine
• opioid use disorder
• peer support
• discharge planning

Acknowledgements

We would like to acknowledge Elsa Tamru and Addy Adwell for their assistance.

Author contributions

JIT conceptualized the study. EDD, BAC, and DS collected data and coded peer notes. KLB and KAH analyzed data with input on analysis plan from JIT, JWK, JOM, and HEJ. HEJ wrote the first draft of the manuscript. All authors provided feedback on and contributed to writing subsequent drafts of the manuscript.

Additional information

Funding

Research reported here was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number 1R25DA050985-01. The collection of data for this research was made possible utilizing University of Washington Institute of Translational Health Sciences’ (ITHS) REDCap servers which receive grant support from NCATS/NIH (UL1 TR002319, KL2 TR002317, and TL1 TR002318). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding source had no role in the creation of this manuscript.