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Tatangelo M, Landry R, Beaulieu D, Watson C, Knowlan S, Anawati A, Bodson A, Aubin N, Marsh DC, Leary T, Morin KA. Association of hospital-based substance use supports on emergency department revisits: a retrospective cohort study in Sudbury, Canada from 2018 to 2022. Harm Reduct J 2024; 21:71. [PMID: 38549074 PMCID: PMC10976798 DOI: 10.1186/s12954-024-00985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 03/09/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND This study compares emergency department (ED) revisits for patients receiving hospital-based substance-use support compared to those who did not receive specialized addiction services at Health Sciences North in Sudbury, Ontario, Canada. METHODS The study is a retrospective observational study using administrative data from all patients presenting with substance use disorder (SUD) at Health Sciences North from January 1, 2018, and August 31, 2022 with ICD-10 codes from the Discharge Abstract Database (DAD) and the National Ambulatory Care Database (NACRS). There were two interventions under study: addiction medicine consult services (AMCS group), and specialized addiction medicine unit (AMU group). The AMCS is a consult service offered for patients in the ED and those who are admitted to the hospital. The AMU is a specialized inpatient medical unit designed to offer addiction support to stabilize patients that operates under a harm-reduction philosophy. The primary outcome was all cause ED revisit within 30 days of the index ED or hospital visit. The secondary outcome was all observed ED revisits in the study period. Kaplan-Meier curves were used to measure the proportion of 30-day revisits by exposure group. Odds ratios and Hazard Ratios were calculated using logistic regression models with random effects and Cox-proportional hazard model respectively. RESULTS A total of 5,367 patients with 10,871 ED index visits, and 2,127 revisits between 2018 and 2022 are included in the study. 45% (2,340/5,367) of patient were not admitted to hospital. 30-day revisits were less likely among the intervention group: Addiction Medicine Consult Services (AMCS) in the ED significantly reduced the odds of revisits (OR 0.53, 95% CI 0.39-0.71, p < 0.01) and first revisits (OR 0.42, 95% CI 0.33-0.53, p < 0.01). The AMU group was associated with lower revisits odds (OR 0.80, 95% CI 0.66-0.98, p = 0.03). For every additional year of age, the odds of revisits slightly decreased (OR 0.99, 95% CI 0.98-1.00, p = 0.01) and males were found to have an increased risk compared to females (OR 1.50, 95% CI 1.35-1.67, p < 0.01). INTERPRETATION We observe statistically significant differences in ED revisits for patients receiving hospital-based substance-use support at Health Sciences North. Hospital-based substance-use supports could be applied to other hospitals to reduce 30-day revisits.
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Affiliation(s)
- Mark Tatangelo
- Health Science North, Sudbury, ON, Canada
- ICES North, Sudbury, ON, Canada
| | | | | | | | | | - Alex Anawati
- Health Science North, Sudbury, ON, Canada
- Dr. Gilles Arcand Centre for Health Equity, Sudbury, ON, Canada
| | | | - Natalie Aubin
- Health Science North, Sudbury, ON, Canada
- Laurentian University, Sudbury, ON, Canada
| | - David C Marsh
- Health Science North, Sudbury, ON, Canada
- ICES North, Sudbury, ON, Canada
- Dr. Gilles Arcand Centre for Health Equity, Sudbury, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
- Laurentian University, Sudbury, ON, Canada
| | - Tara Leary
- Health Science North, Sudbury, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Kristen A Morin
- Health Science North, Sudbury, ON, Canada.
- ICES North, Sudbury, ON, Canada.
- Dr. Gilles Arcand Centre for Health Equity, Sudbury, ON, Canada.
- Northern Ontario School of Medicine University, Sudbury, ON, Canada.
- Laurentian University, Sudbury, ON, Canada.
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Morin KA, Ghartey K, Bodson A, Sirois A, Leary T. Evaluating an addiction medicine unit in Sudbury, Ontario Canada: a mixed-methods study protocol. BMC Health Serv Res 2023; 23:1366. [PMID: 38057899 DOI: 10.1186/s12913-023-10313-0] [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: 09/21/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND In response to the escalating global prevalence of substance use and the specific challenges faced in Northern Ontario, Canada, an Addiction Medicine Unit (AMU) was established at Health Sciences North (HSN) in Sudbury. This protocol outlines the approach for a comprehensive evaluation of the AMU, with the aim of assessing its impact on patient outcomes, healthcare utilization, and staff perspectives. METHODS We conducted a parallel mixed-method study that encompassed the analysis of single-center-level administrative health data and primary data collection, including a longitudinal observational study (target n = 1,200), pre- and post-admission quantitative interviews (target n = 100), and qualitative interviews (target n = 25 patients and n = 15 staff). We implemented a participatory approach to this evaluation, collaborating with individuals who possess lived or living expertise in drug use, frontline staff, and decision-makers across the hospital. Data analysis methods encompass a range of statistical techniques, including logistic regression models, Cox proportional hazards models, Kaplan-Meier curves, Generalized Estimating Equations (GEE), and thematic qualitative analysis, ensuring a robust evaluation of patient outcomes and healthcare utilization. DISCUSSION This protocol serves as the foundation for a comprehensive assessment designed to provide insights into the AMU's effectiveness in addressing substance use-related challenges, reducing healthcare disparities, and improving patient outcomes. All study procedures have been meticulously designed to align with the ethical principles outlined in the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. The findings will be disseminated progressively through committees and working groups established for this research, and subsequently published in peer-reviewed journals. Anticipated outcomes include informing evidence-based healthcare decision-making and driving improvements in addiction treatment practices within healthcare settings.
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Affiliation(s)
- Kristen A Morin
- Health Sciences North, Sudbury, ON, Canada.
- ICES North (Institute for Clinical and Evaluative Sciences), Sudbury, ON, Canada.
- Northern Ontario School of Medicine University, Sudbury, ON, Canada.
| | - Karla Ghartey
- University of Toronto, Toronto, ON, Canada
- Cambrian College, Sudbury, ON, Canada
| | | | - Alexandra Sirois
- Health Sciences North, Sudbury, ON, Canada
- Laurentian University, Sudbury, ON, Canada
| | - Tara Leary
- Health Sciences North, Sudbury, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
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Leary T, Aubin N, Marsh DC, Roach M, Nikodem P, Caswell JM, Irwin B, Pillsworth E, Mclelland M, Long B, Bhagavatula S, Eibl JK, Morin KA. Building an inpatient addiction medicine consult service in Sudbury, Canada: preliminary data and lessons learned in the era of COVID-19. Subst Abuse Treat Prev Policy 2023; 18:29. [PMID: 37217953 DOI: 10.1186/s13011-023-00537-y] [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: 01/18/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE The goal of this study was to (1) Describe the patient population of a newly implemented addiction medicine consult service (AMCS); (2) Evaluate referrals to community-based addiction support services and acute health service use, over time; (3) Provide lessons learned. METHODS A retrospective observational analysis was conducted at Health Sciences North in Sudbury, Ontario, Canada, with a newly implemented AMCS from November 2018 and July 2021. Data were collected using the hospital's electronic medical records. The outcomes measured included the number of emergency department visits, inpatient admissions, and re-visits over time. An interrupted time-series analysis was performed to measure the effect of AMCS implementation on acute health service use at Health Sciences North. RESULTS A total of 833 unique patients were assessed through the AMCS. A total of 1,294 referrals were made to community-based addiction support services, with the highest proportion of referrals between August and October 2020. The post-intervention trend for ED visits, ED re-visits, ED length of stay, inpatient visits, re-visits, and inpatient length of stay did not significantly differ from the pre-intervention period. CONCLUSION Implementation of an AMCS provides a focused service for patients using with substance use disorders. The service resulted in a high referral rate to community-based addiction support services and limited changes in health service usage.
