Many hospitals employ recovery coaches to engage with patients in the emergency department coming in due to substance-related problems. Questions remain however, about these recovery support services. This study investigated who appears to be helped the most by this type of emergency department peer support intervention.
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Recovery coaches are increasingly being utilized in hospital emergency departments to engage with patients presenting for psychiatric and medical problems associated with substance use disorder. Though they may have a wide range of goals, typically, their primary focus is to help patients engage with some form of substance use disorder care, and in turn reduce emergency department and hospital encounters. Emergency departments are an opportune place to engage individuals with substance use problems in this way, as many such individuals have few other interactions with healthcare providers.
While preliminary research on this class of peer recovery support services has been promising, questions remain about the impact of these programs and who is most likely to benefit from them. The researchers in this study retrospectively analyzed medical records from a mid-western hospital system that had implemented telehealth-based, emergency department recovery coaching, with the goal of identifying who is most likely to follow up with an active linkage to these services.
This was an observational study that included 2,953 individuals who had presented at a hospital emergency department with medical and/or psychiatric problems related to substance use disorder and had been offered recovery coaching via video call. Participant data was collected retrospectively through review of electronic medical records.
All emergency department patients between September 2018 and September 2021 who presented for substance use related medical or psychiatric problems were offered a consultation with a recovery coach. If the patient indicated they were interested in talking to a coach, a video monitor was brought to their bedside and a recovery coach engaged with them via video call.
Recovery coaches were available 24/7 and patients were free to decline this service. Patients who engaged with a recovery coach received referrals to whatever services they’d indicated interest in (e.g., harm reduction, community-based recovery supports, treatment, etc.). The recovery coach subsequently attempted phone follow-ups with the patient at 48 hours, 1 week, 2 weeks, 1 month, 2 months, 6 months, 9 months, and 12 months.
Study outcomes included: 1) Whether the recovery coach was successful in contacting the patient after their emergency department discharge, and 2) whether the patient had any subsequent emergency department encounters over the next 365 days.
The researchers wanted to test whether a range of individual characteristics might be predictive of whether patients engage with a recovery coach after discharge and have another emergency department encounter. These measures included: 1) Primary substance associated with the emergency department visit (alcohol 44%; opioids 19%; methamphetamine 19%; multi-substance 20%), 2) co-occurring problems or diagnoses (i.e., opioid use disorder; overdose; substance use disorder apart from opioid use disorder; other mental health diagnosis), 3) whether the patient had received naloxone (an opioid blocking medication best known by the trade name Narcan) immediately before being admitted to the emergency department, 4) history of opioid use, and 5) the patient’s primary presenting concern (i.e., medical; psychiatric; substance use related).
Rather than simply exploring if each of these measures was associated with their study outcomes, the researchers identified clusters of people who were similar to one another on these characteristics. They then examined differences in study outcomes between these clusters of people, called “classes”.
Four key individual characteristics were controlled for in the analysis and were also explored independently as predictors of the study outcomes. These included: 1) Sex, 2) race/ethnicity, 3) age, and 4) whether the patient had at least one emergency department visit in the 365 days prior.
The study sample of 2,953 individuals was on average 38 years old, 67% male and predominantly White (91%). Of the primary reason for presenting to the emergency department, 36% needed medical treatment, 23% needed psychiatric care, and 40% were seeking care directly related to substance use disorder. Twenty-two percent of patients had a past-year emergency department encounters.
Six patient classes were identified
Most patients completed at least one recovery coach follow-up
The majority of patients (88%) completed at least one follow-up call with a recovery coach with 11% unreachable for follow-up. The authors did not report the average number or range of follow-ups the sample completed.
In terms of post-year emergency department encounters, 31% had at least one more encounter, while 69% did not return to an emergency department in the researchers’ hospital system.
Previous emergency department encounters, male sex, and White race predicted lower odds of successful follow-up
Patients who had at least one past-year emergency department encounter were about 50% more likely to complete at least one recovery coaching follow-up call. Conversely, males were about 24% less likely to complete a recovery coaching follow-up and White patients were about 40% less likely to complete a recovery coaching follow-up.
