Strategies to support substance use disorder care transitions from acute-care to community-based settings: a scoping review and typology

Abstract

Background Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies. Methods We searched Pubmed, Embase, CINAHL and PsychINFO for peer-reviewed articles published between 2000 and 2021 that studied interventions linking patients with SUD from ED or inpatient hospital settings to community-based SUD services. Eligible articles measured at least one post-discharge treatment outcome and included a description of the strategy used to promote linkage to community care. Detailed information was extracted on the components of the transition strategies and a thematic coding process was used to categorize strategies into a typology based on shared characteristics. Facilitators and barriers to transitions of care were synthesized using the Consolidated Framework for Implementation Research. Results Forty-five articles met inclusion criteria. 62% included ED interventions and 44% inpatient interventions. The majority focused on patients with opioid (71%) or alcohol (31%) use disorder. The transition strategies reported across studies were heterogeneous and often not well described. An initial typology of ten transition strategies, including five pre- and five post-discharge transition strategies is proposed. The most common strategy was scheduling an appointment with a community-based treatment provider prior to discharge. A range of facilitators and barriers were described, which can inform efforts to improve hospital-to-community transitions of care. Conclusions Strategies to support transitions from acute-care to community-based SUD services, although critical for ensuring continuity of care, vary greatly across interventions and are inconsistently measured and described. More research is needed to classify SUD care transition strategies, understand their components, and explore which lead to the best patient outcomes.

Strategies to improve delivery of equitable and evidence-informed care for pregnant and birthing people with a substance use disorder in acute care settings: A scoping review protocol

“…A preliminary search of MEDLINE (PubMed), Google Scholar, OSF, and Prospero found no existing or planned reviews on this specific topic. Existing reviews on acute care interventions and transitions from hospital to the community focus on patients with SUD broadly, [ 26 , 27 ] but do not specifically describe those that target pregnant or birthing people with gender-related social needs [ 28 ]. Our study extends beyond a previous review by Lim et al [ 29 ], which primarily focused on evidence related to clinical practices in OUD and peri-delivery pain management.…”

Linking Hospitalized Patients With Opioid Use Disorder to Treatment—The Importance of Care Transitions

“…Postdischarge strategies commonly described included transportation assistance and care navigation, bridge prescription and follow-up calls and/or texts, and peer support. 3 In the study by Marcovitz et al, 2 both the bridge clinic and usual care groups received many of the care transition strategies highlighted by this scoping review, with the main difference between intervention groups being the type of predischarge linkage to treatment. Patients in the bridge clinic group received enhanced case management during hospitalization and met bridge staff prior to discharge.…”

“…The literature surrounding best practices in care transitions for hospitalized patients with OUD is limited but of growing interest as hospitals seek to address the overdose crisis. A recent scoping review of substance use–related care transition strategies from acute care to outpatient settings found the predischarge strategies most commonly described included scheduling an appointment, discussing treatment options, unspecified linkage to treatment, and giving patients a clinician list. Postdischarge strategies commonly described included transportation assistance and care navigation, bridge prescription and follow-up calls and/or texts, and peer support .…”

“…A recent scoping review of substance use–related care transition strategies from acute care to outpatient settings found the predischarge strategies most commonly described included scheduling an appointment, discussing treatment options, unspecified linkage to treatment, and giving patients a clinician list. Postdischarge strategies commonly described included transportation assistance and care navigation, bridge prescription and follow-up calls and/or texts, and peer support . In the study by Marcovitz et al, both the bridge clinic and usual care groups received many of the care transition strategies highlighted by this scoping review, with the main difference between intervention groups being the type of predischarge linkage to treatment.…”