“OPTIONS-DC”, a feasible discharge planning conference to expand infection treatment options for people with substance use disorder

Abstract

Background Serious bacterial infections associated with substance use often result in long hospitalizations, premature discharges, and high costs. Out-of-hospital treatment options in people with substance use disorder (SUD) are often limited. Methods We describe a novel multidisciplinary and interprofessional care conference, “OPTIONS-DC,” to identify treatment options agreeable to both patients and providers using the frameworks of harm reduction and patient-centered care. We retrospectively reviewed charts of patients who had an OPTIONS-DC between February 2018 and July 2019 and used content analysis to understand the conferences’ effects on antibiotic treatment options. Results Fifty patients had an OPTIONS-DC during the study window. Forty-two (84%) had some intravenous (IV) substance use and 44 (88%) had an active substance use disorder. Participants’ primary substances included opioids (65%) or methamphetamines (28%). On average, conferences lasted 28 min. OPTIONS-DC providers recommended out-of-hospital antibiotic treatment options for 34 (68%) of patients. OPTIONS-DC recommended first line therapy of IV antibiotics for 35 (70%) patients, long-acting injectable antibiotics for 14 (28%), and oral therapy for 1 (2%). 35 (70%) patients that had an OPTIONS-DC completed an antibiotic course and 6 (12%) left the hospital prematurely. OPTIONS-DC expanded treatment options by exposing and contextualizing SUD, psychosocial risk and protective factors; incorporating patient preferences; and allowing providers to tailor antibiotic and SUD recommendations. Conclusions OPTIONS-DC is a feasible intervention that allows providers to integrate principles of harm reduction and offer patient-centered choices among patients needing prolonged antibiotic treatment.

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

“…While this might seem curious, it is because, despite leaving against medical advice, these participants remained reachable, often providing reliable contact information and agreeing to follow up before leaving the medical facility. Further, the involvement of a dedicated, interprofessional team focused on co-management of substance use disorder and infections aided discharge discussions, similar to that proposed by other models ( 34 ). In contrast, preintervention patients were left without similar options, and many who did discharge against the medical team's advice did so in a less coordinated way, often remaining unreachable or, when reached, declining to discuss their stay.…”

Health care professional perspectives on discharging hospitalized patients with injection drug use-associated infections

“…OPTIONS-DC, a multidisciplinary and interprofessional care conference developed at Oregon Health & Science University, works under harm reduction and patient-centered models to identify treatment options which are acceptable to both patients and HCPs, and investigators demonstrated that it is entirely feasible to integrate practices of harm reduction into treatment for patients who need long-term antibiotic treatment. 29 Other studies have shown that hospital-based harm reduction promotes patient-centered care. 30 In our study, many participants emphasized harm reduction principles and the importance of prioritizing the needs and preferences of PWUD, even when those preferences are against what HCPs believe to be the best treatment course for the patient.…”

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

“…Intensive and collaborative clinical care and coordination by dedicated, expert teams, in the style of tumor boards, can ameliorate some of the challenges of the fragmented health and social support systems. 29 …”