Making the business case for an addiction medicine consult service: a qualitative analysis

Priest, Kelsey C.; McCarty, Dennis

doi:10.1186/s12913-019-4670-4

Cited by 19 publications

(13 citation statements)

References 29 publications

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“… 22 , 23 To account for the sparsity of addiction consultation service in the US, we assumed that hospitalized individuals did not receive a consultation for addiction care services, underwent opioid withdrawal management with buprenorphine or methadone, and did not continue MOUD use after hospital discharge. 24 , 25 , 26 However, if someone was using MOUD before hospitalization, use of this medication would be continued after hospital discharge. Individuals also have a probability of being discharged against medical advice.…”

Section: Methodsmentioning

confidence: 99%

Estimated Clinical Outcomes and Cost-effectiveness Associated With Provision of Addiction Treatment in US Primary Care Clinics

et al. 2023

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ImportanceUS primary care practitioners (PCPs) are the largest clinical workforce, but few provide addiction care. Primary care is a practical place to expand addiction services, including buprenorphine and harm reduction kits, yet the clinical outcomes and health care sector costs are unknown.ObjectiveTo estimate the long-term clinical outcomes, costs, and cost-effectiveness of integrated buprenorphine and harm reduction kits in primary care for people who inject opioids.Design, Setting, and ParticipantsIn this modeling study, the Reducing Infections Related to Drug Use Cost-Effectiveness (REDUCE) microsimulation model, which tracks serious injection-related infections, overdose, hospitalization, and death, was used to examine the following treatment strategies: (1) PCP services with external referral to addiction care (status quo), (2) PCP services plus onsite buprenorphine prescribing with referral to offsite harm reduction kits (BUP), and (3) PCP services plus onsite buprenorphine prescribing and harm reduction kits (BUP plus HR). Model inputs were derived from clinical trials and observational cohorts, and costs were discounted annually at 3%. The cost-effectiveness was evaluated over a lifetime from the modified health care sector perspective, and sensitivity analyses were performed to address uncertainty. Model simulation began January 1, 2021, and ran for the entire lifetime of the cohort.Main Outcomes and MeasuresLife-years (LYs), hospitalizations, mortality from sequelae (overdose, severe skin and soft tissue infections, and endocarditis), costs, and incremental cost-effectiveness ratios (ICERs).ResultsThe simulated cohort included 2.25 million people and reflected the age and gender of US persons who inject opioids. Status quo resulted in 6.56 discounted LYs at a discounted cost of $203 500 per person (95% credible interval, $203 000-$222 000). Each strategy extended discounted life expectancy: BUP by 0.16 years and BUP plus HR by 0.17 years. Compared with status quo, BUP plus HR reduced sequelae-related mortality by 33%. The mean discounted lifetime cost per person of BUP and BUP plus HR were more than that of the status quo strategy. The dominating strategy was BUP plus HR. Compared with status quo, BUP plus HR was cost-effective (ICER, $34 400 per LY). During a 5-year time horizon, BUP plus HR cost an individual PCP practice approximately $13 000.Conclusions and RelevanceThis modeling study of integrated addiction service in primary care found improved clinical outcomes and modestly increased costs. The integration of addiction service into primary care practices should be a health care system priority.

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Section: Methodsmentioning

confidence: 99%

Estimated Clinical Outcomes and Cost-effectiveness Associated With Provision of Addiction Treatment in US Primary Care Clinics

et al. 2023

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“…Therefore, we considered any quantitative outcome measured in association with ACS-delivered treatment, such as intra-hospital treatment engagement (eg, agreeing to consultation and initiation of SUD-related treatment while in hospital), postdischarge treatment engagement (eg, attendance at an outpatient addiction treatment center), postdischarge acute care utilization (eg, the number of hospital readmissions and emergency room visits for SUD-related concerns), hospitalization-related metrics (eg, the total length of stay, number of patient-direct discharges), frequency of postdischarge substance use, and other SUD-related outcomes (eg, postdischarge SUD-related incarceration). We did not consider qualitative outcomes, given that there have been several previous reviews on this already 24,28,35–38 . We considered peer-reviewed observational and experimental studies evaluating the impact of ACS on SUD-related outcomes.…”

Section: Methodsmentioning

confidence: 99%

The Effectiveness of Inpatient Addiction Consult Services: A Systematic Review and Narrative Synthesis

