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Nordeck CD, Kelly SM, Schwartz RP, Mitchell SG, Welsh C, O'Grady KE, Gryczynski J. Hospital admissions among patients with Comorbid Substance Use disorders: a secondary analysis of predictors from the NavSTAR Trial. Addict Sci Clin Pract 2024; 19:33. [PMID: 38678216 PMCID: PMC11056040 DOI: 10.1186/s13722-024-00463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Individuals with substance use disorders (SUDs) frequently use acute hospital services. The Navigation Services to Avoid Rehospitalization (NavSTAR) trial found that a patient navigation intervention for hospitalized patients with comorbid SUDs reduced subsequent inpatient admissions compared to treatment-as-usual (TAU). METHODS This secondary analysis extends previous findings from the NavSTAR trial by examining whether selected patient characteristics independently predicted hospital service utilization and moderated the effect of the NavSTAR intervention. Participants were 400 medical/surgical hospital patients with comorbid SUDs. We analyzed 30- and 90-day inpatient readmissions (one or more readmissions) and cumulative incidence of inpatient admissions through 12 months using multivariable logistic and negative binomial regression, respectively. RESULTS Consistent with primary findings and controlling for patient factors, NavSTAR participants were less likely than TAU participants to be readmitted within 30 (P = 0.001) and 90 (P = 0.03) days and had fewer total readmissions over 12 months (P = 0.008). Hospitalization in the previous year (P < 0.001) was associated with cumulative readmissions over 12 months, whereas Medicaid insurance (P = 0.03) and index diagnoses of infection (P = 0.001) and injuries, poisonings, or procedural complications (P = 0.004) were associated with fewer readmissions. None of the selected covariates moderated the effect of the NavSTAR intervention. CONCLUSIONS Previous findings showed that patient navigation could reduce repeat hospital admissions among patients with comorbid SUDs. Several patient factors were independently associated with readmission. Future research should investigate risk factors for hospital readmission among patients with comorbid SUDs to optimize interventions. TRIAL REGISTRATION NIH ClinicalTrials.gov NCT02599818, Registered November 9, 2015 https://classic. CLINICALTRIALS gov/ct2/show/NCT02599818 .
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Affiliation(s)
- Courtney D Nordeck
- Friends Research Institute, 1040 Park Avenue #103, Baltimore, MD, USA, 21201.
| | - Sharon M Kelly
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue #103, Baltimore, MD, USA, 21201
| | - Shannon G Mitchell
- Friends Research Institute, 1040 Park Avenue #103, Baltimore, MD, USA, 21201
| | | | | | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue #103, Baltimore, MD, USA, 21201
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Severson MA, Onanong S, Dolezal A, Bartelt-Hunt SL, Snow DD, McFadden LM. Analysis of Wastewater Samples to Explore Community Substance Use in the United States: Pilot Correlative and Machine Learning Study. JMIR Form Res 2023; 7:e45353. [PMID: 37883150 PMCID: PMC10636622 DOI: 10.2196/45353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Substance use disorder and associated deaths have increased in the United States, but methods for detecting and monitoring substance use using rapid and unbiased techniques are lacking. Wastewater-based surveillance is a cost-effective method for monitoring community drug use. However, the examination of the results often focuses on descriptive analysis. OBJECTIVE The objective of this study was to explore community substance use in the United States by analyzing wastewater samples. Geographic differences and commonalities of substance use were explored. METHODS Wastewater was sampled across the United States (n=12). Selected drugs with misuse potential, prescriptions, and over-the-counter drugs and their metabolites were tested across geographic locations for 7 days. Methods used included wastewater assessment of substances and metabolites paired with machine learning, specifically discriminant analysis and cluster analysis, to explore similarities and differences in wastewater measures. RESULTS Geographic variations in the wastewater drug or metabolite levels were found. Results revealed a higher use of methamphetamine (z=-2.27, P=.02) and opioids-to-methadone ratios (oxycodone-to-methadone: z=-1.95, P=.05; hydrocodone-to-methadone: z=-1.95, P=.05) in states west of the Mississippi River compared to the east. Discriminant analysis suggested temazepam and methadone were significant predictors of geographical locations. Precision, sensitivity, specificity, and F1-scores were 0.88, 1, 0.80, and 0.93, respectively. Finally, cluster analysis revealed similarities in substance use among communities. CONCLUSIONS These findings suggest that wastewater-based surveillance has the potential to become an effective form of surveillance for substance use. Further, advanced analytical techniques may help uncover geographical patterns and detect communities with similar needs for resources to address substance use disorders. Using automated analytics, these advanced surveillance techniques may help communities develop timely, tailored treatment and prevention efforts.