Additionally, males were about 50% more likely to have a subsequent emergency department encounter in the following 365 days, while those who did not complete any recovery coach follow-ups were 70% more likely to have a subsequent emergency department encounter in the following year.
Patients presenting for opioid overdose had poorer odds of successful follow-up
When comparing patient classes on study outcomes, patients with ‘opioid use disorder + a co-occurring mental health condition + presenting to the emergency department with an opioid overdose’ fared more poorly than all other patient classes. Patients with ‘substance use disorder + a co-occurring mental health condition + alcohol use’, ‘presenting to the emergency department with a medical concern + polysubstance use’, and ‘having substance use disorder + methamphetamine use + psychiatric presentation’ had around two times the odds of a completing a recovery coach follow-up, while patients ‘having substance use disorder + a co-occurring mental health condition + polysubstance use’ had around three times greater odds.
Patients presenting for opioid overdose also had the highest subsequent emergency department encounter rates
Patients with ‘opioid use disorder + a co-occurring mental health condition + presenting to the emergency department with an opioid overdose’ were more likely than several other patient classes to have a subsequent emergency department encounter in the following year. Specifically, they were 98% more likely than those ‘having substance use disorder + a co-occurring mental health condition + alcohol use’, 97% more likely than those ‘presenting to the emergency department with a medical concern + alcohol use’, and 84% more likely than those ‘having substance use disorder + methamphetamine use + psychiatric presentation’ to have an emergency department encounter in the following year.
Peer recovery support services such as recovery coaching have the potential to cover critical gaps in the care of individuals with substance use disorder. Deploying recovery coaches in emergency departments is a great example of this.
A previous review of studies on peer recovery support services highlighted this potential, but also highlights current knowledge gaps, such as who is likely to benefit most from recovery coaching. This study suggests people with opioid use disorder + co-occurring mental health problems, who present to the emergency department for overdose are least likely to engage with recovery coaching and more likely to re-present at the emergency department. This could potentially be a function of the burden of additional mental health problems in this identified class, although those having substance use disorder + a co-occurring mental health condition + polysubstance use, may be similar in terms of overall problem severity. Being male and White were each associated with lower likelihood of recovery coach follow-up. While the reasons for this are not clear, it could be that these individuals are less likely to follow up because they have more resources and their needs are being met. Overall, future research can test whether there are barriers to following up with recovery coaching referrals for specific sub-groups and why.
Based on these findings, presenting to the emergency department for an overdose appears to be a risk factor for lower odds of following up with recovery coaching and greater odds of readmission. Greater active linkage to treatment than was provided may be needed for this population. Important to note is that while those admitted due to overdose had especially high risk for readmission, this risk was elevated across all groups. Also, regarding the initial emergency room visit, 9% were there related to drug overdose, but more than half were there for an alcohol use-related consequence.
These findings should be considered in light of some distinct methodological elements involved in the study. Because all participants in the study were offered and agreed to meet via video with a recovery coach in the emergency department, it cannot be known directly from these findings whether this meeting and any meetings that occurred over follow-up in any way influenced patients’ substance use disorder or recovery trajectory. Though some studies have shown recovery coaching interventions in the emergency department can reduce subsequent emergency department encounters, and improve access to life saving medications like naloxone (an overdose reversal medication best known by the brand name Narcan), their ability to link patients to sustained substance use disorder care is more mixed.
Peer recovery support services like recovery coaching are increasingly being utilized in emergency department settings to engage people presenting with medical and psychiatric problems related to substance use. The researchers’ results highlight the challenges faced by individuals experiencing opioid overdose who were least likely to successfully follow up with recovery coaches and most likely to be readmitted to the emergency department. While overdose may be an especially salient risk factor, other groups without overdose (e.g., those with alcohol-related consequences) also had high risk for readmission to the emergency department.
