Patterns of substance use before and after hospitalization among patients seen by an inpatient addiction consult service: A latent transition analysis

King, Caroline; Nicolaidis, Christina; Korthuis, P. Todd; Priest, Kelsey C.; Englander, Honora

doi:10.1016/j.jsat.2020.108121

Cited by 33 publications

(36 citation statements)

References 46 publications

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“…This study is part of the larger IMPACT intervention project, which uses a multiphase mixed methods design. 22 We started with qualitative and quantitative studies to inform the intervention, 13,23 and have conducted multiple, iterative qualitative, 12,24 quantitative, 10,25,26 and mixed-methods 27 evaluations at different time-points. For this particular analysis, we use an embedded design.…”

Section: Mixed Methods Analysismentioning

confidence: 99%

Trust in Hospital Physicians Among Patients With Substance Use Disorder Referred to an Addiction Consult Service: A Mixed-methods Study

King

Collins

Patten

et al. 2021

Journal of Addiction Medicine

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Background: Trust is essential in patient-physician relationships. Hospitalized patients with substance use disorders (SUDs) often experience stigma and trauma in the hospital, which can impede trust. Little research has explored the role of hospital-based addictions care in creating trusting relationships with patients with SUDs. This study describes how trust in physicians changed among hospitalized people with SUDs who were seen by an interprofessional addiction medicine service. Methods:We analyzed data from hospitalized patients with SUD seen by an addiction consult service from 2015 to 2018. Participants completed surveys at baseline and 30 to 90 days after hospital discharge. Follow-up assessments included open-ended questions exploring participant experiences with hospitalization and the addiction consult service. We measured provider trust using the Wake Forest Trust scale. We modeled trust trajectories using discrete mixture modeling, and sampled qualitative interviews from those trust trajectories. Results: Of 328 participants with SUD who had prior hospitalizations but had not previously been seen by an addiction consult service, 196 (59.8%) had both baseline and follow-up trust scores. We identified 3 groups of patients: Persistent-Low Trust, Increasing Trust, and Persistent-High Trust and 4 qualitative themes around inhospital trust: humanizing care, demonstrating addiction expertise, reliability, and granting agency. Conclusions: Most participants retained or increased to high trust levels after hospitalization with an addiction consult service. Addiction consult services can create environments where healthcare providers build trust with, and humanize care for, hospitalized patients with SUD, and can also mitigate power struggles that hospitalized patients with SUD frequently experience.

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Section: Mixed Methods Analysismentioning

confidence: 99%

Trust in Hospital Physicians Among Patients With Substance Use Disorder Referred to an Addiction Consult Service: A Mixed-methods Study

King

Collins

Patten

et al. 2021

Journal of Addiction Medicine

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“…1,2 Most people with SUD who present to general medical hospitals are not seeking addictions treatment, but hospitalization can be a pivotal moment to engage patients and initiate SUD care. 3,4 Hospital-based addictions care is associated with improved patient experience, 5,6 improved post-hospital SUD treatment engagement, 7,8 decreased substance use severity, 7,9 improved provider experience, 10 and lower costs. 7 Yet, most hospitals do not treat addiction.…”

Section: Introductionmentioning

confidence: 99%

Spreading Addictions Care Across Oregon’s Rural and Community Hospitals: Mixed-Methods Evaluation of an Interprofessional Telementoring ECHO Program