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Affiliation(s)
- Tara Leary
- Health Science North, Sudbury, Canada
- Northern Ontario School of Medicine, 936 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
| | | | - David C Marsh
- ICES North, Sudbury, Canada
- Health Sciences North Research Institute, Sudbury, Canada
- Northern Ontario School of Medicine, 936 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
| | | | | | | | | | | | | | - Brad Long
- Health Science North, Sudbury, Canada
- Northern Ontario School of Medicine, 936 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
| | - Sastry Bhagavatula
- Health Science North, Sudbury, Canada
- Northern Ontario School of Medicine, 936 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
| | - Joseph K Eibl
- Health Sciences North Research Institute, Sudbury, Canada
- Northern Ontario School of Medicine, 936 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
| | - Kristen A Morin
- Health Science North, Sudbury, Canada.
- ICES North, Sudbury, Canada.
- Health Sciences North Research Institute, Sudbury, Canada.
- Northern Ontario School of Medicine, 936 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada.
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Development of an intravenous low-dose buprenorphine initiation protocol. Drug Alcohol Depend 2022; 237:109541. [PMID: 35753281 DOI: 10.1016/j.drugalcdep.2022.109541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Buprenorphine is a life-saving treatment for opioid use disorder (OUD). Low-dose initiation (LDI) is an emerging buprenorphine initiation strategy that circumvents barriers associated with standard initiation. This study aims to describe tolerability and completion of LDI using intravenous (IV) buprenorphine and to define dosing protocols in a cohort of patients hospitalized in an urban academic hospital. METHODS Data was collected via retrospective chart review for IV buprenorphine LDI cases initiated between September 1, 2020 and February 28, 2021. Cases were excluded if diagnostic criteria for OUD was not met, Clinical Opiate Withdrawal Scale (COWS) scores were not recorded, or sublingual (SL) buprenorphine was given within 24 h before IV buprenorphine. Completion of LDI and COWS data were assessed for all cases. Cases were categorized based on adherence to a dosing strategy and LDI indication, including OUD and acute pain, non-prescribed fentanyl exposure, and transition from methadone. RESULTS Seventy-two cases were identified, and thirteen cases were excluded, leaving 59 cases in the population. Of these cases, 72.9% (43/59) tolerated LDI, and 91.5% (54/59) completed buprenorphine initiation. Forty-four (44/59, 75%) cases were adherent. Median duration of LDI within the adherent group was 23.7 h (IQR 22.8-27.0), 37.1 h (IQR 36.2-40.9), and 48.8 h (IQR 47.0-52.4) for the "rapid," "moderate," and "slow" dosing strategies, respectively. CONCLUSIONS IV buprenorphine LDI was tolerated and completed in a majority of patients. Dosing protocols allowed for rapid transition to sublingual buprenorphine. Acute pain or recent methadone or fentanyl exposure may inform IV LDI dosing strategy selection.
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Mitchell SG, Nordeck CD, Lertch E, Ross TE, Welsh C, Schwartz RP, Gryczynski J. Patients with substance use disorders receiving continued care in skilled nursing facilities following hospitalization. Subst Abus 2022; 43:848-854. [PMID: 35179452 PMCID: PMC9793431 DOI: 10.1080/08897077.2021.2007512] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: As hospitals in the US face pressures to reduce lengths of stay, healthcare systems are increasingly utilizing skilled nursing facilities (SNFs) to continue treating patients stable enough to leave the hospital, but not to return home. Substance use disorder (SUD) can complicate care of patients transferred to SNFs. The objective of this paper is to understand SNF experiences for this population of patients with comorbid SUD transferred to SNFs and examine care experiences in these facilities. Methods: This secondary mixed-methods analysis focuses on SNF experiences from a clinical trial of patient navigation services for medically-hospitalized adults with comorbid opioid, cocaine, and/or alcohol use disorder. This study compared baseline assessments and medical record review for participants (N = 400) with vs. without SNF transfer, and analyzed semi-structured qualitative interviews with a subsample of 15 participants purposively selected based on their transfer to a SNF. Results: Over 1 in 4 participants had a planned discharged to a SNF (26.8% sub-acute, 3.3% acute). Compared to participants with other types of discharge, participants discharged to a SNF had longer initial hospitalizations (4.9 vs. 11.8 days, p < 0.001), and were more likely to be White (38.6 vs. 50.8%; p = 0.02), female (38.9 vs. 52.5%; p = 0.01), have opioid use disorder (75.7 vs. 85.0%, p = 0.03), and be hospitalized for infection (43.6 vs. 58.3%; p = 0.007), and less likely to have worked prior to hospitalization (24.3 vs. 12.5%; p = 0.006). Qualitative narratives identified several themes from the SNF experience, including opioid analgesic dosing issues, challenges to the use of opioid agonist treatment of OUD, illicit opioid dealing/use, and limited access to addiction recovery support services during and following the SNF stay. Conclusions: SNFs are a common disposition for patients in need of subacute services following hospitalization but may be ill-equipped to properly manage patients in need of new or continuing SUD treatment.
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Affiliation(s)
| | - Courtney D. Nordeck
- Friends Research Institute, Inc., Baltimore, MD,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Christopher Welsh
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
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Jacobs P, Feaster DJ, Pan Y, Gooden LK, Daar ES, Lucas GM, Jain MK, Marsh EL, Armstrong WS, Rodriguez A, del Rio C, Metsch LR. Initiation of Antiretroviral Therapy in the Hospital Is Associated With Linkage to Human Immunodeficiency Virus (HIV) Care for Persons Living With HIV and Substance Use Disorder. Clin Infect Dis 2021; 73:e1982-e1990. [PMID: 32569355 PMCID: PMC8492224 DOI: 10.1093/cid/ciaa838] [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: 02/22/2020] [Accepted: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies have demonstrated benefits of antiretroviral therapy (ART) initiation on the day of human immunodeficiency virus (HIV) testing or at first clinical visit. The hospital setting is understudied for immediate ART initiation. METHODS CTN0049, a linkage-to-care randomized clinical trial, enrolled 801 persons living with HIV (PLWH) and substance use disorder (SUD) from 11 hospitals across the United States. This secondary analysis examined factors related to initiating (including reinitiating) ART in the hospital and its association with linkage to HIV care, frequency of outpatient care visits, retention, and viral suppression. RESULTS Of 801 participants, 124 (15%) initiated ART in the hospital, with more than two-thirds of these participants (80/124) initiating ART for the first time. Time to first HIV care visit among those who initiated ART in the hospital and those who did not was 29 and 54 days, respectively (P = .0145). Hospital initiation of ART was associated with increased frequency of HIV outpatient care visits at 6 and 12 months. There was no association with ART initiation in the hospital and retention and viral suppression over a 12-month period. Participants recruited in Southern hospitals were less likely to initiate ART in the hospital (P < .001). CONCLUSIONS Previous research demonstrated benefits of immediate ART initiation, yet this approach is not widely implemented. Research findings suggest that starting ART in the hospital is beneficial for increasing linkage to HIV care and frequency of visits for PLWH and SUD. Implementation research should address barriers to early ART initiation in the hospital.