Watson, D. P., Swartz, J. A., Magee, L. A., Bray, B. C., Phalen, P., Medcalf, S., & McGuire, A. B. (2023). Latent class analysis of emergency department patients engaged in telehealth peer recovery support services and associations of identified classes with post-discharge outcomes. J Subst Use Addict Treat, 160, 209282. doi:10.1016/j.josat.2023.209282
l
Recovery coaches are increasingly being utilized in hospital emergency departments to engage with patients presenting for psychiatric and medical problems associated with substance use disorder. Though they may have a wide range of goals, typically, their primary focus is to help patients engage with some form of substance use disorder care, and in turn reduce emergency department and hospital encounters. Emergency departments are an opportune place to engage individuals with substance use problems in this way, as many such individuals have few other interactions with healthcare providers.
While preliminary research on this class of peer recovery support services has been promising, questions remain about the impact of these programs and who is most likely to benefit from them. The researchers in this study retrospectively analyzed medical records from a mid-western hospital system that had implemented telehealth-based, emergency department recovery coaching, with the goal of identifying who is most likely to follow up with an active linkage to these services.
This was an observational study that included 2,953 individuals who had presented at a hospital emergency department with medical and/or psychiatric problems related to substance use disorder and had been offered recovery coaching via video call. Participant data was collected retrospectively through review of electronic medical records.
All emergency department patients between September 2018 and September 2021 who presented for substance use related medical or psychiatric problems were offered a consultation with a recovery coach. If the patient indicated they were interested in talking to a coach, a video monitor was brought to their bedside and a recovery coach engaged with them via video call.
Recovery coaches were available 24/7 and patients were free to decline this service. Patients who engaged with a recovery coach received referrals to whatever services they’d indicated interest in (e.g., harm reduction, community-based recovery supports, treatment, etc.). The recovery coach subsequently attempted phone follow-ups with the patient at 48 hours, 1 week, 2 weeks, 1 month, 2 months, 6 months, 9 months, and 12 months.
Study outcomes included: 1) Whether the recovery coach was successful in contacting the patient after their emergency department discharge, and 2) whether the patient had any subsequent emergency department encounters over the next 365 days.
The researchers wanted to test whether a range of individual characteristics might be predictive of whether patients engage with a recovery coach after discharge and have another emergency department encounter. These measures included: 1) Primary substance associated with the emergency department visit (alcohol 44%; opioids 19%; methamphetamine 19%; multi-substance 20%), 2) co-occurring problems or diagnoses (i.e., opioid use disorder; overdose; substance use disorder apart from opioid use disorder; other mental health diagnosis), 3) whether the patient had received naloxone (an opioid blocking medication best known by the trade name Narcan) immediately before being admitted to the emergency department, 4) history of opioid use, and 5) the patient’s primary presenting concern (i.e., medical; psychiatric; substance use related).
Rather than simply exploring if each of these measures was associated with their study outcomes, the researchers identified clusters of people who were similar to one another on these characteristics. They then examined differences in study outcomes between these clusters of people, called “classes”.
Four key individual characteristics were controlled for in the analysis and were also explored independently as predictors of the study outcomes. These included: 1) Sex, 2) race/ethnicity, 3) age, and 4) whether the patient had at least one emergency department visit in the 365 days prior.
The study sample of 2,953 individuals was on average 38 years old, 67% male and predominantly White (91%). Of the primary reason for presenting to the emergency department, 36% needed medical treatment, 23% needed psychiatric care, and 40% were seeking care directly related to substance use disorder. Twenty-two percent of patients had a past-year emergency department encounters.
Six patient classes were identified
Most patients completed at least one recovery coach follow-up
The majority of patients (88%) completed at least one follow-up call with a recovery coach with 11% unreachable for follow-up. The authors did not report the average number or range of follow-ups the sample completed.
In terms of post-year emergency department encounters, 31% had at least one more encounter, while 69% did not return to an emergency department in the researchers’ hospital system.
Previous emergency department encounters, male sex, and White race predicted lower odds of successful follow-up
Patients who had at least one past-year emergency department encounter were about 50% more likely to complete at least one recovery coaching follow-up call. Conversely, males were about 24% less likely to complete a recovery coaching follow-up and White patients were about 40% less likely to complete a recovery coaching follow-up.