et al. 2020

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BACKGROUND: Despite evidence of effectiveness, most US hospitals do not deliver hospital-based addictions care. ECHO (Extension for Community Healthcare Outcomes) is a telementoring model for providers across diverse geographic areas. We developed and implemented a substance use disorder (SUD) in hospital care ECHO to support statewide dissemination of best practices in hospital-based addictions care. OBJECTIVES: Assess the feasibility, acceptability, and effects of ECHO and explore lessons learned and implications for the spread of hospital-based addictions care. DESIGN: Mixed-methods study with a pre-/post-intervention design. PARTICIPANTS: Interprofessional hospital providers and administrators across Oregon. INTERVENTION: A 10-12-week ECHO that included participant case presentations and brief didactics delivered by an interprofessional faculty, including peers with lived experience in recovery. APPROACH: To assess feasibility and acceptability, we collected enrollment, attendance, and participant feedback data. To evaluate ECHO effects, we used pre-/post-ECHO assessments and performed a thematic analysis of open-ended survey responses and participant focus groups. KEY RESULTS: We recruited 143 registrants to three cohorts between January and September 2019, drawing from 32 of Oregon's 62 hospitals and one southwest Washington hospital. Ninety-six (67.1%) attended at least half of ECHO sessions. Participants were highly satisfied with ECHO. After ECHO, participants were more prepared to treat SUD; however, prescribing did not change. Participants identified substantial gains in knowledge and skills, particularly regarding the use of medications for opioid use disorder; patient-centered communication with people who use drugs; and understanding harm reduction as a valid treatment approach. ECHO built a community of practice and reduced provider isolation. Participants recognized the need for supportive hospital leadership, policies, and SUD resources to fully implement and adopt hospital-based SUD care. CONCLUSIONS: A statewide, interprofessional SUD hospital care ECHO was feasible and acceptable. Findings may be useful to health systems, states, and regions looking to expand hospital-based addictions care.

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“…In addition, this study did not explicitly review the proportions of patients with polysubstance use and stimulant use, which have been noted in the substance use patterns of non-VA hospitalized inpatients. 11 Lastly, this analysis does not reflect patterns of substance use during the COVID-19 pandemic. Anecdotally, we have seen high rates of substance use among inpatients during the pandemic, likely because of isolation and lack of usual anchors of abstinence such as work, family, and support groups.…”

Section: Discussionmentioning

confidence: 95%

“…Alcohol and opioids were chosen because these substances have been identified in use patterns of inpatients and because both have well-studied MAT options that can be initiated during inpatient admission. 11 Nicotine was not analyzed as a subgroup because it is usually managed by primary medical and mental health care providers.…”

Section: Methodsmentioning

confidence: 99%

Addiction Services for Veterans: Opportunities in Acute Care

Shah

Starks

Wander

et al. 2022

Journal of Addiction Medicine

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ObjectiveThis study aimed to estimate the proportion of total hospital discharges that involved a primary or secondary substance-related diagnosis code (SubDx) on inpatient medicine, psychiatry, and surgery services as part of a needs assessment for inpatient addiction consultation at our large, academic-affiliated Veterans Affairs (VA) hospital.MethodsWe first calculated the percentage of total and service-specific discharges with a primary or secondary substance-related International Classification of Disease, Tenth Revision, code on all inpatient services (medicine, psychiatry, and surgery) in Fiscal Year 2017, 2018, and 2019, using facility-level data. Second, we calculated the proportion of total discharges that involved alcohol- and opioid-related diagnoses.ResultsOver the 3 years studied, 29% of total discharges had a SubDx (4469 of 15,575). The proportion of total discharges that involved a SubDx was 23% (1246 of 5449) in 2017, 31% (1664 of 5332) in 2018, and 33% in 2019 (1559 of 4794), a statistically significant increase (P < 0.001). As a percentage of service-specific discharges, 65% of discharges from psychiatry (1446 of 2217) had a SubDx, compared with 25% from medicine (2469 of 9713), and 15% from surgery (554 of 3645). Medicine services had the most discharges with SubDx, with a year-over-year increase in the number of discharges with SubDx. The percentage of total discharges that involved alcohol- and opioid-related diagnoses was 14% and 4%, respectively.ConclusionsSubstance-related diagnoses are prevalent at our hospital and are increasing over time. The largest number of discharges with SubDx was found on medicine services. Alcohol-related diagnoses were nearly 4 times more prevalent than opioid-related diagnoses. We found focused need around alcohol use and alcohol withdrawal.

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Patterns of substance use before and after hospitalization among patients seen by an inpatient addiction consult service: A latent transition analysis

Cited by 33 publications

References 46 publications

Trust in Hospital Physicians Among Patients With Substance Use Disorder Referred to an Addiction Consult Service: A Mixed-methods Study

Trust in Hospital Physicians Among Patients With Substance Use Disorder Referred to an Addiction Consult Service: A Mixed-methods Study

Spreading Addictions Care Across Oregon’s Rural and Community Hospitals: Mixed-Methods Evaluation of an Interprofessional Telementoring ECHO Program

Addiction Services for Veterans: Opportunities in Acute Care

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