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Affiliation(s)
- Petra Jacobs
- National Institute on Drug Abuse, Bethesda, Maryland, USA
| | | | - Yue Pan
- University of Miami, Miami, Florida, USA
| | | | - Eric S Daar
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | | | - Mamta K Jain
- UT Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Carlos del Rio
- Emory University School of Medicine, Atlanta, Georgia, USA
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Braithwaite V, Ti L, Fairbairn N, Ahamad K, McLean M, Harrison S, Wood E, Nolan S. Building a hospital-based addiction medicine consultation service in Vancouver, Canada: the path taken and lessons learned. Addiction 2021; 116:1892-1900. [PMID: 33339073 PMCID: PMC8862688 DOI: 10.1111/add.15383] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/22/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS To improve evidence-based addiction care in acute care settings, many hospitals across North America are developing an inpatient addiction medicine consultation service (AMCS). St Paul's Hospital in Vancouver, Canada houses a large interdisciplinary AMCS. This study aimed to: (1) describe the current model of clinical care and its evolution over time; (2) evaluate requests for an AMCS consultation over time; (3) highlight the established clinical training opportunities and educational curriculum and (4) provide some lessons learned. DESIGN, SETTING AND PARTICIPANTS A retrospective observational analysis in an urban, academic hospital in Vancouver, Canada with a large interdisciplinary AMCS, studied from 2013 to 2018, among individuals who presented to hospital and had a substance use disorder. MEASUREMENTS Data were collected using the hospital's electronic medical records. The primary outcome was number of AMCS consultations over time. FINDINGS In 2014 the hospital's AMCS was restructured into an academic, interdisciplinary consultation service. A 228% increase in the number of consultations was observed between 2013 (1 year prior to restructuring) and 2018 (1373 versus 4507, respectively; P = 0.027). More than half of AMCS consultations originated from the emergency department, with this number increasing over time (55% in 2013 versus 74% in 2018). Referred patients were predominantly male (> 60% in all 5 years) between the ages of 45 and 65 years. Reasons for consultation remained consistent and included: opioids (33%), stimulants (30%), alcohol (23%) and cannabis use (8%). CONCLUSIONS After St Paul's Hospital in Vancouver, Canada was restructured in 2014 to a large, interdisciplinary addiction medicine consultation service (AMCS), the AMCS saw a 228% increase in the number of consultation requests with more than half of requests originating from the emergency department. Approximately two-thirds of consultation requests were for opioid or stimulant use.
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Affiliation(s)
| | - Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | - Keith Ahamad
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | - Mark McLean
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | - Scott Harrison
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
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Weimer M, Morford K, Donroe J. Treatment of Opioid Use Disorder in the Acute Hospital Setting: a Critical Review of the Literature (2014–2019). CURRENT ADDICTION REPORTS 2019. [DOI: 10.1007/s40429-019-00267-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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McNeely J, Troxel AB, Kunins HV, Shelley D, Lee JD, Walley A, Weinstein ZM, Billings J, Davis NJ, Marcello RK, Schackman BR, Barron C, Bergmann L. Study protocol for a pragmatic trial of the Consult for Addiction Treatment and Care in Hospitals (CATCH) model for engaging patients in opioid use disorder treatment. Addict Sci Clin Pract 2019; 14:5. [PMID: 30777122 PMCID: PMC6380041 DOI: 10.1186/s13722-019-0135-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Treatment for opioid use disorder (OUD) is highly effective, yet it remains dramatically underutilized. Individuals with OUD have disproportionately high rates of hospitalization and low rates of addiction treatment. Hospital-based addiction consult services offer a potential solution by using multidisciplinary teams to evaluate patients, initiate medication for addiction treatment (MAT) in the hospital, and connect patients to post-discharge care. We are studying the effectiveness of an addiction consult model [Consult for Addiction Treatment and Care in Hospitals (CATCH)] as a strategy for engaging patients with OUD in treatment as the program rolls out in the largest municipal hospital system in the US. The primary aim is to evaluate the effectiveness of CATCH in increasing post-discharge initiation and engagement in MAT. Secondary aims are to assess treatment retention, frequency of acute care utilization and overdose deaths and their associated costs, and implementation outcomes. METHODS A pragmatic trial at six hospitals, conducted in collaboration with the municipal hospital system and department of health, will be implemented to study the CATCH intervention. Guided by the RE-AIM evaluation framework, this hybrid effectiveness-implementation study (Type 1) focuses primarily on effectiveness and also measures implementation outcomes to inform the intervention's adoption and sustainability. A stepped-wedge cluster randomized trial design will determine the impact of CATCH on treatment outcomes in comparison to usual care for a control period, followed by a 12-month intervention period and a 6- to 18-month maintenance period at each hospital. A mixed methods approach will primarily utilize administrative data to measure outcomes, while interviews and focus groups with staff and patients will provide additional information on implementation fidelity and barriers to delivering MAT to patients with OUD. DISCUSSION Because of their great potential to reduce the negative health and economic consequences of untreated OUD, addiction consult models are proliferating in response to the opioid epidemic, despite the absence of a strong evidence base. This study will provide the first known rigorous evaluation of an addiction consult model in a large multi-site trial and promises to generate knowledge that can rapidly transform practice and inform the potential for widespread dissemination of these services. TRIAL REGISTRATION NCT03611335.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, Section on Alcohol, Tobacco and Drug Use, NYU School of Medicine, 180 Madison Avenue, 17th floor, New York, NY 10016 USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 462 1st Avenue, New York, NY 10016 USA
| | - Andrea B. Troxel
- Department of Population Health, Division of Biostatistics, NYU School of Medicine, 180 Madison Avenue, 5th floor, New York, NY 10016 USA
| | - Hillary V. Kunins
- NYC Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention Care and Treatment, 42-09 28th Street, Room CN14, Queens, NY 11101 USA
| | - Donna Shelley
- Department of Population Health, Section on Alcohol, Tobacco and Drug Use, NYU School of Medicine, 180 Madison Avenue, 17th floor, New York, NY 10016 USA
| | - Joshua D. Lee
- Department of Population Health, Section on Alcohol, Tobacco and Drug Use, NYU School of Medicine, 180 Madison Avenue, 17th floor, New York, NY 10016 USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 462 1st Avenue, New York, NY 10016 USA
| | - Alexander Walley
- Clinical Addiction Research and Education Unit, Boston University School of Medicine, 801 Massachusetts Ave., 2nd Foor, Boston, MA 02118 USA
| | - Zoe M. Weinstein
- Clinical Addiction Research and Education Unit, Boston University School of Medicine, 801 Massachusetts Ave., 2nd Foor, Boston, MA 02118 USA
| | - John Billings
- Wagner School of Health Policy and Public Service, New York University, 295 Lafayette Street, New York, NY 10012 USA
| | - Nichola J. Davis
- Office of Population Health, NYC Health and Hospitals, 199 Water Street, New York, NY 10038 USA
| | | | - Bruce R. Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College, 425 E. 61st St., Ste 301, New York, NY 10065 USA
| | - Charles Barron
- Office of Behavioral Health, NYC Health + Hospitals, 125 Worth St, New York, NY 10013 USA
| | - Luke Bergmann
- Office of Behavioral Health, NYC Health + Hospitals, 125 Worth St, New York, NY 10013 USA
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Weinstein ZM, Wakeman SE, Nolan S. Inpatient Addiction Consult Service: Expertise for Hospitalized Patients with Complex Addiction Problems. Med Clin North Am 2018; 102:587-601. [PMID: 29933817 PMCID: PMC6750950 DOI: 10.1016/j.mcna.2018.03.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Substance use disorders are highly prevalent and are a large driver of costly inpatient medical care; however, historically the substance use disorder has gone unaddressed during an inpatient stay. Inpatient addiction consult services are an important intervention to use the reachable moment of hospitalization to engage patients and initiate addiction treatment. Addiction consultation involves taking an addiction-specific history, motivational interviewing, withdrawal symptom management, and initiation of long-term pharmacotherapy. Addiction consult services have the potential to decrease readmissions and utilization costs for medical systems and improve substance-related outcomes for patients.
