Which patients receive an addiction consult? A preliminary analysis of the INREACH (INpatient REadmission post-Addiction Consult Help) study

D'Amico, Maria J; Walley, Alexander Y.; Cheng, Debbie M.; Forman, Leah S; Regan, Danny; Yurkovic, Alexandra; Samet, Jeffrey H.; Weinstein, Zoe

doi:10.1016/j.jsat.2019.08.013

Cited by 13 publications

(7 citation statements)

References 23 publications

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“…Hospitals have extensive experience using care managers to improve in-hospital and follow-up care for several patient populations at high risk of readmission [94,95], including acute medical patients [96], and some have a consultation service to support the medical team with patients in need of behavioral health care. More recently, addiction-focused consult teams have begun to emerge in hospitals across the United States and elsewhere [29,31,47,49,[55][56][57][58][59][60][61][62][63]. However, patient-level randomized controlled trials are necessary to evaluate how addiction consult teams affect outcomes for hospitalized patients with OUD.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, studies also show that patients who initiate MOUD in the hospital are more likely to continue MOUD for their OUD after discharge. [54] However, while these descriptive, observational, and quasi-experimental studies [29,31,47,49,53,[55][56][57][58][59][60][61][62][63] provide high-quality evidence, there have been no randomized controlled trials (RCTs) to test effectiveness of this model specifically for patients with OUD. RCTs can add definitive evidence to inform decisions on adoption of models of care, which is particularly valuable in a resource constrained health care system [64].…”

Section: Introductionmentioning

confidence: 99%

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The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder

Ober

Murray‐Krezan

Page

et al. 2022

Addict Sci Clin Pract

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Background People with opioid use disorder experience high burden of disease from medical comorbidities and are increasingly hospitalized with medical complications. Medications for opioid use disorder are an effective, life-saving treatment, but patients with an opioid use disorder admitted to the hospital seldom initiate medication for their disorder while in the hospital, nor are they linked with outpatient treatment after discharge. The inpatient stay, when patients may be more receptive to improving their health and reducing substance use, offers an opportunity to discuss opioid use disorder and facilitate medication initiation and linkage to treatment after discharge. An addiction-focus consultative team that uses evidence-based tools and resources could address barriers, such as the need for the primary medical team to focus on the primary health problem and lack of time and expertise, that prevent primary medical teams from addressing substance use. Methods This study is a pragmatic randomized controlled trial that will evaluate whether a consultative team, called the Substance Use Treatment and Recovery Team (START), increases initiation of any US Food and Drug Administration approved medication for opioid use disorder (buprenorphine, methadone, naltrexone) during the hospital stay and increases linkage to treatment after discharge compared to patients receiving usual care. The study is being conducted at three geographically distinct academic hospitals. Patients are randomly assigned within each hospital to receive the START intervention or usual care. Primary study outcomes are initiation of medication for opioid use disorder in the hospital and linkage to medication or other opioid use disorder treatment after discharge. Outcomes are assessed through participant interviews at baseline and 1 month after discharge and data from hospital and outpatient medical records. Discussion The START intervention offers a compelling model to improve care for hospitalized patients with opioid use disorder. The study could also advance translational science by identifying an effective and generalizable approach to treating not only opioid use disorder, but also other substance use disorders and behavioral health conditions. Trial registration: Clinicaltrials.gov: NCT05086796, Registered on 10/21/2021. https://www.clinicaltrials.gov/ct2/results?recrs=ab&cond=&term=NCT05086796&cntry=&state=&city=&dist =

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder

Ober

Murray‐Krezan

Page

et al. 2022

Addict Sci Clin Pract

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“…As a result, the severity and acuity of SUD seen by the service are not likely more severe on average compared to an outpatient service but rather more complex in a variety of ways. Specifically, D’Amico et al 13 showed that patients receiving an addiction consultation were more likely to be experiencing homelessness, be experiencing acute problems related to substance use, and have a longer length of hospital stay. 13 The population served by APCL is consistent with this description and patients’ social determinants of health often contribute to hospitalization.…”

Section: Methodsmentioning

confidence: 99%

“…Specifically, D’Amico et al 13 showed that patients receiving an addiction consultation were more likely to be experiencing homelessness, be experiencing acute problems related to substance use, and have a longer length of hospital stay. 13 The population served by APCL is consistent with this description and patients’ social determinants of health often contribute to hospitalization. APCL also offers the unique experience of working with patients who are not necessarily seeking help for SUD, providing greater emphasis on motivational interviewing and meeting patients where they are at.…”

