Picture of Monte StatonCDIS faculty, Monte Staton, PhD, CDIS faculty affiliate, Dennis Watson, PhD, and UIC Mile Square physician, Nicole Gastala, MD published their work on emergency department-based interventions for engaging patients presenting with opioid use disorder. Their study focused on addressing gaps in knowledge regarding implementation of emergency department-based peer support services in rural areas by comparing implementation of rural and urban programs that participated in Indiana’s Recovery Coach and Peer Support Initiative (RCPSI).

The researchers conducted a secondary analysis of qualitative semi-structured implementation interviews collected as part of an evaluation of 10 programs (4 rural and 6 urban) participating in the RCPSI across 3 time points. They identified key differences for rural programs corresponding to each of the 5 primary constructs in the coding scheme. (1) Intervention characteristics: rural sites questioned intervention fit with their context, required more adaptations, and encountered unexpected costs. (2) External context: rural sites were not appropriately staffed to meet patient needs, encountered logistical and legal barriers regarding patient privacy, and had limited patient transportation options. (3) Inner setting: rural sites lacked strong mechanisms for internal communication and difficulties integrating with pre-existing culture and climate. (4) Characteristics of individuals: some rural providers resisted working with peers due to pre-existing attitudes and beliefs. (5) Implementation process: rural sites spent more time identifying external partners and abandoned more components of their initial implementation plans.

Findings demonstrate how rural programs faced greater challenges implementing emergency department-based peer services over time. These challenges required flexible adaptations to originally intended plans. Rural programs likely require flexibility to adapt interventions that were developed in urban settings to ensure success considering local contextual constraints that were identified by our analysis.

Watson DP, Staton MD, Gastala N. Identifying unique barriers to implementing rural emergency department-based peer services for opioid use disorder through qualitative comparison with urban sites. Addict Sci Clin Pract. 2022 Jul 28;17(1):41. doi: 10.1186/s13722-022-00324-3. PMID: 35902890; PMCID: PMC9331574.