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Affiliation(s)
- Zoe M Weinstein
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, Crosstown 2, Boston, MA 02118, USA.
| | - Sarah E Wakeman
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114, USA
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
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11
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Nordeck CD, Welsh C, Schwartz RP, Mitchell SG, Cohen A, O’Grady KE, Gryczynski J. Rehospitalization and substance use disorder (SUD) treatment entry among patients seen by a hospital SUD consultation-liaison service. Drug Alcohol Depend 2018; 186. [PMID: 29529456 PMCID: PMC5922267 DOI: 10.1016/j.drugalcdep.2017.12.043] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Substance use disorders (SUD) are associated with non-adherence to medical care and high utilization of hospital services. This study characterized patterns and correlates of rehospitalization among patients seen by a hospital-based SUD consultation-liaison (CL) team. METHODS This study was a retrospective medical record review of patients in a large urban academic hospital who received SUD consultation and were diagnosed with opioid, cocaine, and/or alcohol use disorder (N = 267). Data were collected on patient characteristics, substance-specific SUD diagnoses (opioids, cocaine, and alcohol), opioid agonist treatment (OAT) with methadone or buprenorphine (treatment status at admission; in-hospital initiation of OAT), and rehospitalization through 180 days post-discharge. Associations with rehospitalization were examined using bivariate tests of independence and multivariate logistic regression, with patient background and medical characteristics, substance-specific SUD diagnoses, and OAT status (at admission and in-hospital initiation) as predictors. RESULTS Rehospitalization rates were higher among patients with current opioid (38% vs. 24%; p < .05) and cocaine use disorders (39% vs. 26%; p < .05) compared to patients without these diagnoses. In multivariate logistic regression analysis, the number of medical comorbidities [Adjusted Odds Ratio (AOR) = 1.2; p < .01] and opioid use disorder (AOR = 2.4, p < .05) were independently associated with rehospitalization. CONCLUSIONS In this sample of hospital patients receiving SUD CL services, the risk of rehospitalization differed by type of SUD diagnosis. In-hospital initiation of OAT is promising for facilitating treatment linkage post-discharge, but this small study did not show differences in rehospitalization based on OAT initiation. These findings could inform services for hospital patients with comorbid SUDs.
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Affiliation(s)
- Courtney D. Nordeck
- Friends Research Institute, 1040 Park Avenue, Suite 103. Baltimore, MD 21201, USA
| | - Christopher Welsh
- Department of Psychiatry, Division of Alcohol and Drug Abuse, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Robert P. Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103. Baltimore, MD 21201, USA
| | | | - Art Cohen
- Department of Psychiatry, Division of Alcohol and Drug Abuse, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD 20742, USA
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103. Baltimore, MD 21201, USA.
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Lee CS, Liebschutz JM, Anderson BJ, Stein MD. Hospitalized opioid-dependent patients: Exploring predictors of buprenorphine treatment entry and retention after discharge. Am J Addict 2017; 26:667-672. [PMID: 28324627 DOI: 10.1111/ajad.12533] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 03/02/2017] [Accepted: 03/04/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Few studies have explored predictors of entry into and retention in buprenorphine treatment following linkage from an acute medical hospitalization. METHODS This secondary analysis of a completed clinical trial focuses on medically hospitalized, opioid-dependent patients (n = 72) who were randomized to an intervention including buprenorphine induction and dose stabilization during hospitalization followed by post-discharge transition to office-based buprenorphine treatment (OBOT). Predictors included demographics, days hospitalized, prior buprenorphine/methadone treatment, PTSD symptoms, social support, and readiness for drug use cessation. Outcome variables were treatment entry and retention (number of days in OBOT). RESULTS Previous buprenorphine treatment, more days hospitalized, and higher PTSD symptoms predicted OBOT entry. Prior treatment, older age, and non-minority status were associated with a higher mean number of days in OBOT. CONCLUSIONS OBOT may appeal to patients who have tried buprenorphine in other settings. Linking hospitalized patients to OBOT may improve utilization of addiction treatment. SCIENTIFIC SIGNIFICANCE Prior substance treatment, longer hospital stay, and mental health should be examined in future linkage studies. (Am J Addict 2017;26:667-672).
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Affiliation(s)
- Christina S Lee
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Jane M Liebschutz
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Bradley J Anderson
- Department of Behavioral Medicine, Butler Hospital, Providence, Rhode Island
| | - Michael D Stein
- Department of Behavioral Medicine, Butler Hospital, Providence, Rhode Island.,Boston University School of Public Health, Boston, Massachusetts
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Cushman PA, Liebschutz JM, Anderson BJ, Moreau MR, Stein MD. Buprenorphine Initiation and Linkage to Outpatient Buprenorphine do not Reduce Frequency of Injection Opiate Use Following Hospitalization. J Subst Abuse Treat 2016; 68:68-73. [PMID: 27431049 PMCID: PMC5018431 DOI: 10.1016/j.jsat.2016.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 04/11/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Buprenorphine has established effectiveness for outpatient treatment of opioid use disorder. Our previously published STOP (Suboxone Transition to Opiate Program) trial showed that buprenorphine induction, stabilization, and linkage to outpatient treatment in opioid-dependent inpatients (injection and non-injection drug users) decreased illicit opioid use over 6months. The present study was a planned subgroup analysis of injection opiate users from STOP. OBJECTIVE To determine if inpatient buprenorphine initiation and linkage to outpatient buprenorphine reduce injection opiate users' frequency of injection opiate use (IOU). METHODS Inpatient injection opiate users at a safety-net hospital were randomized to buprenorphine linkage (induction, stabilization, bridge prescription, and facilitated referral to outpatient treatment) or detoxification (5-day inpatient buprenorphine taper). Conditional fixed-effects Poisson regression was used to estimate the effects of intervention on 30-day (self-report) at 1, 3, and 6months, measured using 30-day timeline follow-back. The secondary outcome was linkage effectiveness, measured as % presenting to initial outpatient buprenorphine visits after hospital discharge. RESULTS Analysis was limited to persons (n=62 randomized to detoxification and n=51 to linkage) with baseline IOU. There were no significant differences in age, ethnicity, or baseline IOU frequency. At follow-up, linkage patients (70.6%) were significantly more likely (p<0.001) to present to initial buprenorphine visits than detoxification patients (9.7%). However, there was no significant between group difference in the rate of IOU at 1- (IRR=0.73, p=0.32), 3- (IRR=1.20, p=0.54), or 6-month (IRR=0.73, p=0.23) follow-ups. Using person-day analysis, participants self-reported IOU on 5.8% of follow-up days in which they used prescription buprenorphine and 37.5% of non-buprenorphine days. Using a generalized estimating equation, the estimated odds of IOU was 4.57 times higher (p<0.001) on non-buprenorphine days. CONCLUSIONS Despite STOP's success in linking patients who inject opiates to outpatient buprenorphine, the intervention did not significantly decrease their IOU frequency. Injection opiate users will require a more intensive protocol to sustain outpatient buprenorphine treatment and decrease injection with its attendant risks.
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Affiliation(s)
- Phoebe A Cushman
- General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Crosstown 2nd Floor, 801 Massachusetts Ave, Boston, MA, USA, 02118.
| | - Jane M Liebschutz
- General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Crosstown 2nd Floor, 801 Massachusetts Ave, Boston, MA, USA, 02118.
| | - Bradley J Anderson
- General Internal Medicine, Butler Hospital, 345 Blackstone Blvd., Providence, RI, USA, 02906.
| | - Merredith R Moreau
- General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Crosstown 2nd Floor, 801 Massachusetts Ave, Boston, MA, USA, 02118.
| | - Michael D Stein
- General Internal Medicine, Butler Hospital, 345 Blackstone Blvd., Providence, RI, USA, 02906; Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.