Additionally, males were about 50% more likely to have a subsequent emergency department encounter in the following 365 days, while those who did not complete any recovery coach follow-ups were 70% more likely to have a subsequent emergency department encounter in the following year.
Patients presenting for opioid overdose had poorer odds of successful follow-up
When comparing patient classes on study outcomes, patients with ‘opioid use disorder + a co-occurring mental health condition + presenting to the emergency department with an opioid overdose’ fared more poorly than all other patient classes. Patients with ‘substance use disorder + a co-occurring mental health condition + alcohol use’, ‘presenting to the emergency department with a medical concern + polysubstance use’, and ‘having substance use disorder + methamphetamine use + psychiatric presentation’ had around two times the odds of a completing a recovery coach follow-up, while patients ‘having substance use disorder + a co-occurring mental health condition + polysubstance use’ had around three times greater odds.
Patients presenting for opioid overdose also had the highest subsequent emergency department encounter rates
Patients with ‘opioid use disorder + a co-occurring mental health condition + presenting to the emergency department with an opioid overdose’ were more likely than several other patient classes to have a subsequent emergency department encounter in the following year. Specifically, they were 98% more likely than those ‘having substance use disorder + a co-occurring mental health condition + alcohol use’, 97% more likely than those ‘presenting to the emergency department with a medical concern + alcohol use’, and 84% more likely than those ‘having substance use disorder + methamphetamine use + psychiatric presentation’ to have an emergency department encounter in the following year.
Peer recovery support services such as recovery coaching have the potential to cover critical gaps in the care of individuals with substance use disorder. Deploying recovery coaches in emergency departments is a great example of this.
A previous review of studies on peer recovery support services highlighted this potential, but also highlights current knowledge gaps, such as who is likely to benefit most from recovery coaching. This study suggests people with opioid use disorder + co-occurring mental health problems, who present to the emergency department for overdose are least likely to engage with recovery coaching and more likely to re-present at the emergency department. This could potentially be a function of the burden of additional mental health problems in this identified class, although those having substance use disorder + a co-occurring mental health condition + polysubstance use, may be similar in terms of overall problem severity. Being male and White were each associated with lower likelihood of recovery coach follow-up. While the reasons for this are not clear, it could be that these individuals are less likely to follow up because they have more resources and their needs are being met. Overall, future research can test whether there are barriers to following up with recovery coaching referrals for specific sub-groups and why.
Based on these findings, presenting to the emergency department for an overdose appears to be a risk factor for lower odds of following up with recovery coaching and greater odds of readmission. Greater active linkage to treatment than was provided may be needed for this population. Important to note is that while those admitted due to overdose had especially high risk for readmission, this risk was elevated across all groups. Also, regarding the initial emergency room visit, 9% were there related to drug overdose, but more than half were there for an alcohol use-related consequence.
These findings should be considered in light of some distinct methodological elements involved in the study. Because all participants in the study were offered and agreed to meet via video with a recovery coach in the emergency department, it cannot be known directly from these findings whether this meeting and any meetings that occurred over follow-up in any way influenced patients’ substance use disorder or recovery trajectory. Though some studies have shown recovery coaching interventions in the emergency department can reduce subsequent emergency department encounters, and improve access to life saving medications like naloxone (an overdose reversal medication best known by the brand name Narcan), their ability to link patients to sustained substance use disorder care is more mixed.
Peer recovery support services like recovery coaching are increasingly being utilized in emergency department settings to engage people presenting with medical and psychiatric problems related to substance use. The researchers’ results highlight the challenges faced by individuals experiencing opioid overdose who were least likely to successfully follow up with recovery coaches and most likely to be readmitted to the emergency department. While overdose may be an especially salient risk factor, other groups without overdose (e.g., those with alcohol-related consequences) also had high risk for readmission to the emergency department.
