Evaluation of an Emergency Department-Based Peer Recovery Support Intervention for People Who Use Substances in Nevada

Abstract

Introduction:

Emergency department (ED)-based interventions for patients with substance use concerns have been implemented across the USA to reduce drug-related ED utilization and improve other outcomes. To date, findings about their effectiveness have been mixed.

Methods:

We conducted a nonrandomized, quasi-experimental evaluation of an ED-based intervention implemented by Certified Peer Recovery Support Specialists (CPRSS) in 3 hospitals in Nevada, USA. We compared patients who received the intervention to those who did not on 1 primary (drug/alcohol poisoning/overdose ED visits) and 4 secondary outcomes (number of drug/alcohol-related ED visits, number of nondrug/alcohol-related ED visits, number of drug/alcohol-related inpatient hospital admissions, number of nondrug/alcohol-related inpatient hospital admissions) 9 months post-intervention. De-identified patient-level data were obtained from the Nevada Department of Health and Human Services. Analyses included within- and between-group comparisons of the number of visits in each outcome category.

Results:

A total of 4643 patients were included in this analysis (631 intervention and 4012 comparison patients). We observed significant differences in the demographic and ED utilization profiles of the 2 groups. Within-group pre–post comparisons showed small but statistically significant increases in the mean number of drug/alcohol-related ED visits in both groups, and a statistically significant but small increase in the mean number of drug/alcohol poisoning/overdose and nondrug-related ED visits in the comparison group, but not the intervention group. Overall, the change in mean number of visits was small and similar across both groups.

Conclusion:

We did not observe a clinically significant effect of the intervention on the outcomes, consistent with an emerging literature showing mixed results of ED-based CPRSS interventions. However, we identified several opportunities for further study, including a focus on multiple substances and patient-centered outcomes.

OSF pre-registration: https://doi.org/10.17605/OSF.IO/YHEC5