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Sarkar S, Balhara YPS, Gautam N, Singh J. A Retrospective Chart Review of Treatment Completers Versus Noncompleters Among In-patients at a Tertiary Care Drug Dependence Treatment Centre in India. Indian J Psychol Med 2016; 38:296-301. [PMID: 27570339 PMCID: PMC4980895 DOI: 10.4103/0253-7176.185943] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS Engagement into treatment is crucial for improving outcomes among patients with substance use disorders. This study aimed to find the rates and characteristics of treatment noncompletion in patients who were admitted to a drug dependence treatment center in north India. METHODS This retrospective record review analyzed data from consecutive patients admitted between January 1, 2014, and December 31, 2014, at the National Drug Dependence Treatment Centre, Ghaziabad, India. The type of discharge was discerned from the records, along with selected demographic and clinical characteristics of the patient. RESULTS A total of 942 in-patients were included in the analysis, 936 (99.4%) of whom were males. The mean duration of ward stay was 12.7 (±8.1) days. Of the 942 patients, 779 (82.7%) completed the inpatient treatment while 163 (17.3%) did not complete (n = 95, 10.1% were discharged against medical advice; n = 44, 4.7% were discharged on disciplinary grounds and n = 24, 2.5% absconded or left without intimation). The inpatient treatment noncompleters had a shorter duration of ward stay (8.3 ± 6.9 days vs. 13.6 ± 8.0 days, P < 0.001), were of a greater average age (33.1 ± 10.0 years vs. 30.5 ± 9.4 years, P = 0.002), were more likely to be dependent on opioids (71.2% vs. 59.1%, P = 0.004) and less likely to be dependent on alcohol (30.1% vs. 42.9%, P = 0.002) than treatment completers. CONCLUSION Understanding the characteristics of patients with substance use disorders who do not complete inpatient treatment may help in identifying those at-risk of having poor outcomes. Efforts are required to address their concerns so that the overall patient outcomes can be improved.
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Affiliation(s)
- Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Namita Gautam
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Jawahar Singh
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
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Suzuki J. Medication-assisted treatment for hospitalized patients with intravenous-drug-use related infective endocarditis. Am J Addict 2016; 25:191-4. [PMID: 26991660 DOI: 10.1111/ajad.12349] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/08/2016] [Accepted: 02/14/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A feared complication of opioid use disorder (OUD) is intravenous drug use related infective endocarditis (IDU-IE). We report on our experience engaging hospitalized IDU-IE patients to initiate medication-assisted treatment (MAT). METHODS A retrospective study (n = 29) using descriptive statistics. RESULTS Overall, 9 (31.0%) successfully initiated buprenorphine maintenance during the hospitalization, and 9 (31.0%) accepted a referral to methadone maintenance following discharge. Eleven (37.9%) declined MAT altogether. DISCUSSION AND CONCLUSIONS Hospitalizations may represent an important opportunity to engage IDU-IE patients to initiate MAT. SCIENTIFIC SIGNIFICANCE The study provides preliminary support of engaging hospitalized IDU-IE patients to initiate MAT.
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Affiliation(s)
- Joji Suzuki
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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16
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Suzuki J, DeVido J, Kalra I, Mittal L, Shah S, Zinser J, Weiss RD. Initiating buprenorphine treatment for hospitalized patients with opioid dependence: A case series. Am J Addict 2015; 24:10-4. [DOI: 10.1111/ajad.12161] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 08/18/2014] [Accepted: 09/20/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Joji Suzuki
- Department of Psychiatry; Brigham and Women's Hospital; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
| | - Jeffrey DeVido
- Department of Psychiatry; University of California; San Francisco California
- School of Medicine; University of California; San Francisco California
| | - Inder Kalra
- Department of Psychiatry; Albert Einstein Healthcare Network; Philadelphia Pennsylvania
| | - Leena Mittal
- Department of Psychiatry; Brigham and Women's Hospital; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
| | - Sejal Shah
- Department of Psychiatry; Brigham and Women's Hospital; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
| | - Jennifer Zinser
- Department of Psychiatry; Brigham and Women's Hospital; Boston Massachusetts
| | - Roger D. Weiss
- Harvard Medical School; Boston Massachusetts
- Division of Alcohol and Drug Abuse; McLean Hospital; Belmont Massachusetts
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17
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Jackson LA, Buxton JA, Dingwell J, Dykeman M, Gahagan J, Gallant K, Karabanow J, Kirkland S, LeVangie D, Sketris I, Gossop M, Davison C. Improving psychosocial health and employment outcomes for individuals receiving methadone treatment: a realist synthesis of what makes interventions work. BMC Psychol 2014; 2:26. [PMID: 25566385 PMCID: PMC4269989 DOI: 10.1186/s40359-014-0026-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For over 50 years, methadone has been prescribed to opioid-dependent individuals as a pharmacological approach for alleviating the symptoms of opioid withdrawal. However, individuals prescribed methadone sometimes require additional interventions (e.g., counseling) to further improve their health. This study undertook a realist synthesis of evaluations of interventions aimed at improving the psychosocial and employment outcomes of individuals on methadone treatment, to determine what interventions work (or not) and why. METHODS The realist synthesis method was utilized because it uncovers the processes (or mechanisms) that lead to particular outcomes, and the contexts within which this occurs. A comprehensive search process resulted in 31 articles for review. Data were extracted from the articles, and placed in four templates to assist with analysis. Data analysis was an iterative process and involved comparing and contrasting data within and across each template, and cross checking with original articles to determine key patterns in the data. RESULTS For individuals on methadone, engagement with an intervention appears to be important for improved psychosocial and/or employment outcomes. The engagement process involves attendance at interventions as well as an investment in what is offered. Three intervention contexts (often in some combination) support the engagement process: a) client-centered contexts (or those where clients' psychosocial and/or employment needs/issues/skills are recognized and/or addressed); b) contexts which address clients' socio-economic conditions and needs; and, c) contexts where there are positive client-counselor and/or peer relationships. There is some evidence that sometimes ongoing engagement is necessary to maintain positive outcomes. There is also some evidence that complete abstinence from drugs (e.g., cocaine, heroin) is not necessary for engagement. CONCLUSIONS It is important to consider how the contexts of interventions might elicit and/or support clients' engagement. Further research is needed to explore how an individual's background (e.g., involvement with different interventions over an extended period) may influence engagement. Long-term engagement may be necessary to sustain some positive outcomes although how long is unclear and requires further research. Engagement can occur without complete abstinence from such drugs as cocaine or heroin, but additional research is required as engagement may be influenced by the extent and type of drug use.
