The Need for Multidisciplinary Hospital Teams for Injection Drug Use-related Infective Endocarditis

Abstract

Injection drug use-related infective endocarditis (IDU-IE) is a complex disease with increasing incidence. Although universally recognized that IDU-IE requires antibiotics and often requires cardiac surgery, most patients do not receive addiction treatment which substantially increases their risk of recurrent IDU-IE from drug use recurrence. Accordingly, a multidisciplinary approach integrating addiction treatment may benefit patients with IDU-IE. We describe the format and structure of a team called the Multidisciplinary Endocarditis Evaluation Team (MEET) whose purpose is to optimize, formalize, and standardize the care of patients with IDUIE. Given the complexity of IDU-IE, MEET is comprised of addiction medicine, anesthesia, cardiology, cardiac surgery, infectious disease, case management, nursing, and social work. MEET strived to be acceptable to patients and families to support their preferences and values. MEET focused treatment of IDU-IE on the patient’s medical and surgical needs with attention to the patients’ underlying substance use disorder as an essential component.

Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

“…In response to identified gaps in care (informed by the present study), hospital-based resident physicians at the Halifax site partnered with community-based addiction physicians to provide an informal (unfunded) addiction medicine consultation service [ 27 , 31 ]. Clinicians have also begun to call for incorporation of addiction medicine specialists into multidisciplinary endocarditis care teams [ 8 , 47 , 48 ]. Improving access to OAT in general medical settings requires changes in several areas, including improved education for health professionals, prioritizing access to medications on-demand, enabling multiple medication treatment options, and decreasing patients’ out-of-pocket costs [ 31 , 49 ].…”

Review of management priorities for invasive infections in people who inject drugs: highlighting the need for patient‐centred multidisciplinary care

“…These teams require collaboration and a willingness to re‐evaluate practices by all specialties and should be spearheaded by change‐makers at institutions to drive their initiation. 56 We argue that there should be no defined exclusions to patients receiving surgery, instead the patient and their multidisciplinary team should make an informed decision assessing both medical and psychosocial factors of the individual case at hand.…”

“…For PWID, these teams should include not only surgical and medical staff but also addiction medicine, psychiatry, anaesthetics, social work, nursing and peer support as well as the patient themselves so an individualised plan can be made. These teams require collaboration and a willingness to re‐evaluate practices by all specialties and should be spearheaded by change‐makers at institutions to drive their initiation 56 . We argue that there should be no defined exclusions to patients receiving surgery, instead the patient and their multidisciplinary team should make an informed decision assessing both medical and psychosocial factors of the individual case at hand.…”

A step-by-step guide to implementing a multidisciplinary endocarditis team

“…This will help inform the future composition of the team as addiction medicine/ psychiatry and social work play critical roles in caring for this population. 12 If these providers are not already available at an institution, endocarditis team members can advocate for their hospital to acquire more addiction treatment resources.…”

“…1,2 Inclusion of addiction medicine/ psychiatry and social work is also imperative as almost all referral centers will care for patients with injection drug use associated endocarditis. 12 If the hospital has an outpatient antimicrobial treatment program, it may be beneficial to include these providers as well. Although not every patient with endocarditis will have an indication for valve surgery initially, they may develop indications subsequently.…”