Watson, D. P., Swartz, J. A., Magee, L. A., Bray, B. C., Phalen, P., Medcalf, S., & McGuire, A. B. (2023). Latent class analysis of emergency department patients engaged in telehealth peer recovery support services and associations of identified classes with post-discharge outcomes. J Subst Use Addict Treat, 160, 209282. doi:10.1016/j.josat.2023.209282
l
Recovery coaches are increasingly being utilized in hospital emergency departments to engage with patients presenting for psychiatric and medical problems associated with substance use disorder. Though they may have a wide range of goals, typically, their primary focus is to help patients engage with some form of substance use disorder care, and in turn reduce emergency department and hospital encounters. Emergency departments are an opportune place to engage individuals with substance use problems in this way, as many such individuals have few other interactions with healthcare providers.
While preliminary research on this class of peer recovery support services has been promising, questions remain about the impact of these programs and who is most likely to benefit from them. The researchers in this study retrospectively analyzed medical records from a mid-western hospital system that had implemented telehealth-based, emergency department recovery coaching, with the goal of identifying who is most likely to follow up with an active linkage to these services.
This was an observational study that included 2,953 individuals who had presented at a hospital emergency department with medical and/or psychiatric problems related to substance use disorder and had been offered recovery coaching via video call. Participant data was collected retrospectively through review of electronic medical records.
All emergency department patients between September 2018 and September 2021 who presented for substance use related medical or psychiatric problems were offered a consultation with a recovery coach. If the patient indicated they were interested in talking to a coach, a video monitor was brought to their bedside and a recovery coach engaged with them via video call.
Recovery coaches were available 24/7 and patients were free to decline this service. Patients who engaged with a recovery coach received referrals to whatever services they’d indicated interest in (e.g., harm reduction, community-based recovery supports, treatment, etc.). The recovery coach subsequently attempted phone follow-ups with the patient at 48 hours, 1 week, 2 weeks, 1 month, 2 months, 6 months, 9 months, and 12 months.
Study outcomes included: 1) Whether the recovery coach was successful in contacting the patient after their emergency department discharge, and 2) whether the patient had any subsequent emergency department encounters over the next 365 days.
The researchers wanted to test whether a range of individual characteristics might be predictive of whether patients engage with a recovery coach after discharge and have another emergency department encounter. These measures included: 1) Primary substance associated with the emergency department visit (alcohol 44%; opioids 19%; methamphetamine 19%; multi-substance 20%), 2) co-occurring problems or diagnoses (i.e., opioid use disorder; overdose; substance use disorder apart from opioid use disorder; other mental health diagnosis), 3) whether the patient had received naloxone (an opioid blocking medication best known by the trade name Narcan) immediately before being admitted to the emergency department, 4) history of opioid use, and 5) the patient’s primary presenting concern (i.e., medical; psychiatric; substance use related).
Rather than simply exploring if each of these measures was associated with their study outcomes, the researchers identified clusters of people who were similar to one another on these characteristics. They then examined differences in study outcomes between these clusters of people, called “classes”.
Four key individual characteristics were controlled for in the analysis and were also explored independently as predictors of the study outcomes. These included: 1) Sex, 2) race/ethnicity, 3) age, and 4) whether the patient had at least one emergency department visit in the 365 days prior.
The study sample of 2,953 individuals was on average 38 years old, 67% male and predominantly White (91%). Of the primary reason for presenting to the emergency department, 36% needed medical treatment, 23% needed psychiatric care, and 40% were seeking care directly related to substance use disorder. Twenty-two percent of patients had a past-year emergency department encounters.
Six patient classes were identified
Most patients completed at least one recovery coach follow-up
The majority of patients (88%) completed at least one follow-up call with a recovery coach with 11% unreachable for follow-up. The authors did not report the average number or range of follow-ups the sample completed.
In terms of post-year emergency department encounters, 31% had at least one more encounter, while 69% did not return to an emergency department in the researchers’ hospital system.
Previous emergency department encounters, male sex, and White race predicted lower odds of successful follow-up
Patients who had at least one past-year emergency department encounter were about 50% more likely to complete at least one recovery coaching follow-up call. Conversely, males were about 24% less likely to complete a recovery coaching follow-up and White patients were about 40% less likely to complete a recovery coaching follow-up.
Additionally, males were about 50% more likely to have a subsequent emergency department encounter in the following 365 days, while those who did not complete any recovery coach follow-ups were 70% more likely to have a subsequent emergency department encounter in the following year.