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Affiliation(s)
- Lois A Jackson
- School of Health and Human Performance, Dalhousie University, 6230 South Street, P.O. Box 15000, Halifax, NS B3H 4R2 Canada ; Atlantic Health Promotion Research Centre, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2 Canada
| | - Jane A Buxton
- School of Population & Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Julie Dingwell
- AIDS Saint John, 62 Waterloo St, Saint John, NB E2L 3P3 Canada
| | - Margaret Dykeman
- University of New Brunswick, 2140 Hanwell Rd, Hanwell, NB B3C 1 M8 Canada
| | - Jacqueline Gahagan
- School of Health and Human Performance, Dalhousie University, 6230 South Street, P.O. Box 15000, Halifax, NS B3H 4R2 Canada ; Atlantic Health Promotion Research Centre, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2 Canada
| | - Karen Gallant
- School of Health and Human Performance, Dalhousie University, 6230 South Street, P.O. Box 15000, Halifax, NS B3H 4R2 Canada
| | - Jeff Karabanow
- School of Social Work, Dalhousie University, Suite 3201-1459 LeMarchant Street, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Susan Kirkland
- Community Health & Epidemiology, Dalhousie University, 5790 University Ave., 4th Floor, Halifax, NS B3H 1 V7 Canada
| | - Dolores LeVangie
- School of Health and Human Performance, Dalhousie University, 6230 South Street, P.O. Box 15000, Halifax, NS B3H 4R2 Canada ; Atlantic Health Promotion Research Centre, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2 Canada
| | - Ingrid Sketris
- College of Pharmacy, Dalhousie University, 5968 College St, Halifax, NS B3H 4R2 Canada
| | - Michael Gossop
- National Addiction Centre, King's College London, PO48, 4 Windsor Walk, Denmark Hill, London, SE5 8BB UK
| | - Carolyn Davison
- Mental Health, Children's Services, and Addictions Branch, Nova Scotia Department of Health and Wellness, PO Box 488, Halifax, NS B3J 2R8 Canada
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Quanbeck AR, Gustafson DH, Ford JH, Pulvermacher A, French MT, McConnell KJ, McCarty D. Disseminating quality improvement: study protocol for a large cluster-randomized trial. Implement Sci 2011; 6:44. [PMID: 21524303 PMCID: PMC3108336 DOI: 10.1186/1748-5908-6-44] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 04/27/2011] [Indexed: 11/21/2022] Open
Abstract
Background Dissemination is a critical facet of implementing quality improvement in organizations. As a field, addiction treatment has produced effective interventions but disseminated them slowly and reached only a fraction of people needing treatment. This study investigates four methods of disseminating quality improvement (QI) to addiction treatment programs in the U.S. It is, to our knowledge, the largest study of organizational change ever conducted in healthcare. The trial seeks to determine the most cost-effective method of disseminating quality improvement in addiction treatment. Methods The study is evaluating the costs and effectiveness of different QI approaches by randomizing 201 addiction-treatment programs to four interventions. Each intervention used a web-based learning kit plus monthly phone calls, coaching, face-to-face meetings, or the combination of all three. Effectiveness is defined as reducing waiting time (days between first contact and treatment), increasing program admissions, and increasing continuation in treatment. Opportunity costs will be estimated for the resources associated with providing the services. Outcomes The study has three primary outcomes: waiting time, annual program admissions, and continuation in treatment. Secondary outcomes include: voluntary employee turnover, treatment completion, and operating margin. We are also seeking to understand the role of mediators, moderators, and other factors related to an organization's success in making changes. Analysis We are fitting a mixed-effect regression model to each program's average monthly waiting time and continuation rates (based on aggregated client records), including terms to isolate state and intervention effects. Admissions to treatment are aggregated to a yearly level to compensate for seasonality. We will order the interventions by cost to compare them pair-wise to the lowest cost intervention (monthly phone calls). All randomized sites with outcome data will be included in the analysis, following the intent-to-treat principle. Organizational covariates in the analysis include program size, management score, and state. Discussion The study offers seven recommendations for conducting a large-scale cluster-randomized trial: provide valuable services, have aims that are clear and important, seek powerful allies, understand the recruiting challenge, cultivate commitment, address turnover, and encourage rigor and flexibility. Trial Registration ClinicalTrials. govNCT00934141
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Affiliation(s)
- Andrew R Quanbeck
- Center for Health Enhancement Systems Studies, Industrial and Systems Engineering Department, University of Wisconsin-Madison, Madison, WI 53706, USA.
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Wu E, El-Bassel N, Gilbert L, Chang M, Sanders G. Effects of receiving additional off-site services on abstinence from illicit drug use among men on methadone: a longitudinal study. EVALUATION AND PROGRAM PLANNING 2010; 33:403-9. [PMID: 20034671 PMCID: PMC2891366 DOI: 10.1016/j.evalprogplan.2009.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 07/20/2009] [Accepted: 11/13/2009] [Indexed: 05/28/2023]
Abstract
Health and psychosocial service needs that may be co-morbid with opioid addiction may impede the success of drug treatment among patients attending methadone maintenance treatment programs (MMTPs). This longitudinal panel study investigates whether receipt of services from one or more helping professionals outside of the MMTP confers a benefit for drug treatment outcomes among a random sample of male MMTP patients (N=356). Each participant was interviewed 3 times, with 6 months between each interview. Since this observational study did not employ random assignment, propensity score matching was employed to strengthen causal validity of effect estimates. Results support hypotheses that receiving additional off-site services has significant beneficial effects in increasing the likelihood of abstaining from cocaine, heroin, and any illicit drug use over both the ensuing 6- and 12-month time periods. These findings indicate that receipt of additional medical and/or psychosocial services enhances the efficacy of methadone treatment in increasing abstinence from illicit drug use.
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Affiliation(s)
- Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, USA.
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20
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A transitional opioid program to engage hospitalized drug users. J Gen Intern Med 2010; 25:803-8. [PMID: 20237960 PMCID: PMC2896583 DOI: 10.1007/s11606-010-1311-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 09/08/2009] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Many opioid-dependent patients do not receive care for addiction issues when hospitalized for other medical problems. Based on 3 years of clinical practice, we report the Transitional Opioid Program (TOP) experience using hospitalization as a "reachable moment" to identify and link opioid-dependent persons to addiction treatment from medical care. METHODS A program nurse identified, assessed, and enrolled hospitalized, out-of-treatment opioid-dependent drug users based on their receipt of methadone during hospitalization. At discharge, patients transitioned to an outpatient interim opioid agonist program providing 30-day stabilization followed by 60-day taper. The nurse provided case management emphasizing HIV risk reduction, health education, counseling, and medical follow-up. Treatment outcomes included opioid agonist stabilization then taper or transfer to long-term opioid agonist treatment. RESULTS From January 2002 to January 2005, 362 unique hospitalized, opioid-dependent drug users were screened; 56% (n = 203) met eligibility criteria and enrolled into the program. Subsequently, 82% (167/203) presented to the program clinic post-hospital discharge; for 59% (119/203) treatment was provided, for 26% (52/203) treatment was not provided, and for 16% (32/203) treatment was not possible (pursuit of TOP objectives precluded by medical problems, psychiatric issues, or incarceration). Program patients adhered to a spectrum of medical recommendations (e.g., obtaining prescription medications, medical follow-up). CONCLUSIONS The Transitional Opioid Program (TOP) identified at-risk hospitalized, out-of-treatment opioid-dependent drug users and, by offering a range of treatment intensity options, engaged a majority into addiction treatment. Hospitalization can be a "reachable moment" to engage and link drug users into addiction treatment.
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Scaduto AA, Barbieri V. [The discourse about adherence of chemically dependent adolescents to treatment in a public health institution]. CIENCIA & SAUDE COLETIVA 2009; 14:605-14. [PMID: 19197435 DOI: 10.1590/s1413-81232009000200029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 07/09/2007] [Indexed: 11/21/2022] Open
Abstract
Promoting adherence to chemical dependence (CD) treatment has been a challenge in several contexts, especially regarding adolescents. Such challenge has been related to assumptions about who adolescents are, what is understood by dependence and about its treatment. Twelve professionals from a CD outpatient service in the region of Ribeirão Preto (SP) were interviewed about the meanings they attributed to the following subjects: adolescence, substance use/abuse and its treatment and adherence to such treatment. It was observed that the interviewees considered several determinants for explaining adolescence; however, there was a predominance of individualizing arguments regarding this subject. Chemical Dependence was understood as the individual's loss of self-control; consequently the aim of the treatment was favoring this individual's reflection about the role of substance use in his/her life. The interviewees showed a critical discourse, seeking for institutional and staff-related factors as well as for external factors to explain treatment adherence. The discourses of the interviewees are discussed in terms of their interrelations with the literature about the subjects approached in the interviews and its implications for CD treatment.
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Affiliation(s)
- Alessandro Antonio Scaduto
- Centro de Pesquisa e Psicologia Aplicada, Departamento de Psicologia e Educação, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto SP.
