Increased Awareness Needed for Inpatient Substance Use Disorder Treatment in Drug Use-Associated Infective Endocarditis

Pharmacy Students' Professional Skill Development through a Scaffolded Internship

Description of the problem: The establishment of hospital pharmacy internships helps promote the growth of student pharmacists alongside the standard pharmacy curriculum. These programs are vital to helping students expand their clinical knowledge, while also benefiting the host institution. Our objective was to characterize the value of a longitudinal internship program to both the institution and its interns. Description of the innovation: The Atrium Health Wake Forest Baptist (AHWFB) Pharmacy Intern Program is a unique program designed with a scaffolded concept that directly complements traditional pharmacy school curriculum and provides interns opportunities to complement tasks of health-system pharmacists. Starting with operational responsibilities in the central distribution pharmacy during the first year of the curriculum, the interns transition to more patient-facing roles during the second and third years. Throughout the course of the program, interns are also given opportunities to participate in research and professional development activities. An IRB-approved, retrospective, observational study was conducted to evaluate the benefits of the program to the institution and interns. Critical analysis: Intern interventions were quantitatively evaluated to determine institutional benefit. From October 2017 to June 2020, 16 interns completed a total of 7,191 interventions, which equates to approximately $1,295,825 of cost avoidance for the institution. A quality assurance survey was also conducted to evaluate the program's benefit to the interns. Fourteen of the 16 eligible interns participated in the survey. Of the 14 participating interns, 85.7% (n=12) strongly agreed with overall satisfaction of the program. Additionally, 71% (n=10) strongly agreed with feeling more professionally prepared than their classmates. Next steps: Implementing a scaffolded internship program has positively benefited AHWFB and the participating interns. The program's design allows for clinical and professional development alongside the pharmacy school curriculum.

Getting to the heart of the opioid crisis: Infective endocarditis

ABSTRACT

Infective endocarditis is a potentially fatal infection of the endocardium or valves that can result from IV drug abuse. This article describes a patient with infective endocarditis masked by opioid abuse withdrawal symptoms. This challenging presentation brings to the forefront the need for clinicians to be aware of and understand the changing risk factors and demographics of patients with nonspecific infective endocarditis.

Bridging Recovery Initiative Despite Gaps in Entry (BRIDGE): study protocol for a randomized controlled trial of a bridge clinic compared with usual care for patients with opioid use disorder

Background

Patients with substance use disorders are overrepresented among general hospital inpatients, and their admissions are associated with longer lengths of stay and increased readmission rates. Amid the national opioid crisis, increased attention has been given to the integration of addiction with routine medical care in order to better engage such patients and minimize fragmentation of care. General hospital addiction consultation services and transitional, hospital-based “bridge” clinics have emerged as potential solutions. We designed the Bridging Recovery Initiative Despite Gaps in Entry (BRIDGE) trial to determine if these clinics are superior to usual care for these patients.

Methods

This single-center, pragmatic, randomized controlled clinical trial is enrolling hospitalized patients with opioid use disorder (OUD) who are initiating medication for OUD (MOUD) in consultation with the addiction consult service. Patients are randomized for referral to a co-located, transitional, multidisciplinary bridge clinic or to usual care, with the assignment probability being determined by clinic capacity. The primary endpoint is hospital length of stay. Secondary endpoints include quality of life, linkage to care, self-reported buprenorphine or naltrexone fills, rate of known recurrent opioid use, readmission rates, and costs. Implementation endpoints include willingness to be referred to the bridge clinic, attendance rates among those referred, and reasons why patients were not eligible for referral. The main analysis will use an intent-to-treat approach with full covariate adjustment.

Discussion

This ongoing pragmatic trial will provide evidence on the effectiveness of proactive linkage to a bridge clinic intervention for hospitalized patients with OUD initiating evidence-based pharmacotherapy in consultation with the addiction consult service.

Trial registration

ClinicalTrials.govNCT04084392. Registered on 10 September 2019. The study has been approved by the Vanderbilt Institutional Review Board. The current approved protocol is dated version May 12, 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05698-4.