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Affiliation(s)
- Marie A Severson
- Division of Basic Biomedical Sciences, University of South Dakota, Vermillion, SD, United States
| | - Sathaporn Onanong
- Water Sciences Laboratory & Nebraska Water Center, part of the Daugherty Water for Food Global Institute, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Alexandra Dolezal
- Division of Basic Biomedical Sciences, University of South Dakota, Vermillion, SD, United States
| | - Shannon L Bartelt-Hunt
- Department of Civil and Environmental Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Daniel D Snow
- Water Sciences Laboratory & Nebraska Water Center, part of the Daugherty Water for Food Global Institute, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Lisa M McFadden
- Division of Basic Biomedical Sciences, University of South Dakota, Vermillion, SD, United States
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Point-of-Care Lung Ultrasound Predicts Severe Disease and Death Due to COVID-19: A Prospective Cohort Study. Crit Care Explor 2022; 4:e0732. [PMID: 35982837 PMCID: PMC9377680 DOI: 10.1097/cce.0000000000000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The clinical utility of point-of-care lung ultrasound (LUS) among hospitalized patients with COVID-19 is unclear. DESIGN Prospective cohort study. SETTING A large tertiary care center in Maryland, between April 2020 and September 2021. PATIENTS Hospitalized adults (≥ 18 yr old) with positive severe acute respiratory syndrome coronavirus 2 reverse transcriptase-polymerase chain reaction results. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All patients were scanned using a standardized protocol including 12 lung zones and followed to determine clinical outcomes until hospital discharge and vital status at 28 days. Ultrasounds were independently reviewed for lung and pleural line artifacts and abnormalities, and the mean LUS Score (mLUSS) (ranging from 0 to 3) across lung zones was determined. The primary outcome was time to ICU-level care, defined as high-flow oxygen, noninvasive, or invasive mechanical ventilation, within 28 days of the initial ultrasound. Cox proportional hazards regression models adjusted for age and sex were fit for mLUSS and each ultrasound covariate. A total of 264 participants were enrolled in the study; the median age was 61 years and 114 participants (43.2%) were female. The median mLUSS was 1.0 (interquartile range, 0.5-1.3). Following enrollment, 27 participants (10.0%) went on to require ICU-level care, and 14 (5.3%) subsequently died by 28 days. Each increase in mLUSS at enrollment was associated with disease progression to ICU-level care (adjusted hazard ratio [aHR], 3.61; 95% CI, 1.27-10.2) and 28-day mortality (aHR, 3.10; 95% CI, 1.29-7.50). Pleural line abnormalities were independently associated with disease progression to death (aHR, 20.93; CI, 3.33-131.30). CONCLUSIONS Participants with a mLUSS greater than or equal to 1 or pleural line changes on LUS had an increased likelihood of subsequent requirement of high-flow oxygen or greater. LUS is a promising tool for assessing risk of COVID-19 progression at the bedside.
