Peer Support Workers to Improve Emergency Department Care Completion Among Patients Who Use Substances: A Pilot Randomized Controlled Trial

Objectives Assess feasibility of a randomized trial and the hypothesis that emergency department (ED) Peer support workers (Peers), who share personal lived experiences and resources, may decrease ED patients with substance use who leave before treatment completion (LBTC). Specific objectives included assessing operational feasibility, estimating recruitment rates, and seeking preliminary evidence of benefit to support the definitive trial. Methods Pragmatic, open-label pilot randomized trial over the initial 15 weeks of an ED Peer program. Shifts randomized 2:1 to Peer support or usual care. We analyzed patients aged 18-75 years with the 3 most common substance use-related presenting complaints: (1) localized swelling/redness, (2) withdrawal, and (3) substance misuse/intoxication. Feasibility outcomes were patient acceptance and recruitment rate. The primary measure was LBTC (shift level and patient level). Exploratory analyses evaluated naloxone kits and 48-hour ED revisits. Results There were 72 intervention shifts (391 visits) and 37 control shifts (198 visits). Patients had a median age of 44 (IQR 35-54); 71.3% were male. Feasibility A total of 94.9% of patients accepted Peer support. The mean recruitment rate was 30 patient visits per week. LBTC Mean LBTC was 17.0% (SD 18.3%) among Peer shifts, and 23.1% (SD 22.8%) among control shifts, a difference of −6.1% (95% CI −14.6%, 2.4%). The Peer modestly impacted patient-level LBTC (OR 0.78 [95% CI 0.46, 1.32]). Among patients with substance misuse/intoxication or withdrawal, the Peer decreased odds of LBTC (21.4% vs 26.9%; OR 0.39 [95% CI 0.18, 0.84]). Exploratory Peer interaction increased odds of receiving a naloxone kit (OR 2.33 [95% CI 1.34, 4.04]) and decreased 48-hour ED return visits (OR 0.46 [95% CI 0.22, 0.95]). Conclusion An ED Peer may decrease LBTC among patients who use substances. A randomized trial is feasible.