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Murphy MK, Chabon B, Delgado A, Newville H, Nicolson SE. Development of a substance abuse consultation and referral service in an academic medical center: challenges, achievements and dissemination. J Clin Psychol Med Settings 2009; 16:77-86. [PMID: 19219627 DOI: 10.1007/s10880-009-9149-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 01/20/2009] [Indexed: 11/26/2022]
Abstract
Approximately 25% of US hospital beds are occupied by individuals with active substance use disorders (SUD). Acute medical hospitalization provides an opportunity to address SUDs and provide patient-centered intervention and referral for treatment. Nationally, some hospitals have developed substance abuse consultation departments to improve the care of hospitalized substance users. In this paper we describe the Addiction Psychiatry Service (APS) in a large urban hospital which provides bed-side SUD consultation, screening, intervention and referral to treatment. APS utilizes the multiple disciplines of psychology, social work and medicine to integrate substance abuse services throughout the hospital and educate future generations of medical and psychology trainees. We conclude with how the APS service is informing the development of similar programs in other academic departments within our hospital and best practice recommendations to further disseminate this service model.
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Affiliation(s)
- Mary K Murphy
- Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
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Strathdee SA, Ricketts EP, Huettner S, Cornelius L, Bishai D, Havens JR, Beilenson P, Rapp C, Lloyd JJ, Latkin CA. Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial. Drug Alcohol Depend 2006; 83:225-32. [PMID: 16364566 PMCID: PMC2196224 DOI: 10.1016/j.drugalcdep.2005.11.015] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2005] [Revised: 11/12/2005] [Accepted: 11/15/2005] [Indexed: 12/12/2022]
Abstract
We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%, p=0.03). In a multivariate "intention to treat" model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional "as treated" analyses revealed that participants who received 30 min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment.
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Affiliation(s)
- Steffanie A Strathdee
- Division of International Health and Cross-Cultural Medicine, Department of Family and Preventive Medicine, University of California-San Diego, 9500 Gilman Drive, Ash Building, Room 118, Mailstop 0622, San Diego, CA 92093, USA.
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O'Toole TP, Conde-Martel A, Young JH, Price J, Bigelow G, Ford DE. Managing acutely ill substance-abusing patients in an integrated day hospital outpatient program: medical therapies, complications, and overall treatment outcomes. J Gen Intern Med 2006; 21:570-6. [PMID: 16808738 PMCID: PMC1924635 DOI: 10.1111/j.1525-1497.2006.00398.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 09/15/2005] [Accepted: 12/05/2005] [Indexed: 12/15/2022]
Abstract
BACKGROUND Substance-abusing adults are admitted to hospitals for medical complications from their drug and alcohol use at substantially higher rates than the general public; yet, their care is often defined by against medical advice (AMA) discharges and low rates of referral to addiction treatment programs. METHODS We present findings from a chart review of consecutive admissions to an integrated medical-substance abuse treatment program designed for acutely ill, hospitalized substance using adults. We specifically looked at factors associated with program completion and medical complications in this cohort of at-risk adults. RESULTS Overall, 83 patient cases were studied. The mean age was 41.2 years; most were African American (73.5%), male (68.7%), and homeless (77.1%). Heroin (96.4%) and cocaine (88.0%), followed by alcohol (44.6%) were the most commonly used substances before admission. The most common admitting diagnoses were infectious endocarditis (43.4%), abscess or nonhealing ulcer (18.1%), and osteomyelitis (13.3%) with intravenous antibiotic (68.7%), physical therapy (48.2%), or wound care (41.0%), the most commonly prescribed care on the integrated care/day hospital unit. The mean length of stay in the day hospital was 12.4 days. Overall, 69.9% of patients successfully completed their medical therapy, and 63.9% were successfully referred to an outpatient substance abuse treatment program. Only 10.8% required an unscheduled hospital readmission and 15.7% required an after-hours emergency department visit during their stay. CONCLUSION Outpatient/day hospital-based integrated treatment is a viable option for medically ill substance-abusing adults who would otherwise be hospitalized and is associated with higher than expected completion rates and low rate of complications. Co-locating the unit at a hospital and integrating extensive social supports appear to be key components to this model.
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Affiliation(s)
- Thomas P O'Toole
- Georgetown University School of Medicine, Washington, DC 20057, USA.
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25
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Sorensen JL, Masson CL, Delucchi K, Sporer K, Barnett PG, Mitsuishi F, Lin C, Song Y, Chen T, Hall SM. Randomized trial of drug abuse treatment-linkage strategies. J Consult Clin Psychol 2006; 73:1026-35. [PMID: 16392976 DOI: 10.1037/0022-006x.73.6.1026] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A clinical trial contrasted 2 interventions designed to link opioid-dependent hospital patients to drug abuse treatment. The 126 out-of-treatment participants were randomly assigned to (a) case management, (b) voucher for free methadone maintenance treatment (MMT), (c) case management plus voucher, or (d) usual care. Services were provided for 6 months. MMT enrollment at 3 months was 47% (case management), 89% (voucher), 93% (case management plus voucher), and 11% (usual care); at 6 months enrollment was 48%, 68%, 79%, and 21%, respectively. Case management and vouchers can be valuable in health settings to link substance abusers with medical problems to drug abuse treatment.
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Affiliation(s)
- James L Sorensen
- Department of Psychiatry, University of California, San Francisco, 94110, USA.
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26
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Wu E, El-Bassel N, Gilbert L, Piff J, Sanders G. Sociodemographic disparities in supplemental service utilization among male methadone patients. J Subst Abuse Treat 2004; 26:197-202. [PMID: 15063913 DOI: 10.1016/s0740-5472(03)00246-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2003] [Revised: 10/27/2003] [Accepted: 12/04/2003] [Indexed: 10/26/2022]
Abstract
The high prevalence of health and psychosocial needs among methadone treatment patients has prompted efforts to supplement methadone treatment with additional services. Research has generally focused on linking supplemental service utilization to drug treatment outcomes, with fewer studies aimed at understanding supplemental service utilization itself. This study with randomly selected male methadone maintenance treatment program (MMTP) patients examined associations between sociodemographic factors and supplemental service utilization while controlling for need for services and treatment duration. Findings indicate that MMTP patients who are African American, Latino, uninsured, or have less education were less likely to report any supplemental service utilization. Hypotheses positing sociodemographic differences in regular vs. occasional service utilization were not supported. There is a need to improve access to supplemental services for minority and disadvantaged MMTP patients, and MMTPs may represent an important venue to address health disparities in general.
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Affiliation(s)
- Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, 475 Riverside Drive #1842, New York, NY 10115, USA.
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27
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Predictors of Treatment Completion for Patients Receiving Residential Drug and Alcohol Treatment. ADDICTIVE DISORDERS & THEIR TREATMENT 2004. [DOI: 10.1097/00132576-200403000-00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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De Castro S, Sabaté E. Adherence to heroin dependence therapies and human immunodeficiency virus/acquired immunodeficiency syndrome infection rates among drug abusers. Clin Infect Dis 2004; 37 Suppl 5:S464-7. [PMID: 14648465 DOI: 10.1086/377561] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Adherence is a primary determinant of treatment effectiveness; thus, poor adherence attenuates optimum clinical benefit. A bibliographic review was conducted to evaluate the impact of adherence to heroin dependence treatment on human immunodeficiency virus (HIV) transmission and to identify interventions proven to be effective in improving adherence. The best adherence rates were achieved by methadone and diacetylmorphine, both of which are comparable in promoting significant reduction in heroin use. Methadone adjusted-dose studies with daily doses ranging from 100 to 200 mg and multiple support interventions achieved the highest adherence rates. Studies of methadone maintenance that examined changes in HIV prevalence of infection have found that higher treatment adherence is correlated with a reduction in HIV transmission. These data suggest that patients who adhere continuously to methadone treatment are less likely to continue injecting illicit drugs and sharing contaminated injection equipment than are those who interrupt treatment, thus preventing the spread of HIV via drug injection.
