Early data from project engage: a program to identify and transition medically hospitalized patients into addictions treatment

Abstract

BackgroundPatients with untreated substance use disorders (SUDs) are at risk for frequent emergency department visits and repeated hospitalizations. Project Engage, a US pilot program at Wilmington Hospital in Delaware, was conducted to facilitate entry of these patients to SUD treatment after discharge. Patients identified as having hazardous or harmful alcohol consumption based on results of the Alcohol Use Disorders Identification Test-Primary Care (AUDIT-PC), administered to all patients at admission, received bedside assessment with motivational interviewing and facilitated referral to treatment by a patient engagement specialist (PES). This program evaluation provides descriptive information on self-reported rates of SUD treatment initiation of all patients and health-care utilization and costs for a subset of patients.MethodsProgram-level data on treatment entry after discharge were examined retrospectively. Insurance claims data for two small cohorts who entered treatment after discharge (2009, n = 18, and 2010, n = 25) were reviewed over a six-month period in 2009 (three months pre- and post-Project Engage), or over a 12-month period in 2010 (six months pre- and post-Project Engage). These data provided descriptive information on health-care utilization and costs. (Data on those who participated in Project Engage but did not enter treatment were unavailable).ResultsBetween September 1, 2008, and December 30, 2010, 415 patients participated in Project Engage, and 180 (43%) were admitted for SUD treatment. For a small cohort who participated between June 1, 2009, and November 30, 2009 (n = 18), insurance claims demonstrated a 33% ($35,938) decrease in inpatient medical admissions, a 38% ($4,248) decrease in emergency department visits, a 42% ($1,579) increase in behavioral health/substance abuse (BH/SA) inpatient admissions, and a 33% ($847) increase in outpatient BH/SA admissions, for an overall decrease of $37,760. For a small cohort who participated between June 1, 2010, and November 30, 2010 (n = 25), claims demonstrated a 58% ($68,422) decrease in inpatient medical admissions; a 13% ($3,308) decrease in emergency department visits; a 32% ($18,119) decrease in BH/SA inpatient admissions, and a 32% ($963) increase in outpatient BH/SA admissions, for an overall decrease of $88,886.ConclusionsThese findings demonstrate that a large percentage of patients entered SUD treatment after participating in Project Engage, a novel intervention with facilitated referral to treatment. Although the findings are limited by the retrospective nature of the data and the small sample sizes, they do suggest a potentially cost-effective addition to existing hospital services if replicated in prospective studies with larger samples and controls.

Factors contributing to dropping out from and returning to HIV treatment in an inner city primary care HIV clinic in the United States

“…Potential strategies include providing Screening Brief Intervention and Referral to Treatment (SBIRT; e.g., Madras et al, 2009) interventions that incorporate Motivational Interviewing and facilitated referrals to engage patients into Substance Abuse Treatment (e.g., Pecoraro et al, 2012c) and/or providing substance abuse and mental health treatment onsite at primary care HIV clinics (Samet, Friedmann, & Saitz, 2001). Additionally, the commonality of depression and suicide attempts among participants, and in the literature (e.g., Catalan et al, 2011), suggests patients should be questioned about depression and suicidal ideation at medical visits.…”

“It’s been an Experience, a Life Learning Experience”: A Qualitative Study of Hospitalized Patients with Substance Use Disorders

“…[1][2][3][4][5] Despite frequent contact with healthcare systems, many people are not engaged in addiction treatment. 3,6 Hospitalization is often unplanned, and most persons do not come to the hospital seeking addiction treatment.…”

Brief interventions for alcohol misuse

“…More effective are interventions that have been developed and can be applied to increase engagement. [28][29][30] Furthermore, for patients with accompanying psychiatric or social conditions and more severe dependence, more intense monitoring and management of recovery following treatment may be necessary. 31 Review drinking practices; and the complex social, cultural and moral context concerning what constitutes problematic drinking.…”