Care cascade for patients with opioid use disorder and serious injection related infections

Abstract

Objectives: To define the care cascade for patients with serious injection drug use related infections (SIRI) in a tertiary hospital system and compare outcomes of those who did and did not participate in an opioid use disorder (OUD) treatment referral program. Methods: The medical records of patients admitted with both OUD and SIRI including endocarditis, osteomyelitis, septic arthritis, epidural abscess, thrombophlebitis, myositis, bacteremia, and fungemia from 2016-2019 were retrospectively reviewed. Patient demographics, clinical covariates, 90-day readmission rates, and outcomes data were collected. We compared data from those who were successfully referred to outpatient care through Engaging Patients in Care Coordination (EPICC), a peer recovery specialist-run OUD treatment referral program, to those who did not receive outpatient referral. Results: During the study period 334 persons who inject opioids were admitted with SIRI. Fourteen admitted patients died and were excluded from the analysis. The all-cause readmission rate was lower among patients referred to the EPICC program (18/76 [23.7%]) compared to those not referred to EPICC (100/244 [41.0%]) (OR 0.44; 95% CI 0.25-0.80). Conclusion: An OUD care cascade evaluation for patients with SIRI demonstrated that referral to peer recovery services with outpatient OUD treatment was associated with reduced 90-day readmission rate.

Patients With Serious Injection Drug Use–Related Infections who Experience Patient-Directed Discharges on Oral Antibiotics Have High Rates of Antibiotic Adherence but Require Multidisciplinary Outpatient Support for Retention in Care

“…Care coordination also formed part of this initiative. Linking PWID to community SUD care was a primary goal for all participants as retention on MOUDS has been previously associated with improved health outcomes [ 19 , 27 ]. Bridge care through the telehealth program and collocated care at ID clinic visits was successful in re-engaging individuals who did not attend initially scheduled SUD appointments.…”

The Risk of Infective Endocarditis among COVID-19 Patients with Non-Medical Opioid Use

“…Among COVID-19 patients, 1.8% patients with non-medical opioid use and 0.09% patients with no opioid use developed IE within 90 days of contracting COVID-19 (Table 1). Researchers have found that the individuals who have been afflicted by the opioid crisis are at greater risk of a plethora of subsequent infections and health conditions, such as HIV, septic arthritis, Staphylococcus aureus bacteremia, thrombophlebitis, myositis, fungemia, osteomyelitis/discitis, abscesses, and IE [31]. Among these serious diseases and conditions, IE is rapidly increasing in prevalence, especially among individuals with substance use.…”

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

“…Thus, more work is needed to understand and address barriers as they relate to the range of transition strategies identified in this review, how they are supported and reimbursed, and how they play out differently in ED vs. inpatient hospital settings. This understanding can help better guide resource allocation towards closing gaps in continuity of care, especially as hospital systems begin to integrate OUD Cascade of Care models and other mechanisms to track patient continuity across care settings [63,64] Critical to these efforts will be continuing to address existing barriers to retention in treatment once patients are linked with community-based care, which are frequently experienced among patients referred to treatment from ED or inpatient hospital settings [65][66][67].…”