Bahji

Brothers

Mauer-Vakil

et al. 2023

Canadian Journal of Addiction

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Background: Addiction Consult Services (ACS) have become an emergent clinical intervention for persons with substance use disorders (SUD) requiring hospital-based care. However, there have been few recent evaluations of the evidence for the effectiveness of ACS on SUD outcomes.Objective: We aimed to assess the effectiveness of ACS for persons with SUD on a range of SUD-related outcomes.Methods: We systematically reviewed peer-reviewed scientific literature measuring ACS outcomes. We searched 5 electronic sources (PubMed, MEDLINE, CINAHL, Cochrane, and EMBASE) from database inception through April 2021 and hand-searched article bibliographies for additional records. In addition, we considered any interventional or observational study design presenting original data and appraised study quality with the Joanna Briggs Institute checklist. Assessed outcomes included pharmacotherapy initiation in-hospital and postdischarge, retention in addiction treatment, length of hospital stay, 30-day readmissions, deaths, and patientdirected discharges. Finally, we conducted a narrative synthesis due to study design and outcome measurement heterogeneity.Results: From the initial pool of 1057 records, 26 studies (n = 12,823 participants; 60% male; mean age: 41 y) met review inclusion criteria. Most ACS provided pharmacotherapy, usually medications for opioid use disorder; add-on services varied, with some also providing psychotherapy (69%), discharge planning services (23%), and infectious disease consultation and treatment (19%). Overall, 7 studies (27%) observed positive impacts of ACS compared with control interventions on postdischarge engagement in addiction treatment and reduced addiction severity. Four studies (15%) reported no significant impacts of ACS versus control interventions on postdischarge care utilization or injection drug use frequency. The remaining 15 studies (58%) described the uptake of ACS-delivered treatments by hospital-based samples of patients with SUD but did not compare against a control condition.

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“…A hospital-based addiction consultation service has the potential to increase delivery of MOUD to patients with OUD (as well as other substance use disorders) during their hospitalization and link them to treatment after hospital discharge [45]. Prior studies suggest that an inpatient addiction consult team may have a positive effect on MOUD initiation and linkage to post-discharge care [34,46] and result in lower readmission rates [47], and that this type of team is feasible, acceptable to patients and providers, and cost-effective to implement [34,[48][49][50][51][52][53]. Additionally, studies also show that patients who initiate MOUD in the hospital are more likely to continue MOUD for their OUD after discharge.…”

Section: Introductionmentioning

confidence: 99%

The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder

Ober

Murray‐Krezan

Page

et al. 2022

Addict Sci Clin Pract

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Background People with opioid use disorder experience high burden of disease from medical comorbidities and are increasingly hospitalized with medical complications. Medications for opioid use disorder are an effective, life-saving treatment, but patients with an opioid use disorder admitted to the hospital seldom initiate medication for their disorder while in the hospital, nor are they linked with outpatient treatment after discharge. The inpatient stay, when patients may be more receptive to improving their health and reducing substance use, offers an opportunity to discuss opioid use disorder and facilitate medication initiation and linkage to treatment after discharge. An addiction-focus consultative team that uses evidence-based tools and resources could address barriers, such as the need for the primary medical team to focus on the primary health problem and lack of time and expertise, that prevent primary medical teams from addressing substance use. Methods This study is a pragmatic randomized controlled trial that will evaluate whether a consultative team, called the Substance Use Treatment and Recovery Team (START), increases initiation of any US Food and Drug Administration approved medication for opioid use disorder (buprenorphine, methadone, naltrexone) during the hospital stay and increases linkage to treatment after discharge compared to patients receiving usual care. The study is being conducted at three geographically distinct academic hospitals. Patients are randomly assigned within each hospital to receive the START intervention or usual care. Primary study outcomes are initiation of medication for opioid use disorder in the hospital and linkage to medication or other opioid use disorder treatment after discharge. Outcomes are assessed through participant interviews at baseline and 1 month after discharge and data from hospital and outpatient medical records. Discussion The START intervention offers a compelling model to improve care for hospitalized patients with opioid use disorder. The study could also advance translational science by identifying an effective and generalizable approach to treating not only opioid use disorder, but also other substance use disorders and behavioral health conditions. Trial registration: Clinicaltrials.gov: NCT05086796, Registered on 10/21/2021. https://www.clinicaltrials.gov/ct2/results?recrs=ab&cond=&term=NCT05086796&cntry=&state=&city=&dist =

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Making the business case for an addiction medicine consult service: a qualitative analysis

Cited by 19 publications

References 29 publications

Estimated Clinical Outcomes and Cost-effectiveness Associated With Provision of Addiction Treatment in US Primary Care Clinics

Estimated Clinical Outcomes and Cost-effectiveness Associated With Provision of Addiction Treatment in US Primary Care Clinics

The Effectiveness of Inpatient Addiction Consult Services: A Systematic Review and Narrative Synthesis

The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder

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