A Taxonomy of Hospital-Based Addiction Care Models: a Scoping Review and Key Informant Interviews

Abstract

BACKGROUND: There is pressing need to improve hospital-based addiction care. Various models for integrating substance use disorder care into hospital settings exist, but there is no framework for describing, selecting, or comparing models. We sought to fill that gap by constructing a taxonomy of hospital-based addiction care models based on scoping literature review and key informant interviews. METHODS: Methods included a scoping review of the literature on US hospital-based addiction care models and interventions for adults, published between January 2000 and July 2021. We conducted semi-structured interviews with 15 key informants experienced in leading, implementing, evaluating, andpracticing hospital-based addiction care to explore model characteristics, including their perceived strengths, limitations, and implementation considerations. We synthesized findings from the literature review and interviews to construct a taxonomy of model types. RESULTS: Searches identified 2,849 unique abstracts. Of these, we reviewed 280 full text articles, of which 76 were included in the final review. We added 8 references from reference lists and informant interviews, and 4 gray literature sources. We identified six distinct hospitalbased addiction care models. Those classified as addiction consult models include (1) interprofessional addiction consult services, (2) psychiatry consult liaison services, and (3) individual consultant models. Those classified as practice-based models, wherein general hospital staff integrate addiction care into usual practice, include (4) hospital-based opioid treatment and (5) hospital-based alcohol treatment. The final type was (6) communitybased in-reach, wherein community providers deliver care. Models vary in their target patient population, staffing, and core clinical and systems change activities. Limitations include that some models have overlapping characteristics and variable ways of delivering core components. DISCUSSION: A taxonomy provides hospital clinicians and administrators, researchers, and policy-makers with a framework to describe, compare, and select models for implementing hospital-based addiction care and measure outcomes.

Management of opioid use disorder, opioid withdrawal, and opioid overdose prevention in hospitalized adults: A systematic review of existing guidelines

“…Finally, guidelines do not specify how hospitals should deliver these recommendations. Various approaches to delivering hospital‐based OUD treatment exist, and future work should explore what models best support effective delivery of evidence‐based guidelines 75 …”

Availability of medications for opioid use disorder in outpatient and inpatient pharmacies in South Florida: a secret shopper survey

“…While our study found higher inpatient availability of buprenorphine in South Florida (88%), we identified further hospital policy-level barriers to induction, most often based on provider specialty restrictions. Englander and colleagues described the variety of approaches to hospital-based OUD care, which could include generalists or specialists as the team tasked with OUD treatment [32]. They suggest that formal protocols for opioid withdrawal or treatment are necessary, at a minimum, to help prompt appropriate care.…”

Implementation of an integrated infectious disease and substance use disorder team for injection drug use-associated infections: a qualitative study

“…Based on the local burden of SIRIs and lack of inpatient addiction medicine consult services, we developed an integrated infectious disease/SUD treatment intervention in 2020 called the Jackson SIRI team. Using Englander and colleagues’ taxonomy of hospital-based addiction care, the SIRI team is a hospital-based opioid treatment (HBOT) program , but additionally includes substantial post-hospital care [ 25 ]. The SIRI team intervention provides integrated infectious disease and SUD treatment across the healthcare continuum, starting from the inpatient setting and continuing for 90-days post-hospital discharge.…”

“…A multidisciplinary approach that incorporates infectious disease (ID) and addiction care in the hospital and after discharge has the potential to mitigate many of the barriers to successful individual and health system outcomes for patients experiencing SIRIs [20]. Some existing models of integrated ID/SUD teams include ID specialists, addiction medicine specialists, psychiatrists, and surgeons and may incorporate pharmacotherapy, behavioral treatments, harm reduction and post discharge follow-up for patients [21][22][23][24][25]. Previous research has demonstrated that integration of evidence-based addiction treatment-such as medications for opioid use disorder (MOUD)-is associated with fewer patient-directed discharges [26,27], lower readmission rates [21,28], higher rates of antimicrobial therapy completion [26,29], higher post-discharge SUD treatment engagement [30], and reduced substance use at 30 days [31].…”