Patients presenting for opioid overdose had poorer odds of successful follow-up
When comparing patient classes on study outcomes, patients with ‘opioid use disorder + a co-occurring mental health condition + presenting to the emergency department with an opioid overdose’ fared more poorly than all other patient classes. Patients with ‘substance use disorder + a co-occurring mental health condition + alcohol use’, ‘presenting to the emergency department with a medical concern + polysubstance use’, and ‘having substance use disorder + methamphetamine use + psychiatric presentation’ had around two times the odds of a completing a recovery coach follow-up, while patients ‘having substance use disorder + a co-occurring mental health condition + polysubstance use’ had around three times greater odds.
Patients presenting for opioid overdose also had the highest subsequent emergency department encounter rates
Patients with ‘opioid use disorder + a co-occurring mental health condition + presenting to the emergency department with an opioid overdose’ were more likely than several other patient classes to have a subsequent emergency department encounter in the following year. Specifically, they were 98% more likely than those ‘having substance use disorder + a co-occurring mental health condition + alcohol use’, 97% more likely than those ‘presenting to the emergency department with a medical concern + alcohol use’, and 84% more likely than those ‘having substance use disorder + methamphetamine use + psychiatric presentation’ to have an emergency department encounter in the following year.
Peer recovery support services such as recovery coaching have the potential to cover critical gaps in the care of individuals with substance use disorder. Deploying recovery coaches in emergency departments is a great example of this.
A previous review of studies on peer recovery support services highlighted this potential, but also highlights current knowledge gaps, such as who is likely to benefit most from recovery coaching. This study suggests people with opioid use disorder + co-occurring mental health problems, who present to the emergency department for overdose are least likely to engage with recovery coaching and more likely to re-present at the emergency department. This could potentially be a function of the burden of additional mental health problems in this identified class, although those having substance use disorder + a co-occurring mental health condition + polysubstance use, may be similar in terms of overall problem severity. Being male and White were each associated with lower likelihood of recovery coach follow-up. While the reasons for this are not clear, it could be that these individuals are less likely to follow up because they have more resources and their needs are being met. Overall, future research can test whether there are barriers to following up with recovery coaching referrals for specific sub-groups and why.
Based on these findings, presenting to the emergency department for an overdose appears to be a risk factor for lower odds of following up with recovery coaching and greater odds of readmission. Greater active linkage to treatment than was provided may be needed for this population. Important to note is that while those admitted due to overdose had especially high risk for readmission, this risk was elevated across all groups. Also, regarding the initial emergency room visit, 9% were there related to drug overdose, but more than half were there for an alcohol use-related consequence.
These findings should be considered in light of some distinct methodological elements involved in the study. Because all participants in the study were offered and agreed to meet via video with a recovery coach in the emergency department, it cannot be known directly from these findings whether this meeting and any meetings that occurred over follow-up in any way influenced patients’ substance use disorder or recovery trajectory. Though some studies have shown recovery coaching interventions in the emergency department can reduce subsequent emergency department encounters, and improve access to life saving medications like naloxone (an overdose reversal medication best known by the brand name Narcan), their ability to link patients to sustained substance use disorder care is more mixed.
Peer recovery support services like recovery coaching are increasingly being utilized in emergency department settings to engage people presenting with medical and psychiatric problems related to substance use. The researchers’ results highlight the challenges faced by individuals experiencing opioid overdose who were least likely to successfully follow up with recovery coaches and most likely to be readmitted to the emergency department. While overdose may be an especially salient risk factor, other groups without overdose (e.g., those with alcohol-related consequences) also had high risk for readmission to the emergency department.
Watson, D. P., Swartz, J. A., Magee, L. A., Bray, B. C., Phalen, P., Medcalf, S., & McGuire, A. B. (2023). Latent class analysis of emergency department patients engaged in telehealth peer recovery support services and associations of identified classes with post-discharge outcomes. J Subst Use Addict Treat, 160, 209282. doi:10.1016/j.josat.2023.209282
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