Section: Methodsmentioning

confidence: 99%

Medical Student Attitudes Toward Patients With Substance Use Disorder After Experiential Learning on an Addiction Psychiatry Consultation-Liaison Service: A Pilot Study

Lew,

Balasanova

2024

Substance Use & Addiction Journal

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Background: Stigma surrounding substance use disorder (SUD) is highly prevalent in health care. Negative attitudes toward patients with SUD have been shown to negatively impact patient care. Addressing SUD stigma in medical students is a promising approach, however, few curricula include experiential learning on addiction psychiatry clinical services. We describe a medical student rotation on an addiction psychiatry clinical service and examine its effect on attitudes toward patients with SUD. Methods: Medical students were integrated onto an addiction psychiatry consultation-liaison service serving medically/surgically hospitalized patients with co-occurring SUD and other psychiatric disorders. Students learned and practiced in-person assessment of patients and received instruction on basic principles of psychiatry and evaluation and management of SUD. A targeted anti-stigma curriculum was included. Attitudes toward patients with SUD were measured with the Medical Condition Regard Scale (MCRS) before and after the experience. Each item of the MCRS and an overall composite attitude score were analyzed. Results: Of the 36 students on the clinical rotation, 33 completed the survey. Attitudes showed widespread improvement toward patients with SUD. Mann–Whitney U tests showed significant improvement in most items of the MCRS. Further analysis of composite scores showed an improvement in overall attitudes toward patients with SUD. Conclusions: Inclusion of medical students on an addiction psychiatry consult service as part of the core psychiatry clerkship may hold promise for helping improve student attitudes and decrease stigma toward patients with SUD. Controlled study is needed to compare other clinical experiences and determine specific causative effects.

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“…“The Addiction Consult Service” was implemented in 2015 to improve the management of SUD for hospitalized patients [ 47 ]. The service includes a supervising addiction-trained physician, addiction medicine and psychiatry fellows, internal medicine residents, nurse practitioners, a social worker, and a recovery coach to assist primary teams with withdrawal management, and diagnosis and treatment of SUD [ 48 ]. Consultative services include MOUD management, linkage to longitudinal outpatient treatment programs, overdose prevention counseling, naloxone provision, harm reduction counseling, and motivational interviewing.…”

Section: Inpatient Servicesmentioning

confidence: 99%

Partnering With State Health Departments to Address Injection-Related Infections During the Opioid Epidemic: Experience at a Safety Net Hospital

Burns

Pierre

Marathe

et al. 2021

Open Forum Infectious Diseases

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Massachusetts is one of the epicenters of the opioid epidemic and has been severely impacted by injection-related viral and bacterial infections. A recent increase in newly diagnosed human immunodeficiency virus (HIV) infections among persons who inject drugs in the state highlights the urgent need to address and bridge the overlapping epidemics of opioid use disorder (OUD) and injection-related infections. Building on an established relationship between the Massachusetts Department of Public Health (MDPH) and Boston Medical Center (BMC), the Infectious Diseases section has contributed to the development and implementation of a cohesive response involving ambulatory, inpatient, emergency department and community-based services. We describe this comprehensive approach including the rapid delivery of antimicrobials for the prevention and treatment of HIV, sexually transmitted diseases, systemic infections such as endocarditis, bone and joint infections, as well as curative therapy for chronic hepatitis C virus (HCV) in a manner that is accessible to patients on the addiction-recovery continuum. We also provide an overview of programs that provide access to medications for opioid use disorder (MOUD), harm reduction services including overdose education and distribution of naloxone. Finally, we outline lessons learned to inform initiatives in other settings.

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Which patients receive an addiction consult? A preliminary analysis of the INREACH (INpatient REadmission post-Addiction Consult Help) study

Cited by 13 publications

References 23 publications

The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder

The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder

Medical Student Attitudes Toward Patients With Substance Use Disorder After Experiential Learning on an Addiction Psychiatry Consultation-Liaison Service: A Pilot Study

Partnering With State Health Departments to Address Injection-Related Infections During the Opioid Epidemic: Experience at a Safety Net Hospital

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