Bridging the gap: An environmental scan of post-overdose program features and evaluation measures

Abstract

Background: Prior overdose incident is a predictor of future non-fatal and fatal overdoses. Therefore, the period immediately following a non-fatal overdose is critical for engaging with survivors; however, they often do not access or receive services immediately after experiencing an overdose. To efficiently reach this high-risk population and provide survivors with services, novel interventions including post-overdose outreach programs have been developed.

Methods: Using PRISMA guidelines, we conducted an environmental scan of the academic and gray literature on post-overdose programs to identify key features and measures used to evaluate post-overdose programs. Using the Donabedian quality framework we then analyzed the frequency of measures by type of initiating stakeholder.

Results: Of the 36 studies included for final extraction, 14 were descriptive studies, ten were evaluation studies, eight studies identified facilitators and barriers, and four were program design toolkits. Initiator entity types included emergency departments (EDs; n = 10), public health agencies (n = 5), community-based organizations (n = 4), emergency medical services (EMS) (n = 4), law enforcement agencies (n = 4), and some combination or unknown (n = 9). We identified six key features of post-overdose programs across the literature: program theory, team composition, identifying and contacting clients, service provision, public private partnerships, and referrals. We extracted 223 operationalized measures, of which we analyzed 173 and categorized them as client experience (n = 2), structural (n = 12), process (n = 69), and outcome measures (n = 90). Public health agency-initiated programs reported all the experience-related measures (n = 2) and the most outcome measures (n = 23). Programs initiated by EDs reported the most process measures (n = 20), whereas community-based agencies reported the most structural measures (n = 12). Only two of the 223 measures related to stigma.

Conclusion: There are six common features across all post-overdose programs and different initiating organization types had differing foci for their evaluation measures. The key features and evaluation measure clusters identified in this environmental scan can help inform future post-overdose programs assess the comprehensiveness of their evaluations, inform funding agencies on the range of existing measures (and gaps) to consider, and support evaluators in study design.

Keywords: Environmental scan; Evaluation metrics; Overdose response; Post-overdose outreach; Post-overdose programs; Quality measures.