Integrated Infectious Disease and Substance Use Disorder Care for the Treatment of Injection Drug Use–Associated Infections: A Prospective Cohort Study With Historical Control

Abstract

Background To address the infectious disease (ID) and substance use disorder (SUD) syndemic, we developed an integrated ID/SUD clinical team rooted in harm reduction at a county hospital in Miami, Florida. The Severe Injection-Related Infection (SIRI) team treats people who inject drugs (PWID) and provides medical care, SUD treatment, and patient navigation during hospitalization and post-hospital discharge. We assessed the impact of the SIRI team on ID and SUD treatment and healthcare utilization outcomes. Methods We prospectively collected data on patients seen by the SIRI team. A diagnostic code algorithm confirmed by chart review was used to identify a historical control group of patients with SIRI hospitalizations in the year preceding implementation of the SIRI team. The primary outcome was death or readmission within 90 days post-hospital discharge. Secondary outcomes included initiation of medications for opioid use disorder (MOUD) and antibiotic course completion. Results There were 129 patients included in the study: 59 in the SIRI team intervention and 70 in the pre-SIRI team control group. SIRI team patients had a 45% risk reduction (aRR = 0.55, 95% CI: [0.32, 0.95]; 24% vs. 44%) of being readmitted in 90 days or dying compared to pre-SIRI historical controls. SIRI team patients were more likely to initiate MOUD in the hospital (93% vs. 33%, p < 0.01), complete antibiotic treatment (90% vs. 60%, p < 0.01), and less likely to have patient-directed discharge (17% vs 37%, p = 0.02). Conclusions An integrated ID/SUD team was associated with improvements in healthcare utilization, MOUD initiation, and antibiotic completion for PWID with infections.

Source control: treating opioid use disorder among inpatients with related infections, an urgent call to action

“…Addiction consults were significantly associated with increased odds of planned discharge [odds ratio (OR) 1.36] and with MOUD initiation and linkage to outpatient care, despite only being completed 44% of the time. This is consistent with prior studies that have described the positive impact of addiction consult services on MOUD receipt, premature discharge and readmission [14–17] as well as stigma [18]. Not surprisingly, if a patient continued or newly initiated MOUD, odds of a planned discharge were even higher (OR 3.87 and 4.85, respectively).…”

Effects of a hospital discharge clinic among people with HIV: Lack of early follow‐up is associated with 30‐day hospital readmission and decreased retention in care

“…In San Diego County, the primary drug used among people with SUD is methamphetamine [22], for which medication‐assisted treatment is not yet in widespread use [23, 24]. Our data highlight the need for aggressive treatment of SUD—including during hospital admissions, where treatment has been shown to improve outcomes [25]—to promote effective linkage and retention in care.…”

Crossroads of Care: Navigating Injection Drug Use-Associated Endocarditis

“…One innovative approach to addressing IDU-IE involves close outpatient follow-up with integrated infectious disease and substance use disorder care teams, which have been associated with improvements in healthcare utilization, management of IDU, and completion of antibiotic treatment for PWID with infections [ 14 ]. Another emerging treatment approach for the management of IDU-IE includes oral antibiotic therapy and long-acting glycopeptides, which have extended half-lives allowing for weekly dosing.…”