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Radic M, Parlier-Ahmad AB, Wills B, Martin CE. Social determinants of health and emergency department utilization among adults receiving buprenorphine for opioid use disorder. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100062. [PMID: 35783992 PMCID: PMC9248991 DOI: 10.1016/j.dadr.2022.100062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Individuals with opioid use disorder (OUD) use the emergency department (ED) at high rates. Medication treatment for OUD (MOUD) is associated with reduced ED utilization. However, individuals receiving MOUD still utilize ED services at higher rates than the general population. The objective of this study is to compare the psychosocial and clinical characteristics of those who do and do not utilize ED services based on the Healthy People 2030 framework regarding social determinants of health (SDoH) among a sample of individuals receiving MOUD. METHODS Participants receiving buprenorphine for OUD at an outpatient addiction clinic completed a cross-sectional survey between July and September 2019. A 6-month prospective medical record review was conducted. The primary outcome was ED visit (yes/no) during the 6-month study period. Demographic, psychosocial, and clinical characteristics were gathered from survey measures and chart abstraction. Chi square and T-tests tested differences by ED utilization. RESULTS Participants (n=142) were 54.9% female and 68.8% Black, with an average age of 43.2 years (SD=12.5). Of the participants, 38.7% visited the ED in the study period, primarily for infectious or musculoskeletal causes. Participants with an ED visit were more likely to be Black (p=.011), have less social support (p=.030), more medical comorbidities (p=.008) including chronic pain (p=.045), and more visits with an addiction provider in the study period (p=.009). CONCLUSIONS Factors associated with ED utilization among individuals receiving buprenorphine for OUD include low social support and medical comorbidities, including chronic pain. More research is needed on modifiable SDoH that influence ED utilization.
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Affiliation(s)
- Maja Radic
- Virginia Commonwealth University School of Medicine, 1201 E Marshall St, Richmond, VA 23298, USA
| | - Anna Beth Parlier-Ahmad
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin St., Richmond, VA 23284, USA
| | - Brandon Wills
- Department of Emergency Medicine, Virginia Commonwealth University, 1250 E. Marshall St., Richmond, VA 23298, USA
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, 1250 E. Marshall St., Richmond, VA 23298, USA
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Bailey KL, Sayles H, Campbell J, Khalid N, Anglim M, Ponce J, Wyatt TA, McClay JC, Burnham EL, Anzalone A, Hanson C. COVID-19 patients with documented alcohol use disorder or alcohol-related complications are more likely to be hospitalized and have higher all-cause mortality. Alcohol Clin Exp Res 2022; 46:1023-1035. [PMID: 35429004 PMCID: PMC9111368 DOI: 10.1111/acer.14838] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/25/2022] [Accepted: 04/07/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19) has affected every country globally, with hundreds of millions of people infected with the SARS-CoV-2 virus and over 6 million deaths to date. It is unknown how alcohol use disorder (AUD) affects the severity and mortality of COVID-19. AUD is known to increase the severity and mortality of bacterial pneumonia and the risk of developing acute respiratory distress syndrome. Our objective is to determine whether individuals with AUD have increased severity and mortality from COVID-19. METHODS We utilized a retrospective cohort study of inpatients and outpatients from 44 centers participating in the National COVID Cohort Collaborative. All were adult COVID-19 patients with and without documented AUDs. RESULTS We identified 25,583 COVID-19 patients with an AUD and 1,309,445 without. In unadjusted comparisons, those with AUD had higher odds of hospitalization (odds ratio [OR] 2.00, 95% confidence interval [CI] 1.94 to 2.06, p < 0.001). After adjustment for age, sex, race/ethnicity, smoking, body mass index, and comorbidities, individuals with an AUD still had higher odds of requiring hospitalization (adjusted OR [aOR] 1.51, CI 1.46 to 1.56, p < 0.001). In unadjusted comparisons, individuals with AUD had higher odds of all-cause mortality (OR 2.18, CI 2.05 to 2.31, p < 0.001). After adjustment as above, individuals with an AUD still had higher odds of all-cause mortality (aOR 1.55, CI 1.46 to 1.65, p < 0.001). CONCLUSION This work suggests that AUD can increase the severity and mortality of COVID-19 infection. This reinforces the need for clinicians to obtain an accurate alcohol history from patients hospitalized with COVID-19. For this study, our results are limited by an inability to quantify the daily drinking habits of the participants. Studies are needed to determine the mechanisms by which AUD increases the severity and mortality of COVID-19.
