Implementation of a Medication for Addiction Treatment (MAT) and Linkage Program by Leveraging Community Partnerships and Medical Toxicology Expertise

Abstract

Introduction Implementing a hospital medication for addiction treatment (MAT) and a linkage program can improve care for patients with substance use disorder (SUD); however, lack of hospital funding and brick and mortar SUD resources are potential barriers to feasibility. Methods This study assesses the feasibility of implementation of a SUD linkage program. Components of the program include a county-funded hospital opioid support team (HOST), a hospital-employed addiction recovery specialist (ARS), and a medical toxicology MAT induction service and maintenance program. Data for linkage by HOST, ARS, and MAT program were tracked from July 2018 to December 2019. Results From July 2018 through December 2019, 1834 patients were linked to treatment: 1536 by HOST and 298 by the ARS.The most common disposition categories for patients linked by HOST were 16.73% to medically monitored detoxification, 9.38% to intensive outpatient, and 8.59% to short-term residential treatment. Among patients linked by the ARS, 65.66% were linked to outpatient treatment and 9.43% were linked directly to inpatient treatment. A total of 223 patients managed by the ARS were started on MAT by medical toxicology and linked to outpatient MAT clinic: 72.68% on buprenorphine/naloxone, 24.59% on naltrexone, 1.09% buprenorphine, and 0.55% acamprosate. Conclusion Implementing a MAT and linkage program in the ED and hospital setting was feasible. Leveraging medical toxicology expertise as well as community and funding partnerships was crucial to successful implementation.

Sustained Implementation of a Multicomponent Strategy to Increase Emergency Department-Initiated Interventions for Opioid Use Disorder

“…Much of the work describing the implementation of ED buprenorphine has focused on initiatives for education, guidelines, or consultative staff models. [37][38][39][40][41] While addressing barriers to opioid use disorder treatment identified in prior studies, these interventions alone may not be sufficient to significantly alter provider practices, as was the case in our study EDs prior to the interventions describe in this study. 12,16,42 The peer recovery specialists likely reduced the typical friction involved in initiation treatment by addressing both providers' ability to prescribe buprenorphine (assisting with patient engagement and linkage to longitudinal care) and their motivation to do so (by providing support for not only the patient but also the prescriber in implementing practice change).…”

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

“…The location of transition staff varied across ED and inpatient interventions, with ED interventions more commonly relying on staff within the ED to facilitate the transition (n = 23, 82%) while inpatient interventions often relied on staff called upon as part of a consult team (n = 3, 15%) or employed by an external organization (n = 7, 35%). Examples of consult or externally-employed staff facilitating transitions included medical toxicologists [ 23 ], resource specialists [ 24 ], patient engagement specialists [ 25 ] and peer specialists [ 22 , 26 , 27 ].…”

A Taxonomy of Hospital-Based Addiction Care Models: a Scoping Review and Key Informant Interviews

“…89 Informants noted HBOT advantages over ACS include lower costs, normalizing MOUD delivery like any other medication, and scalability to hospitals lacking local addiction expertise. Informants noted that many HBOT champions seek training and mentoring through local, 87 regional, 109 and national outlets. 99 One notable example of highly structured and intensive implementation support is the CA Bridge program, which has expanded HBOT statewide by supporting local hospital champions with intensive HBOT technical assistance and training, and by funding navigators.…”