Implementation and Evaluation of a Novel, Unofficial, Trainee-Organized Hospital Addiction Medicine Consultation Service

Abstract

Background: To evaluate a novel, unofficial, trainee-organized, hospital addiction medicine consultation service (AMCS), we aimed to assess whether it was (1) acceptable to hospital providers and patients, (2) feasible to organize and deliver, and (3) impacted patient care. Methods: We performed a retrospective descriptive study of all AMCS consultations over the first 16 months. We determined acceptability via the number of referrals received from admitting services, and the proportion of referred patients who consented to consultation. We evaluated feasibility via continuation/growth of the service over time, and the proportion of referrals successfully completed before hospital discharge. As most referrals related to opioid use disorder, we determined impact through the proportion of eligible patients offered and initiated on opioid agonist therapy (OAT) in hospital, and the proportion of patients who filled their outpatient prescription or attended their first visit with their outpatient OAT prescriber. Results: The unofficial AMCS grew to involve six hospital-based residents and five supervising community-based addiction physicians. The service received 59 referrals, primarily related to injection opioid use, for 50 unique patients from 12 different admitting services. 90% of patients were seen before discharge, and 98% agreed to addiction medicine consultation. Among 34 patients with active moderate-severe opioid use disorder who were not already on OAT, 82% initiated OAT in hospital and 89% of these patients continued after discharge. Conclusions: Established in response to identified gaps in patient care and learning opportunities, a novel, unofficial, trainee-organized AMCS was acceptable, feasible, and positively impacted patient care over the first 16 months. This trainee-organized, unofficial AMCS could be used as a model for other hospitals that do not yet have an official AMCS.

Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

“…Treatment with OAT is the standard-of-care for opioid use disorder; it is associated with large reductions in risk of death [ 12 ] and may be associated with decreased risk of readmission [ 14 ] among patients with IDU-IE. Accumulating evidence suggests that hospitalization is a “reachable moment” to engage patients in addiction treatment, and that most hospitalized patients with untreated opioid use disorder are interested in initiating OAT [ 25 , 27 , 34 , 35 ]. A randomized controlled trial [ 36 ] and several cohort studies [ 15 , 16 ] show that in-hospital initiation of OAT is associated with improved engagement in treatment after hospital discharge, compared to outpatient referrals.…”

“…Specialized addiction medicine consultation services can help close this gap, by providing diagnostic and treatment expertise, increasing uptake of these interventions, and assisting in linking hospitalized patients to outpatient addiction treatment [ 25 , 26 , 34 , 44 – 46 ]. In response to identified gaps in care (informed by the present study), hospital-based resident physicians at the Halifax site partnered with community-based addiction physicians to provide an informal (unfunded) addiction medicine consultation service [ 27 , 31 ]. Clinicians have also begun to call for incorporation of addiction medicine specialists into multidisciplinary endocarditis care teams [ 8 , 47 , 48 ].…”

“…Hospitals differ in the care they offer patients with medical complications of addiction and injection drug use, including IDU-IE [ 7 , 25 – 27 ]. In the Canadian Maritime provinces, two academic, tertiary-care medical centres (one in Halifax, Nova Scotia, and one in Saint John, New Brunswick) provide specialist care to patients with infective endocarditis (IE).…”

Social and structural determinants of injecting-related bacterial and fungal infections among people who inject drugs: protocol for a mixed studies systematic review

“…[79][80][81] The topic was inspired by the deaths of friends and patients to injecting-related bacterial infections, and a recognition of the need to look broader than individual-level interventions. [82][83][84]…”

Linking opioid use disorder treatment from hospital to community

“…We read with interest Jo and colleagues' study of hospitalized patients with injection drug use-associated infective endocarditis and osteomyelitis who received methadone or buprenorphine [1]. These invasive infections are increasingly common [2][3][4][5][6], and in-hospital initiation of medications for opioid use disorder (MOUD) is both a crucial component of secondary prevention [7][8][9][10][11][12] and the standard of care for treating opioid use disorder [13][14][15][16][17]. While the paper refers to 'initiation of MOUD' having limited effect, the investigators did not actually assess the effect of in-hospital initiation of buprenorphine or methadone maintenance treatment for opioid use disorder; they identified patients receiving either medication for any indication, including for opioid withdrawal [1].…”