Facilitating Methadone Use in Hospitals and Skilled Nursing Facilities

Pytell, Jarratt D.; Sharfstein, Joshua M.; Olsen, Yngvild

doi:10.1001/jamainternmed.2019.5731

Cited by 21 publications

(29 citation statements)

References 8 publications

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“…In addition, regulations from the Substance Abuse and Mental Health Services Administration limit the starting dose of methadone and may discourage up-titration to effective doses in acute hospital settings. 27 Clinical considerations also limit the rate of dose increases, which may prohibit the prescription of an effective dose by the time of hospital discharge. Different regulations restrict buprenorphine use.…”

Section: Discussionmentioning

confidence: 99%

Medication for opioid use disorder at hospital discharge is not associated with intravenous antibiotic completion in post-acute care facilities

Traver

Ching

Narayanan

2022

Therapeutic Advances in Infection

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Background: People with opioid use disorder and severe infections may complete their prolonged courses of outpatient parenteral antimicrobial therapy at a post-acute care facility due to adherence and safety concerns. We hypothesized that treatment with medications for opioid use disorder, such as methadone and buprenorphine, would increase antibiotic completion in these facilities. Methods: We performed a retrospective cohort study of people with opioid use disorder and severe infections who were discharged from the University of Maryland Medical Center to a post-acute care facility to complete intravenous antibiotic therapy. The primary outcome was completion of outpatient parenteral antimicrobial therapy. We compared the rate of antibiotic completion between patients prescribed and not prescribed medication for opioid use disorder at discharge from the acute care hospital. Results: A total of 161 patient encounters were included; the mean age was 43.4 years and 56% of patients were male. In 48% of the encounters, the patient was homeless and in 68% they recently injected drugs. The most common infectious syndrome was osteoarticular (44.1%). Medication for opioid use disorder was prescribed at discharge in 103 of 161 encounters and was newly started in 27 encounters. Similar rates of outpatient parenteral antimicrobial therapy completion were found in those who received (65/103) and did not receive (33/58) medication for opioid use disorder at discharge (odds ratio: 1.29; 95% confidence interval: 0.68–2.54; p = 0.44). Conclusion: Medication for opioid use disorder prescription at discharge was not associated with completion of outpatient parenteral antimicrobial therapy in a post-acute care facility. Our study is limited by possible selection bias and infrequent initiation of medication for opioid use disorder, which may have minimized the effect on antibiotic completion.

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Section: Discussionmentioning

confidence: 99%

Medication for opioid use disorder at hospital discharge is not associated with intravenous antibiotic completion in post-acute care facilities

Traver

Ching

Narayanan

2022

Therapeutic Advances in Infection

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“…Transitions of care are a key consideration in evaluating the outcomes observed in our study, since most survivors in our cohort were discharged to subacute facilities. Federal policy, specifically Title 21 of the Code of Federal Regulations, complicates patients’ receipt of MOUD at these facilities, preventing continuation of MOUD started in the inpatient setting unless the patient is already enrolled in an OUD treatment program [ 11 ]. While facilities were expected to continue appropriate therapies after discharge, we were unable to independently verify continuation of MOUD after discharge.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic therapy completion for injection drug use-associated infective endocarditis at a center with routine addiction medicine consultation: a retrospective cohort study

et al. 2022

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Background Addiction medicine consultation and medications for opioid use disorder are shown to improve outcomes for patients hospitalized with infective endocarditis associated with injection drug use. Existing studies describe settings where addiction medicine consultation and initiation of medications for opioid use disorder are not commonplace, and rates of antibiotic therapy completion are infrequently reported. This retrospective study sought to quantify antibiotic completion outcomes in a setting where these interventions are routinely implemented. Methods Medical records of patients hospitalized with a diagnosis of bacteremia or infective endocarditis at an urban hospital between October 1, 2015 and December 31, 2017 were screened for active injection drug use within 6 months of hospitalization and infective endocarditis. Demographic and clinical parameters, receipt of antibiotics and medications for opioid use disorder, and details of re-hospitalizations within 1 year of discharge were recorded. Results Of 567 subjects screened for inclusion, 47 had infective endocarditis and active injection drug use. Addiction medicine consultation was completed for 41 patients (87.2%) and 23 (48.9%) received medications for opioid use disorder for the entire index admission. Forty-three patients (91.5%) survived to discharge, of which 28 (59.6%) completed antibiotic therapy. Twenty-nine survivors (67.4%) were re-hospitalized within 1 year due to infectious complications of injection drug use. Conclusions Among patients admitted to a center with routine addiction medicine consultation and initiation of medications for opioid use disorder, early truncation of antibiotic therapy and re-hospitalization were commonly observed.

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“…11,18 Patients with substance use disorders and/or those needing opioid agonist therapy often face facility rejections and logistical barriers to accessing methadone or buprenorphine. [19][20][21] Other medically complex needs such as hemodialysis (and transport to and from dialysis sessions), 8,11 isolation due to infection, 8,11 bariatric care, 11,[22][23][24][25] and traumatic brain injury 11,26 are known to leave patients without facilities willing or able to care for them. In a small proportion of cases, prolonged stay patients may have histories of incarceration and face legal delays and limits on facilities willing to accept them.…”

Section: Discussionmentioning

confidence: 99%

Nonmedical Discharge Barriers in Prolonged Stays on a General Medicine Ward: A Retrospective Review

Gao

Berland

2022

Journal of Brown Hospital Medicine

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Background: Prolonged stays negatively impact patient outcomes and are costly for the healthcare system. Nonmedical barriers to discharge, such as lack of insurance or post-acute care facility acceptances, are increasingly recognized as causes of prolonged stays beyond medical necessity. Methods: A retrospective chart review of patients admitted over a two-year period with stays beyond 30 days on a general medicine floor of an urban academic hospital was conducted. Demographic, clinical and administrative data were recorded. Barriers to discharge were characterized at days 30, 60, and 90 of admission. Nonmedical barriers were recorded for patients who stayed beyond medical readiness for discharge. Results: Out of 2866 admissions, 101 hospitalizations (3.5%) of 97 patients were prolonged, accounting for a total of 6518 (27.2%) of 23,934 inpatient days. Of the prolonged stays, 37 stays lasted longer than 60 days and 17 lasted longer than 90 days. At lengths of stay day 30, 60, and 90, the proportion of admissions that were prolonged beyond medical necessity by nonmedical factors were 36.6%, 59.5%, and 52.9% respectively. The most common nonmedical barrier to discharge at all three timepoints was barriers to facility placement. Conclusions: A small proportion of prolonged stay patients make up a disproportionately high number of inpatient days, with nonmedical factors contributing to more than half of cases beyond 60 days. The rising prevalence of nonmedical barriers, particularly the lack of facility acceptances, highlights the need to examine delays at the systems-level.

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Facilitating Methadone Use in Hospitals and Skilled Nursing Facilities

Cited by 21 publications

References 8 publications

Medication for opioid use disorder at hospital discharge is not associated with intravenous antibiotic completion in post-acute care facilities

Medication for opioid use disorder at hospital discharge is not associated with intravenous antibiotic completion in post-acute care facilities

Antibiotic therapy completion for injection drug use-associated infective endocarditis at a center with routine addiction medicine consultation: a retrospective cohort study

Nonmedical Discharge Barriers in Prolonged Stays on a General Medicine Ward: A Retrospective Review

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