Pilot randomized controlled trial of a hospital-based substance use treatment and recovery team (START) to improve initiation of medication for alcohol or opioid use disorder and linkage to follow-up care

Ober, Allison J.; Osilla, Karen Chan; Klein, David J.; Burgette, Lane F.; Leamon, Isabel; Mazer, Mia W.; Messineo, Gabrielle; Collier, Stacy; Korouri, Samuel; Watkins, Katherine E.; IsHak, Waghui; Nuckols, Teryl K.; Danovitch, Itai

doi:10.1016/j.josat.2023.209063

Cited by 4 publications

(1 citation statement)

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“…A growing body of evidence from observational studies suggests that treating OUD during hospitalization can be associated with better hospital care, increased use of MOUD, lessened addiction severity, improved trust in clinicians, and reduced mortality after discharge . However, other than a small pilot study, to our knowledge, there have been no prospective randomized clinical trials of the effectiveness of hospital addiction consultation services compared with a control condition. Our pragmatic implementation-effectiveness trial, which was conducted in a large public hospital system, tested the hypothesis that an interprofessional addiction consultation service can increase postdischarge MOUD initiation and engagement.…”

Section: Introductionmentioning

confidence: 99%

Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement

McNeely,

Wang,

Rostam Abadi

et al. 2024

JAMA Intern Med

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ImportanceMedications for opioid use disorder (MOUD) are highly effective, but only 22% of individuals in the US with opioid use disorder receive them. Hospitalization potentially provides an opportunity to initiate MOUD and link patients to ongoing treatment.ObjectiveTo study the effectiveness of interprofessional hospital addiction consultation services in increasing MOUD treatment initiation and engagement.Design, Setting, and ParticipantsThis pragmatic stepped-wedge cluster randomized implementation and effectiveness (hybrid type 1) trial was conducted in 6 public hospitals in New York, New York, and included 2315 adults with hospitalizations identified in Medicaid claims data between October 2017 and January 2021. Data analysis was conducted in December 2023. Hospitals were randomized to an intervention start date, and outcomes were compared during treatment as usual (TAU) and intervention conditions. Bayesian analysis accounted for the clustering of patients within hospitals and open cohort nature of the study. The addiction consultation service intervention was compared with TAU using posterior probabilities of model parameters from hierarchical logistic regression models that were adjusted for age, sex, and study period. Eligible participants had an admission or discharge diagnosis of opioid use disorder or opioid poisoning/adverse effects, were hospitalized at least 1 night in a medical/surgical inpatient unit, and were not receiving MOUD before hospitalization.InterventionsHospitals implemented an addiction consultation service that provided inpatient specialty care for substance use disorders. Consultation teams comprised a medical clinician, social worker or addiction counselor, and peer counselor.Main Outcomes and MeasuresThe dual primary outcomes were (1) MOUD treatment initiation during the first 14 days after hospital discharge and (2) MOUD engagement for the 30 days following initiation.ResultsOf 2315 adults, 628 (27.1%) were female, and the mean (SD) age was 47.0 (12.4) years. Initiation of MOUD was 11.0% in the Consult for Addiction Treatment and Care in Hospitals (CATCH) program vs 6.7% in TAU, engagement was 7.4% vs 5.3%, respectively, and continuation for 6 months was 3.2% vs 2.4%. Patients hospitalized during CATCH had 7.96 times higher odds of initiating MOUD (log-odds ratio, 2.07; 95% credible interval, 0.51-4.00) and 6.90 times higher odds of MOUD engagement (log-odds ratio, 1.93; 95% credible interval, 0.09-4.18).ConclusionsThis randomized clinical trial found that interprofessional addiction consultation services significantly increased postdischarge MOUD initiation and engagement among patients with opioid use disorder. However, the observed rates of MOUD initiation and engagement were still low; further efforts are still needed to improve hospital-based and community-based services for MOUD treatment.Trial RegistrationClinicalTrials.gov Identifier: NCT03611335

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Section: Introductionmentioning

confidence: 99%

Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement

McNeely,

Wang,

Rostam Abadi

et al. 2024

JAMA Intern Med

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The addiction consultation service for hospitalized patients with substance use disorder: An integrative review of the evidence

Danovitch,

Korouri,

Kaur

et al. 2024

Journal of Substance Use and Addiction Treatment

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Hospitalists' Attitudes and Experiences With Posthospitalization Care Transitions for Patients With Substance Use Disorders: A Cross-sectional Analysis

Incze,

Huebler,

Chen

et al. 2024

J Addict Med

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Background Medical hospitalizations are relatively common among individuals who have substance use disorders (SUDs) and represent opportunities for patient engagement and treatment. Posthospitalization transitions of care are an important element of providing full-spectrum inpatient SUD care; however, little is known about clinicians' experiences with postdischarge care transitions. Methods We conducted a cross-sectional study surveying hospital-based medical clinicians (ie, “hospitalists”) across 2 large health systems in the state of Utah to assess current practices, barriers, facilitators, and perceptions toward posthospitalization care transitions for patients with SUDs. We used Wilcoxon signed-rank tests to identify the most impactful barriers and facilitators among all respondents. We used logistic regression models to explore the influence of hospitalists' attitudes toward providing SUD care on perceived barriers and facilitators. Results The survey was distributed to 429 individuals across 15 hospitals. Eighty-two hospitalists responded to the survey (response rate, 21.4%). Most respondents frequently cared for hospitalized patients with SUDs (n = 63, 77%) and prescribed medications for SUDs (n = 44, 56%). Four respondents (5%) felt that patients received adequate support during care transitions. Lack of social support (P < 0.001) and social factors such as lack of transportation (P < 0.001) were perceived as the largest barriers to successful care transitions. Conversely, a partnering outpatient clinic/clinician (P < 0.001) and outpatient-based care coordination (P < 0.001) were perceived as the strongest facilitators. Respondents' attitudes toward people with SUDs had a modest effect on perceived barriers and facilitators. Conclusions Hospitalists perceived increased outpatient SUD treatment infrastructure and transitional care supports as most important in facilitating posthospitalization care transitions for patients with SUDs.

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Pilot randomized controlled trial of a hospital-based substance use treatment and recovery team (START) to improve initiation of medication for alcohol or opioid use disorder and linkage to follow-up care

Cited by 4 publications

References 100 publications

Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement

Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement

The addiction consultation service for hospitalized patients with substance use disorder: An integrative review of the evidence

Hospitalists' Attitudes and Experiences With Posthospitalization Care Transitions for Patients With Substance Use Disorders: A Cross-sectional Analysis

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