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Affiliation(s)
- Kristina L. Bailey
- Division of PulmonaryCritical Care, and Sleep MedicineDepartment of Internal MedicineUniversity of Nebraska Medical Center, College of MedicineOmahaNebraskaUSA
- VA Nebraska‐Western Iowa Health SystemsOmahaNebraskaUSA
| | - Harlan Sayles
- Department of BiostatisticsUniversity of Nebraska Medical Center, College of Public HealthOmahaNebraskaUSA
| | - James Campbell
- Division of PulmonaryCritical Care, and Sleep MedicineDepartment of Internal MedicineUniversity of Nebraska Medical Center, College of MedicineOmahaNebraskaUSA
| | - Neha Khalid
- Division of PulmonaryCritical Care, and Sleep MedicineDepartment of Internal MedicineUniversity of Nebraska Medical Center, College of MedicineOmahaNebraskaUSA
| | - Madyson Anglim
- Division of PulmonaryCritical Care, and Sleep MedicineDepartment of Internal MedicineUniversity of Nebraska Medical Center, College of MedicineOmahaNebraskaUSA
| | - Jana Ponce
- University of Nebraska Medical Center, College of Allied HealthOmahaNebraskaUSA
| | - Todd A. Wyatt
- Division of PulmonaryCritical Care, and Sleep MedicineDepartment of Internal MedicineUniversity of Nebraska Medical Center, College of MedicineOmahaNebraskaUSA
- VA Nebraska‐Western Iowa Health SystemsOmahaNebraskaUSA
- Department of Environmental, Agricultural and Occupational HealthUniversity of Nebraska Medical Center, College of Public HealthOmahaNebraskaUSA
| | - James C. McClay
- Department of Emergency MedicineUniversity of Nebraska Medical Center, College of MedicineOmahaNebraskaUSA
| | - Ellen L. Burnham
- Division of Pulmonary Sciences and Critical Care MedicineDepartment of MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Alfred Anzalone
- Department of Neurological SciencesUniversity of Nebraska Medical Center, College of MedicineOmahaNebraskaUSA
- Great Plains IDeA‐CTROmahaNebraskaUSA
| | - Corrine Hanson
- University of Nebraska Medical Center, College of Allied HealthOmahaNebraskaUSA
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Gryczynski J, Nordeck CD, Welsh C, Mitchell SG, O'Grady KE, Schwartz RP. Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : A Randomized Trial. Ann Intern Med 2021; 174:899-909. [PMID: 33819055 DOI: 10.7326/m20-5475] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hospitalized patients with comorbid substance use disorders (SUDs) are at high risk for poor outcomes, including readmission and emergency department (ED) use. OBJECTIVE To determine whether patient navigation services reduce hospital readmissions. DESIGN Randomized controlled trial comparing Navigation Services to Avoid Rehospitalization (NavSTAR) versus treatment as usual (TAU). (ClinicalTrials.gov: NCT02599818). SETTING Urban academic hospital in Baltimore, Maryland, with an SUD consultation service. PARTICIPANTS 400 hospitalized adults with comorbid SUD (opioid, cocaine, or alcohol). INTERVENTION NavSTAR used proactive case management, advocacy, service linkage, and motivational support to resolve internal and external barriers to care and address SUD, medical, and basic needs for 3 months after discharge. MEASUREMENTS Data on inpatient readmissions (primary outcome) and ED visits for 12 months were obtained for all participants via the regional health information exchange. Entry into SUD treatment, substance use, and related outcomes were assessed at 3-, 6-, and 12-month follow-up. RESULTS Participants had high levels of acute care use: 69% had an inpatient readmission and 79% visited the ED over the 12-month observation period. Event rates per 1000 person-days were 6.05 (NavSTAR) versus 8.13 (TAU) for inpatient admissions (hazard ratio, 0.74 [95% CI, 0.58 to 0.96]; P = 0.020) and 17.66 (NavSTAR) versus 27.85 (TAU) for ED visits (hazard ratio, 0.66 [CI, 0.49 to 0.89]; P = 0.006). Participants in the NavSTAR group were less likely to have an inpatient readmission within 30 days than those receiving TAU (15.5% vs. 30.0%; P < 0.001) and were more likely to enter community SUD treatment after discharge (P = 0.014; treatment entry within 3 months, 50.3% NavSTAR vs. 35.3% TAU). LIMITATION Single-site trial, which limits generalizability. CONCLUSION Patient navigation reduced inpatient readmissions and ED visits in this clinically challenging sample of hospitalized patients with comorbid SUDs. PRIMARY FUNDING SOURCE National Institute on Drug Abuse.
