Addiction Medicine Consultations Reduce Readmission Rates for Patients With Serious Infections From Opioid Use Disorder

Marks, Laura R.; Munigala, Satish; Warren, David K.; Liang, Stephen Y.; Schwarz, Evan S.; Durkin, Michael J.

doi:10.1093/cid/ciy924

Cited by 139 publications

(162 citation statements)

References 11 publications

(10 reference statements)

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“…10 The implementation of addiction consultation services is an important innovation, which can increase the use of MOUD, reduce AMA discharges, help avoid readmissions, and increase linkage to outpatient addiction treatment. 4 The receipt of an addiction psychiatry consultation by nearly all of the individuals in this study may have contributed to the high rates of MOUD initiation. In addition to helping to resolve ambivalence for treatment using motivational interviewing strategies, the addiction consultants helped evaluate each individual for the suitability of initiating MOUD and addiction treatment following discharge.…”

Section: Discussionmentioning

confidence: 89%

“…Despite the availability of evidenced‐based pharmacotherapies, the rate of adoption of MOUD in the hospital setting has been inadequate 10 . The implementation of addiction consultation services is an important innovation, which can increase the use of MOUD, reduce AMA discharges, help avoid readmissions, and increase linkage to outpatient addiction treatment 4 . The receipt of an addiction psychiatry consultation by nearly all of the individuals in this study may have contributed to the high rates of MOUD initiation.…”

Section: Discussionmentioning

confidence: 91%

“…In the context of the growing opioid crisis, increasing numbers of people who inject drugs (PWID) are hospitalized for infective endocarditis 1 . Studies have consistently found that hospitalized PWID are discharged against medical advice (AMA) frequently, with prevalence ranging from 4.8% to 49% 2‐4 . AMA discharges are associated with higher mortality rates, more frequent readmissions, and greater likelihood of future AMA discharges 5 .…”

Section: Introductionmentioning

confidence: 99%

“…1 Studies have consistently found that hospitalized PWID are discharged against medical advice (AMA) frequently, with prevalence ranging from 4.8% to 49%. [2][3][4] AMA discharges are associated with higher mortality rates, more frequent readmissions, and greater likelihood of future AMA discharges. 5 Reasons for the AMA discharge may include the desire to use drugs, opioid withdrawal, poor pain control, poor communication with staff, or feeling stigmatized.…”

Section: Introductionmentioning

confidence: 99%

“…7 Prior studies have identified a number of factors that reduce AMA discharges among PWID, including the use of methadone during and prior to the hospitalization and the implementation of an addiction consultation service. 4,7 Medications for opioid use disorder (MOUD) have been shown to reduce opioid cravings, suppress illicit opioid use, and reduce mortality. However, limited research specifically examines the impact of MOUD on discharge AMA among PWID with endocarditis.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Medications for Opioid Use Disorder on Discharge Against Medical Advice Among People Who Inject Drugs Hospitalized for Infective Endocarditis

et al. 2020

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Background and Objectives The impact of medications for opioid use disorder (MOUD) on against medical advice (AMA) discharges among people who inject drugs (PWID) hospitalized for endocarditis is unknown. Methods A retrospective review of all PWID hospitalized for endocarditis at our institution between 2016 and 2018 (n = 84). Results PWID engaged with MOUD at admission, compared with those who were not, were less likely to be discharged AMA but this did not reach statistical significance in adjusted analysis (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.033‐1.41; P = .11). Among out‐of‐treatment individuals, newly initiating MOUD did not lead to significantly fewer AMA discharges (OR, 0.98; 95% CI, 0.26‐3.7; P = .98). Conclusion and Scientific Significance PWID hospitalized for endocarditis are at high risk for discharge AMA but more research is needed to understand the impact of MOUD. (Am J Addict 2020;29:155–159)

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of Medications for Opioid Use Disorder on Discharge Against Medical Advice Among People Who Inject Drugs Hospitalized for Infective Endocarditis

et al. 2020

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High-Risk Infective Endocarditis in People Who Inject Drugs

