Evaluation of Bundled Interventions for Patients With Opioid Use Disorder Experiencing Homelessness Receiving Extended Antibiotics for Severe Infection

Beieler, Alison M; Klein, Jared W.; Bhatraju, Elenore P.; Iles-Shih, Matthew; Enzian, Leslie; Dhanireddy, Shireesha

doi:10.1093/ofid/ofab285

Cited by 15 publications

(20 citation statements)

References 16 publications

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“…Our study found a similar level of overall OPAT completion (64%) as other studies of similar populations at skilled nursing facilities or SUD treatment facilities (49-73%). 6 , 13 – 15 Rates of OPAT completion may be lower in PWID or those experiencing homelessness, 16 which was common in our study.…”

Section: Discussionmentioning

confidence: 64%

“…Beieler et al 13 performed a small but innovative study of four different interventions (ID consultation, addiction consultation, case management, and MOUD at discharge) in people with OUD experiencing homelessness who were treated with mostly (86%) IV antibiotics at a residential SUD treatment facility. The investigators found that use of all four interventions was associated with improved clinical cure of infection and retention in addiction treatment.…”

Section: Discussionmentioning

confidence: 99%

“…One retrospective study of people with OUD who completed IV or oral antibiotics at a medical respite facility did not demonstrate an association between a four-part intervention that included MOUD initiation and successful antibiotic completion. 13 This study was relatively small and did not report baseline MOUD use or antibiotic completion by discharge MOUD prescription.…”

Section: Introductionmentioning

confidence: 97%

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Medication for opioid use disorder at hospital discharge is not associated with intravenous antibiotic completion in post-acute care facilities

Traver

Ching

Narayanan

2022

Therapeutic Advances in Infection

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Background: People with opioid use disorder and severe infections may complete their prolonged courses of outpatient parenteral antimicrobial therapy at a post-acute care facility due to adherence and safety concerns. We hypothesized that treatment with medications for opioid use disorder, such as methadone and buprenorphine, would increase antibiotic completion in these facilities. Methods: We performed a retrospective cohort study of people with opioid use disorder and severe infections who were discharged from the University of Maryland Medical Center to a post-acute care facility to complete intravenous antibiotic therapy. The primary outcome was completion of outpatient parenteral antimicrobial therapy. We compared the rate of antibiotic completion between patients prescribed and not prescribed medication for opioid use disorder at discharge from the acute care hospital. Results: A total of 161 patient encounters were included; the mean age was 43.4 years and 56% of patients were male. In 48% of the encounters, the patient was homeless and in 68% they recently injected drugs. The most common infectious syndrome was osteoarticular (44.1%). Medication for opioid use disorder was prescribed at discharge in 103 of 161 encounters and was newly started in 27 encounters. Similar rates of outpatient parenteral antimicrobial therapy completion were found in those who received (65/103) and did not receive (33/58) medication for opioid use disorder at discharge (odds ratio: 1.29; 95% confidence interval: 0.68–2.54; p = 0.44). Conclusion: Medication for opioid use disorder prescription at discharge was not associated with completion of outpatient parenteral antimicrobial therapy in a post-acute care facility. Our study is limited by possible selection bias and infrequent initiation of medication for opioid use disorder, which may have minimized the effect on antibiotic completion.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Medication for opioid use disorder at hospital discharge is not associated with intravenous antibiotic completion in post-acute care facilities

Traver

Ching

Narayanan

2022

Therapeutic Advances in Infection

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“…Beieler et al performed a retrospective cohort review of a bundle intervention ([1] ID consult, [2] addiction medicine consult, [3] referral to case management, and [4] medications for OUD usage [MOUD]) approach to the management of patients experiencing homelessness who require at least 14 days of antibiotic treatment (IV or oral) within a 2-year period at 1 urban county hospital in the United States [ 6 ]. In total, 53 patients were included, representing 63 infectious episodes.…”

Section: Publication Summariesmentioning

confidence: 99%

A Bundle of the Top 10 OPAT Publications in 2021

Rivera

Beieler

Childs‐Kean

et al. 2022

Open Forum Infectious Diseases

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“…A growing body of evidence suggests that hospital outcomes for infectious complications of IDU are improved when people who inject opioids are treated with medications for opioid use disorder (MOUD) (8)(9)(10)(11). In patients presenting with OUD, MOUD have been associated with a decrease in all-cause mortality, overdose events, and need for acute care related to opioid use (12,13).…”

Section: Introductionmentioning

confidence: 99%

Experiences Using a Multidisciplinary Model for Treating Injection Drug Use Associated Infections: A Qualitative Study

et al. 2022

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BackgroundOver the past two decades, the United States has experienced a dramatic increase in the rate of injection drug use, injection associated infections, and overdose mortality. A hospital-based program for treating opioid use disorder in people who inject drugs presenting with invasive infections was initiated at an academic tertiary care center in 2020. The goal of this program was to improve care outcomes, enhance patient experiences, and facilitate transition from the hospital to longer term addiction care. The purpose of this study was to interview two cohorts of patients, those admitted before vs. after initiation of this program, to understand the program's impact on care from the patient's perspective and explore ways in which the program could be improved.MethodsThirty patients admitted to the hospital with infectious complications of injection drug use were interviewed using a semi-structured format. Interviews were transcribed and coded. Emergent themes were reported. Limited descriptive statistics were reported based on chart review.ResultsThirty interviews were completed; 16 participants were part of the program (admitted after program implementation) while 14 were not participants (admitted prior to implementation). Common themes associated with hospitalization included inadequate pain control, access to medications for opioid use disorder (MOUD), loss of freedom, stigma from healthcare personnel, and benefits of having an interprofessional team. Participants in the program were more likely to report adequate pain control and access to MOUD and many cited benefits from receiving care from an interprofessional team.ConclusionsPatients with opioid use disorder admitted with injection related infections reported improved experiences when receiving care from an interprofessional team focused on their addiction. However, perceived stigma from healthcare personnel and loss of freedom related to hospitalization were continued barriers to care before and after implementation of this program.

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Evaluation of Bundled Interventions for Patients With Opioid Use Disorder Experiencing Homelessness Receiving Extended Antibiotics for Severe Infection

Cited by 15 publications

References 16 publications

Medication for opioid use disorder at hospital discharge is not associated with intravenous antibiotic completion in post-acute care facilities

Medication for opioid use disorder at hospital discharge is not associated with intravenous antibiotic completion in post-acute care facilities

A Bundle of the Top 10 OPAT Publications in 2021

Experiences Using a Multidisciplinary Model for Treating Injection Drug Use Associated Infections: A Qualitative Study

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