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Affiliation(s)
- Jan Gryczynski
- Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.)
| | - Courtney D Nordeck
- Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.)
| | - Christopher Welsh
- University of Maryland School of Medicine, Baltimore, Maryland (C.W.)
| | - Shannon G Mitchell
- Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.)
| | | | - Robert P Schwartz
- Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.)
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Whiteside LK, Vrablik MC, Russo J, Bulger EM, Nehra D, Moloney K, Zatzick DF. Leveraging a health information exchange to examine the accuracy of self-report emergency department utilization data among hospitalized injury survivors. Trauma Surg Acute Care Open 2021; 6:e000550. [PMID: 33553651 PMCID: PMC7845668 DOI: 10.1136/tsaco-2020-000550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/07/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022] Open
Abstract
Background Accurate acute care medical utilization history is an important outcome for clinicians and investigators concerned with improving trauma center care. The objective of this study was to examine the accuracy of self-report emergency department (ED) utilization compared with utilization obtained from the Emergency Department Information Exchange (EDIE) in admitted trauma surgery patients with comorbid mental health and substance use problems. Methods This is a retrospective cohort study of 169 injured patients admitted to the University of Washington’s Harborview Level I Trauma Center. Patients had high levels of post-traumatic stress disorder and depressive symptoms, suicidal ideation and alcohol comorbidity. The investigation used EDIE, a novel health technology tool that collects information at the time a patient checks into any ED in Washington and other US states. Patterns of EDIE-documented visits were described, and the accuracy of injured patients’ self-report visits was compared with EDIE-recorded visits during the course of the 12 months prior to the index trauma center admission. Results Overall, 45% of the sample (n=76) inaccurately recalled their ED visits during the past year, with 36 participants (21%) reporting less ED visits than EDIE indicated and 40 (24%) reporting more ED visits than EDIE indicated. Patients with histories of alcohol use problems and major psychiatric illness were more likely to either under-report or over-report ED health service use. Discussion Nearly half of all patients were unable to accurately recall ED visits in the previous 12 months compared with EDIE, with almost one-quarter of patients demonstrating high levels of disagreement. The improved accuracy and ease of use when compared with self-report make EDIE an important tool for both clinical and pragmatic trial longitudinal outcome assessments. Orchestrated investigative and policy efforts could further examine the benefits of introducing EDIE and other information exchanges into routine acute care clinical workflows. Level of evidence II/III. Trial registration number ClinicalTrials.gov NCT02274688.
