Prevalence of Unhealthy Substance Use on Teaching and Hospitalist Medical Services: Implications for Education

Abstract

The prevalence of unhealthy substance use (USU) among medical inpatients can vary, and prior research has not characterized the prevalence of USU among patients cared for by a teaching service (TS) and a nonteaching hospitalist service (NTHS). The objective of this study was to compare the prevalence of USU among patients cared for by a TS and an NTHS. We conducted a cross-sectional study from February to June 2009 at a community teaching hospital. Within 24 hours of admission, all eligible internal medicine admissions to the TS or NTHS were screened for USU, using the Alcohol Use Disorders Identification Test-Consumption and Drug Abuse Screening Test. Patients screening positive then underwent a diagnostic interview and blinded chart review to increase case finding and to assess whether each patient's admission was related to USU. There were 414 eligible and consenting patients out of 656 patients identified. Patients on the TS were younger and more likely to be current smokers, male, unmarried, non-white, and unemployed (p<.01 for all comparisons). TS patients were more likely to have evidence of USU (29.2% vs. 12.3%; p<.01). Among all admissions to the TS, 22.2% were deemed to be probably or possibly due to USU, as compared with only 3.7% of admissions to the NTHS (p<.01). Medical TSs care for a greater share of patients with USU as compared with an NTHS. These data highlight the need for expanded medical resident training in the diagnosis and management of USU.

Developing and Implementing a Multispecialty Graduate Medical Education Curriculum on Screening, Brief Intervention, and Referral to Treatment (SBIRT)

“…Only 8% and 2% of the state population who are in need of treatment for alcohol and other drug abuse/dependence, respectively, are receiving it (33). Many patients with unhealthy alcohol and other drug use are uninsured or underinsured and are cared for disproportionately by our residency programs (31).…”

Comparison of the Substance Use Brief Screen (SUBS) to the AUDIT-C and ASSIST for detecting unhealthy alcohol and drug use in a population of hospitalized smokers

“…Alcohol and drug use is highly prevalent among hospitalized patients, (Holt et al, 2012; Katz, Goldberg, Smith, & Trick, 2008; Smothers & Yahr, 2005), and has important health impacts, but in the absence of systematic screening it frequently goes unidentified. Adults with substance use disorders have higher hospitalization rates, and sustain higher acute health care costs, in comparison to the general population (Gryczynski et al, 2016; Santora & Hutton, 2008; Stein, 1999).…”

“…Patients with substance use disorders may be less adherent to treatment and have weaker connections to primary care (Hinkin et al, 2007; Samsone & Sansone, 2008; Tucker et al, 2004). Hospitalized patients have high rates of severe SUDs in comparison to patients seen in outpatient settings (Holt et al, 2012), and the inpatient stay can be an opportunity to engage these patients in SUD treatment.…”

Caring for patients with opioid use disorder in the hospital

“…In two studies conducted in urban hospitals in the United States, substance use not related to alcohol or tobacco among hospital inpatients was about 11%, not including patients stabilized on opioid agonist therapy. 15,16 In practice, either inpatients will have a previous diagnosis of opioid use disorder or providers will become concerned about this condition in patients who exhibit certain "red flag" behaviours. These behaviours may be evident only after discussions with primary care providers and upon review of data from prior hospital admissions and prescription monitoring programs.…”