Peer Support Workers Feasibility Study
- Conditions
- Substance Use Disorder (SUD)
- Registration Number
- NCT07030192
- Lead Sponsor
- University of British Columbia
- Brief Summary
Many people with high-risk opioid use visit emergency departments (EDs), facing a high risk of death if they leave before completing care. Peer support workers (PSWs) - people with lived experience of substance use - may improve patient comfort, reduce early departures, and potentially lower mortality rates. This study aims to evaluate how a hospital-implemented ED PSW program can enhance patient support, reduce barriers to care, and provide harm-reduction resources in a person-centred and trauma-informed manner. The study will also validate the outcome and obtain preliminary estimates of the benefits of decreasing patients who leave the ED before completing care.
- Detailed Description
The main objectives of the study are to 1) to describe, and evaluate the feasibility and acceptability of a novel ED PSW program implemented by the Vancouver Coastal Health at the Vancouver General Hospital (VGH) ED, 2) to evaluate the feasibility of creating a randomized shift schedule in support of a future definitive randomized controlled trial, 3) to validate outcomes related to patients leaving before completing care using administrative data from the National Ambulatory Care Reporting System (NACRS), and 4) to obtain preliminary estimates of incidence of patients who leave the ED before completing care, to inform sample size calculations for a definitive randomized controlled trial.
The study will take place at Vancouver General Hospital (VGH), a large ED with approximately 97,000 visits per year, serving a diverse urban population. Investigators will evaluate our randomized shift schedule generation, and will describe our intervention and patient population through data within our PSW interaction logs and linkages to regional data. To understand our intervention and patient and provider experiences, investigators will use a mixed methods design to comprehensively collect, analyze, and interpret both qualitative and quantitative data. This approach will provide insights from multiple perspectives, offering a robust understanding of the relationships and potential contradictions within the evidence, thereby enriching the data and deepening our understanding of the findings.
Investigators will evaluate feasibility and acceptability of the PSW program at engaging patients with specific demographic, health history, and risk profiles. Investigators will assess the degree to which patients of different backgrounds access and engage with PSW services, and what characteristics affect patient acceptance of PSW services offered. Investigators will then work with the ED leadership team to target and tailor the program to best meet the needs of patients at highest risk.
This feasibility study will set the foundation for a definitive randomized controlled trial, which will be the first to compare patients with substance use who leave EDs before completing care during shifts with PSW availability versus without, addressing a critical knowledge gap. The definitive trial will engage multiple sites across Canada to rigorously evaluate ED PSW effectiveness, with the potential to scale up an intervention that could improve patient outcomes on a national scale.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 3181
- Emergency Department (ED) patient at Vancouver General Hospital (VGH)
- Age 18 years or older
- Identified as using substances
- Able to receive or decline peer support services during the ED visit
- Under 18 years of age
- Does not report substance use
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Primary Outcome Measures
Name Time Method Number of eligible patients with whom PSWs engaged during their shifts Up to 15 months post-study initiation Assessed by counting the number of patients who met predefined eligibility criteria with whom PSWs engaged during their scheduled shifts.
Unit of Measure: Number of participantsDistribution of randomized PSW shifts by day of week Over the 48-week randomized schedule period approved to meet hospital staffing policy Assessed by examining the distribution of scheduled PSW shifts across each day of the week over the 48-week randomized schedule period. The schedule was developed in collaboration with human resources and ED operational leadership and approved as meeting hospital employee policy. The randomization approach used block-based scheduling with built-in constraints (e.g., mandatory weekends off). This outcome evaluates whether the resulting schedule achieved an even weekday/weekend distribution.
Unit of Measure: Number and percentage of PSW shifts scheduled per day of the weekProportion of PSW interactions with complete standardized documentation Up to 15 months post-study initiation Assessed by the proportion of PSW interactions that were fully recorded using the standardized PSW interaction log, with completion defined by filling all required fields.
Unit of Measure: Percentage of interactions with complete logsProportion of visits by patients who interacted with a PSW that were successfully linked to ED data Up to 15 months post-study initiation Assessed by the proportion of patients documented in the PSW logs that could be linked to emergency department visit data in the VGH Cerner electronic health record system.
Unit of Measure: Percentage of patients successfully linkedPatient-reported acceptability of the PSW program using the PSW patient survey Up to 15 months post-study initiation Acceptability will be assessed using the PSW patient survey, a 15-item questionnaire completed by patients following interaction with a peer support worker. Each item is scored on a 5-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Items assess patient experiences related to respect, emotional safety, ease of communication, clarity of information, comfort, confidentiality, and teamwork. The primary reported outcome will be the mean overall score across all 15 items. Secondary analyses may report item-level distributions.
Unit of Measure: Mean overall score (1-5 scale).
Scale Range: 1 (Strongly Disagree) to 5 (Strongly Agree); higher scores indicate higher acceptability of the PSW program.Thematic summary of healthcare providers' perceptions of the PSW program assessed through focus groups From 3 to 15 months after program implementation Acceptability of the PSW program among healthcare providers will be evaluated using semi-structured focus groups conducted between 3-15 months post-implementation. Discussions will explore perceived value, observed patient impact, integration into ED workflows, challenges, and suggestions for improvement. Audio recordings will be transcribed and analyzed using thematic content analysis to identify recurring patterns and representative quotes.
Unit of Measure: Thematic categories identified through qualitative analysis
- Secondary Outcome Measures
Name Time Method Patients leaving the ED prior to completing care Baseline. Data will be linked and assessed at the conclusion of the feasibility study, up to 15 months post-study initiation. Proportion of patients who leave the ED without completing care (e.g., left without being seen, left against medical advice). This will be validated using linked administrative data.
Thematic summary of Indigenous patients' experiences with the PSW program based on storytelling and sharing circles Within 6 months after the patient's ED visit involving PSW interaction Indigenous patient perspectives on the PSW program will be collected through culturally grounded storytelling and sharing circles. Sessions will be guided by open-ended questions to explore perceived safety, support, and emotional impact of PSW involvement in the emergency department. Transcripts will be analyzed using Indigenous-informed thematic analysis to identify key insights and priorities for culturally safe care.
Unit of Measure: Themes and narratives identified through qualitative analysis
Trial Locations
- Locations (1)
Vancouver General Hospital
🇨🇦Vancouver, British Columbia, Canada
Vancouver General Hospital🇨🇦Vancouver, British Columbia, CanadaJessica Moe, MDContactjessica.moe@ubc.ca