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Affiliation(s)
- Silvana De Castro
- Noncommunicable Diseases and Mental Health Cluster/Department of Management of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.
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29
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Abstract
Patients with a history of injected drug use are often distrustful of the medical system. This attitude is generally based on problems in the management of pain or withdrawal or on hostility from medical providers in the past. When treated with respect and appropriate medical concern, hospitalized injection drug users will often actively seek to begin recovery from drug use. Identifying injection drug use is the first step in providing appropriate care. Assessing and systematically addressing key management issues allows the provider to care for the hospitalized injection drug user effectively. The well-trained provider can be a significant catalyst for behavior change in the addicted population.
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Affiliation(s)
- John A Hopper
- Departments of Internal Medicine, Pediatrics, and Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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O'Toole TP, Strain EC, Wand G, McCaul ME, Barnhart M. Outpatient treatment entry and health care utilization after a combined medical/substance abuse intervention for hospitalized medical patients. J Gen Intern Med 2002. [PMID: 12047729 PMCID: PMC1495041 DOI: 10.1046/j.1525-1497.2002.10638.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CONTEXT Drug-abusing patients utilize extensive amounts of health services resources, yet the acute medical hospitalization has typically not been used effectively to engage patients in substance abuse treatment. OBJECTIVES To assess the effect of an integrated substance abuse/acute medical care day hospital (DH) intervention. DESIGN AND SETTING Prospective, consecutive chart review of patients referred to a day hospital program from the medicine service at an urban tertiary care teaching hospital. From the referral cohort, a comparison group receiving usual care was identified. PARTICIPANTS One hundred twenty adult medicine inpatients with active substance abuse and self-identified motivation to enter treatment. MAIN OUTCOME MEASURES Outpatient substance abuse treatment entry and post-intervention health services utilization. RESULTS Following DH treatment, 50.6% entered further outpatient substance abuse treatment (vs 2.4% comparison patients; P <.001). There was a significant increase in ambulatory medical visits for DH patients (pre-6 month 0.49 vs post-6 month 3.46; P <.001), greater than the change noted for comparison patients. However, there was no difference noted in pre-post hospitalization or emergency department utilization following the DH intervention. CONCLUSIONS A DH program for substance abusing hospitalized medicine patients that introduces substance abuse treatment during treatment for an acute medical illness does appear to improve outpatient substance abuse treatment entry and ambulatory care utilization after hospital discharge.
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Affiliation(s)
- Thomas P O'Toole
- Department of Medicine, Johns Hopkins University, Baltimore, Md., USA.
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Laine C, Zhang D, Hauck WW, Turner BJ. HIV-1 RNA viral load monitoring in HIV-infected drug users on antiretroviral therapy: relationship with outpatient care patterns. J Acquir Immune Defic Syndr 2002; 29:270-4. [PMID: 11873076 DOI: 10.1097/00126334-200203010-00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HIV-1 viral load (VL) testing is a standard component of HIV care. We examined the use and predictors of VL testing in drug users, a group at risk for problematic care. Using 1996 to 1998 New York State (NYS) Medicaid files, we studied drug users who had been enrolled >10 months, had been prescribed antiretroviral agents in 1997 and 1998, and who had undergone any VL testing in 1997. Our outcome was regular VL testing shown by two or more paid claims for this test in 1998. Patterns of care in 1997 were defined as: regular source of medical care (>35% of visits to one provider), and/or regular drug treatment of >6 months, or neither. We counted visits in 1997 to a provider offering HIV-focused care. Adjusted odds ratios (AORs) of VL testing were assessed. Of 3131 drug users, 73.9% had at least one VL test, whereas 56.2% had two or more VL tests in 1998. The AORs of two or more VL tests were increased for those with regular drug abuse care alone (AOR, 1.50; 95% confidence interval [CI], 1.21-1.84) or with regular medical care (AOR, 1.27; 95% CI, 1.03-1.57) versus those with neither. HIV-focused care was positively associated with two or more VL tests (AOR, 1.38; 95% CI, 1.05-1.81 for 1-3 visits; AOR, 1.94; 95% CI, 1.50-2.51 for four or more visits). We found that nearly half this cohort of drug users did not have regular VL testing. Drug users with HIV-focused care or with regular drug treatment are more likely to have regular VL testing.
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Affiliation(s)
- Christine Laine
- Division of Internal Medicine, Center for Research in Medical Education and Health Care, Jefferson Medical College, Thomas Jefferson University, Philadelphia, USA
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Lee MT, Reif S, Ritter GA, Levine HJ, Horgan CM. Access to services in the substance abuse treatment system. Variations by facility characteristics. RECENT DEVELOPMENTS IN ALCOHOLISM : AN OFFICIAL PUBLICATION OF THE AMERICAN MEDICAL SOCIETY ON ALCOHOLISM, THE RESEARCH SOCIETY ON ALCOHOLISM, AND THE NATIONAL COUNCIL ON ALCOHOLISM 2001; 15:137-56. [PMID: 11449739 DOI: 10.1007/978-0-306-47193-3_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
In view of the importance of type and intensity of services during substance abuse treatment, this chapter looks at treatment and support services that substance abuse clients have access to during treatment. Trends in services over recent years are described. Services available to clients in the current treatment system are reviewed. Several facility characteristics affecting access to services are examined. Different ways of defining access to services are discussed. Findings from the Alcohol and Drug Services Study are used to illustrate service patterns in the national substance abuse treatment system. Variations in service patterns by facility characteristics such as type of care, treatment setting, ownership, percent of facility dependence on public revenue, and level of affiliation are analyzed. The implication is that clients who enter into treatment at different types of facilities are likely to have access to certain types of services.
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Affiliation(s)
- M T Lee
- Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, Waltham, Massachusetts 02454-9110, USA
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McCorry F, Garnick DW, Bartlett J, Cotter F, Chalk M. Developing performance measures for alcohol and other drug services in managed care plans. Washington Circle Group. THE JOINT COMMISSION JOURNAL ON QUALITY IMPROVEMENT 2000; 26:633-43. [PMID: 11098426 DOI: 10.1016/s1070-3241(00)26054-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Monitoring the quality and availability of alcohol and other drug (AOD) services must be a central tenet of any health-related performance measurement system. The Washington Circle Group (WCG), which was convened by the Center for Substance Abuse Treatment Office of Managed Care in March 1998, has developed a core set of performance measures for AOD services for public- and private-sector health plans. It is also collaborating with a broad range of stakeholders to ensure widespread adoption of these performance measures by health plans, private employers, public payers, and accrediting organizations. CORE PERFORMANCE MEASURES Four domains were identified, with specific measures developed for each domain: (1) prevention/education, (2) recognition, (3) treatment (including initiation of alcohol and other plan services, linkage of detoxification and AOD plan services, treatment engagement, and interventions for family members/significant others), and (4) maintenance of treatment effects. CONTINUING EFFORTS Four measures that are based on administrative information from health plans and two measures that require a consumer survey of behavioral health care are undergoing extensive pilot testing. The WCG has reached out to a broad range of stakeholders in performance measurement and managed care to acquaint them with the measures and to promote their investigation and adoption. As results of pilot testing become available, these outreach efforts will continue. CONCLUSIONS Performance measures for AOD services need to become an integral part of a comprehensive set of behavioral and physical health performance measures for managed care plans.
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Affiliation(s)
- F McCorry
- Clinical Services Unit, New York State Office of Alcoholism and Substance Abuse, Albany, New York, USA
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