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Affiliation(s)
- Lauren K Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Marie C Vrablik
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathleen Moloney
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Schwartz RP, Kelly SM, Mitchell SG, O'Grady KE, Duren T, Sharma A, Gryczynski J, Jaffe JH. Randomized trial of methadone treatment of arrestees: 24-month post-release outcomes. Drug Alcohol Depend 2021; 218:108392. [PMID: 33187759 PMCID: PMC7750207 DOI: 10.1016/j.drugalcdep.2020.108392] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/14/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND We report on the 24-month post-release outcomes of arrestees with opioid use disorder (OUD) enrolled in a randomized trial comparing three treatment approaches initiated in jail. METHODS Adults (N = 225) receiving medically supervised withdrawal from opioids in the Baltimore Detention Center within a few days of arrest were randomly assigned to: (1) interim methadone treatment plus patient navigation (IM + PN) started in the Detention Center; (2) IM; or (3) Enhanced Treatment-as-Usual (ETAU) consisting of detoxification with methadone and referral to treatment in the community. Participants in both methadone conditions could transfer to standard methadone treatment following release. Participants were interviewed at baseline, and 1, 3, 6, 12, and 24 months post-release. Urine was drug tested at follow-up and official arrest records were obtained. RESULTS On an intention-to-treat basis, there were no significant differences among the three conditions over the 24-month post-release period in terms of opioid- or cocaine-positive urine test results or self-reported opioid or cocaine use, meeting opioid or cocaine use disorder criteria, self-reported criminal behavior, or the number of official arrests. There were 9 fatal overdoses, none occurring during methadone treatment, and 109 hospitalizations unrelated to the study. CONCLUSIONS Given the high morbidity and mortality found in this population of arrestees and costs to society associated with their health care utilization and continued crime and arrests, research aimed at finding more effective interventions should be continued. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT02334215.
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Affiliation(s)
- Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
| | - Sharon M Kelly
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
| | - Shannon G Mitchell
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA.
| | - Tiffany Duren
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
| | - Anjalee Sharma
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
| | - Jerome H Jaffe
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
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Navigation Services to Avoid Rehospitalization among Medical/Surgical Patients with Comorbid Substance Use Disorder: Rationale and Design of a Randomized Controlled Trial. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2020; 5. [PMID: 36147996 PMCID: PMC9491361 DOI: 10.20900/jpbs.20200013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Substance use disorders (SUDs) are associated with significant morbidity and mortality and contribute to inefficient use of healthcare services. Hospitalized medical/surgical patients with comorbid SUD are at elevated risk of hospital readmission and poor outcomes. Thus, effective interventions are needed to help such patients during hospitalization and post-discharge. This article reports the rationale, methodological design, and progress to date on a randomized trial comparing the effectiveness of Navigation Services to Avoid Rehospitalization (NavSTAR) vs Treatmentas-Usual (TAU) for hospital medical/surgical patients with comorbid SUD (N = 400). Applying Andersen’s theoretical model of health service utilization, NavSTAR employed Patient Navigation and motivational interventions to promote entry into SUD treatment, facilitate adherence to recommendations for medical follow-up and self-care, address basic needs, and prevent the recurrent use of hospital services. As part of the NavSTAR service model, Patient Navigators embedded within the SUD consultation service at a large urban hospital delivered patient-centered, proactive navigation and motivational services initiated during the hospital stay and continued for up to 3 months post-discharge. Participants randomized to TAU received usual care from the hospital and the SUD consultation service, which included referral to SUD treatment but no continued contact post-hospital discharge. Hospital service utilization will be determined via review of electronic health records and the regional Health Information Exchange. Participants were assessed at baseline and again at 3-, 6-, and 12-month follow-up on various measures of healthcare utilization, substance use, and functioning. The primary outcome of interest is time-to-rehospitalization through 12 months. In addition, a range of secondary outcomes spanning the medical and SUD service areas will be assessed. The study will include a health economic evaluation of NavSTAR. If NavSTAR proves to be effective and cost-effective in this high-risk patient group, it would have important implications for addressing the needs of hospital patients with comorbid SUD, designing hospital discharge planning services, informing cost containment initiatives, and improving public health.
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