Stewardson

Tong

2020

JAMA Netw Open

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In JAMA Network Open, Tan and colleagues 1 performed a retrospective cohort study to describe the occurrence of and risk factors associated with new bloodstream infections (BSIs) and mortality among people who inject drugs (PWIDs) with infective endocarditis. They included 420 consecutive episodes of infective endocarditis occurring in 309 patients from April 1, 2007, to March 31, 2018 3 tertiary hospitals in London, Ontario, Canada. Participants were young (mean [SD] age, 35.7 [9.7] years), with a predominance of Staphylococcus aureus endocarditis (326 [77.6%]) involving the tricuspid valve (296 [70.5%]). Opiates were the most frequently injected substance (365 [86.9%]), but polysubstance use was common (321 [76.4%]), as was homelessness (72 [17.1%]). The investigators found that new BSIs during treatment were common (138 episodes, 68 of which were polymicrobial) but were not significantly associated with mortality.This study was performed in the context of an increasingly well-described epidemic of complex invasive bacterial injection-related infections among PWID. For example, hospitalizations for treatment of drug use-associated infective endocarditis in North Carolina increased 10-fold from 0.10 to 1.38 per 100 000 persons during the same decade that the present study was conducted, and in 2017, 2 in every 5 patients undergoing valve surgery for treatment of endocarditis had injected drugs. 2 Indeed, it is notable that among the 688 episodes of endocarditis screened for inclusion in this study (identified using International Classification of Diseases, Ninth Revision, Clinical Modification, or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes for infectious endocarditis), 420 (61.0%) involved patients with a documented Open Access. This is an open access article distributed under the terms of the CC-BY License.

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Simulated Cost-effectiveness and Long-term Clinical Outcomes of Addiction Care and Antibiotic Therapy Strategies for Patients With Injection Drug Use–Associated Infective Endocarditis

et al. 2022

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IMPORTANCEEmerging evidence supports the use of outpatient parenteral antimicrobial therapy (OPAT) and, in many cases, partial oral antibiotic therapy for the treatment of injection drug use-associated infective endocarditis (IDU-IE); however, long-term outcomes and cost-effectiveness remain unknown. OBJECTIVE To compare the added value of inpatient addiction care services and the costeffectiveness and clinical outcomes of alternative antibiotic treatment strategies for patients with IDU-IE. DESIGN, SETTING, AND PARTICIPANTS This decision analytical modeling study used a validated microsimulation model to compare antibiotic treatment strategies for patients with IDU-IE. Model inputs were derived from clinical trials and observational cohort studies. The model included all patients with injection opioid drug use (N = 5 million) in the US who were eligible to receive OPAT either in the home or at a postacute care facility. Costs were annually discounted at 3%. Costeffectiveness was evaluated from a health care sector perspective over a lifetime starting in 2020. Probabilistic sensitivity, scenario, and threshold analyses were performed to address uncertainty. INTERVENTIONS The model simulated 4 treatment strategies: (1) 4 to 6 weeks of inpatient intravenous (IV) antibiotic therapy along with opioid detoxification (usual care strategy), (2) 4 to 6 weeks of inpatient IV antibiotic therapy along with inpatient addiction care services that offered medication for opioid use disorder (usual care/addiction care strategy), (3) 3 weeks of inpatient IV antibiotic therapy along with addiction care services followed by OPAT (OPAT strategy), and (4) 3 weeks of inpatient IV antibiotic therapy along with addiction care services followed by partial oral antibiotic therapy (partial oral antibiotic strategy). MAIN OUTCOMES AND MEASURES Mean percentage of patients completing treatment for IDU-IE, deaths associated with IDU-IE, life expectancy (measured in life-years [LYs]), mean cost per person, and incremental cost-effectiveness ratios (ICERs). RESULTSAll modeled scenarios were initialized with 5 million individuals (mean age, 42 years; range, 18-64 years; 70% male) who had a history of injection opioid drug use. The usual care strategy resulted in 18.63 LYs at a cost of $416 570 per person, with 77.6% of hospitalized patients completing treatment. Life expectancy was extended by each alternative strategy. The partial oral antibiotic strategy yielded the highest treatment completion rate (80.3%) compared with the OPAT strategy (78.8%) and the usual care/addiction care strategy (77.6%). The OPAT strategy was the least expensive at $412 150 per person. Compared with the OPAT strategy, the partial oral antibiotic (continued) Key Points Question What is the most clinically beneficial and cost-effective antibiotic treatment strategy for injection drug use-associated infective endocarditis (IDU-IE)? Findings In this decision analytical modeling study simulating 4 treatment strategies among 5 million individuals with IDU-IE in the US, a va...

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Addiction Medicine Consultations Reduce Readmission Rates for Patients With Serious Infections From Opioid Use Disorder

Cited by 139 publications

References 11 publications

Impact of Medications for Opioid Use Disorder on Discharge Against Medical Advice Among People Who Inject Drugs Hospitalized for Infective Endocarditis

Impact of Medications for Opioid Use Disorder on Discharge Against Medical Advice Among People Who Inject Drugs Hospitalized for Infective Endocarditis

High-Risk Infective Endocarditis in People Who Inject Drugs

Simulated Cost-effectiveness and Long-term Clinical Outcomes of Addiction Care and Antibiotic Therapy Strategies for Patients With Injection Drug Use–Associated Infective Endocarditis

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