Patient perspectives on a harm reduction-oriented addiction medicine consultation team implemented in a large acute care hospital

Hyshka, Elaine; Morris, Heather; Anderson-Baron, Jalene; Nixon, Lara; Dong, Kathryn; Salvalaggio, Ginetta

doi:10.1016/j.drugalcdep.2019.06.025

Cited by 45 publications

(43 citation statements)

References 39 publications

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“…Addressing existing hospital culture is important and may be a greater challenge than securing funding and implementing the service. 9,10 Cultivating a philosophy of harm reduction, reducing stigma by creating a greater understanding of substance use disorders and engaging staff in addressing the harms associ ated with ongoing drug use in hospital are also important. Furthermore, it is critical to have a strong, clear and visible commitment by hospital leadership, as well as a local cham pion.…”

Section: How Can Supervised Consumption Services Be Delivered To Patients In Acute Care Hospitals?mentioning

confidence: 99%

Supervised consumption services for acute care hospital patients

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Johnston

et al. 2020

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Section: How Can Supervised Consumption Services Be Delivered To Patients In Acute Care Hospitals?mentioning

confidence: 99%

Supervised consumption services for acute care hospital patients

Dong

Brouwer

Johnston

et al. 2020

CMAJ

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“…The SUIT program as an example of integrated ACS serves many important functions for effective treatment of substance misuse during hospitalization including patient experience [21][22][23][24], clinician experience [25], and care quality [18,26]. The present analysis focuses on the SUIT program's potential impact on key cost drivers for the hospital system, namely LOS and routine discharge to home, and aims to: (1) identify differences in LOS over a 12-month period and (2) estimate the hazard of a hospitalization ending in a routine discharge home versus the alternative, competing events of leaving against medical advice (AMA), in-hospital death, or a transfer to another level of care.…”

Section: Objectivesmentioning

confidence: 99%

“…The SUIT program is based on principles of harm reduction [22,29]. The intervention accounts for gradations of misuse and the incremental stages of change with respect to reducing misuse by using a risk-stratified screening process and by consenting patients for education and treatment.…”

Section: Conceptual Modelmentioning

confidence: 99%

“…That is, to what extent, if any, are these covariate associations with routine discharge related to any systemic biases, a lack of coverage, or clinician bias particularly with respect to SUD patients who did not receive a consultation [17,39,40]? Alternatively, mistrust in medicine, perceived discrimination, self-reliance for substance misuse healing and treatment or lack of treatment readiness may also inform these associations (e.g., for patients who may have denied outpatient treatment or patients who did not receive a consultation) [22,40,41].…”

Section: Plos Onementioning

confidence: 99%

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Differences in length of stay and discharge destination among patients with substance use disorders: The effect of Substance Use Intervention Team (SUIT) consultation service

et al. 2020

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Background Addiction medicine consultation services (ACS) may improve outcomes of hospitalized patients with substance use disorders (SUD). Our aim was to examine the difference in length of stay and the hazard ratio for a routine hospital discharge between SUD patients receiving and not receiving ACS. Methods Structured EHR data from 2018 of 1,900 adult patients with a SUD-related diagnostic code at an urban academic health center were examined among 35,541 total encounters. Cox proportional hazards regression models were fit using a cause-specific approach to examine differences in hospital outcome (i.e., routine discharge, leaving against medical advice, in-hospital death, or transfer to another level of care). Models were adjusted for age, sex, race, ethnicity, insurance status, and comorbidities. Results Length of stay was shorter among encounters with a SUD that received a SUIT consultation versus those admissions that did not receive one (5.77 v. 6.54 days, p<0.01). In adjusted analyses, admissions that received a SUIT consultation had a higher hazard of a routine discharge [hazard ratio (95% confidence interval): 1.16 (1.03-1.30)] compared to those not receiving a SUIT consultation. Conclusions The SUIT consultation service was associated with a reduced length of stay and an increased hazard of a routine discharge. The SUIT model may serve as a benchmark

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“…SIS offer a professionally supervised space in which people can use pre-obtained drugs in a hygienic environment, access sterile injection equipment, and have rapid access to emergency overdose responsesthereby reducing risks associated with using alone; rushing injections; sharing equipment and/or increasing dosagesas well as referrals to various health and social services [13,14]. Inclusion of SIS has increasingly been considered [15] and often recommended as a useful complement to existing in-hospital services for PWUD [5,[9][10][11][12][16][17][18][19][20]. The possibility of SIS to maintain client engagement in HIV care is crucial given the increased risks of harm for people living with HIV/AIDS (PLHIV) who inject drugs [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Feasibility, acceptability, concerns, and challenges of implementing supervised injection services at a specialty HIV hospital in Toronto, Canada: perspectives of people living with HIV

et al. 2021

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Background Substance use significantly impacts health and healthcare of people living with HIV/AIDS (PLHIV), especially their ability to remain in hospital following admission. Supervised injection services (SIS) reduce overdoses and drug-related harms, but are not often provided within hospitals/outpatient programs. Leading us to question, what are PLHIV’s perceptions of hospital-based SIS? Methods This mixed-methods study explored feasibility and acceptability of implementing SIS at Casey House, a Toronto-based specialty HIV hospital, from the perspective of its in/outpatient clients. We conducted a survey, examining clients’ (n = 92) demand for, and acceptability of, hospital-based SIS. Following this, we hosted two focus groups (n = 14) and one-on-one interviews (n = 8) with clients which explored benefits/drawbacks of in-hospital SIS, wherein participants experienced guided tours of a demonstration SIS space and/or presentations of evidence about impacts of SIS. Data were analysed using descriptive statistics and thematic analysis. Results Among survey participants, 76.1% (n = 70) identified as cis-male and over half (n = 49;54.4%) had been a hospital client for 2 years or less. Nearly half (48.8%) knew about clients injecting in/near Casey House, while 23.6% witnessed it. Survey participants were more supportive of SIS for inpatients (76.1%) than for outpatients (68.5%); most (74.7%) reported SIS implementation would not impact their level of service use at Casey House, while some predicted coming more often (16.1%) and others less often (9.2%). Most focus group/interview participants, believed SIS would enhance safety by reducing health harms (e.g. overdose), increasing transparency between clients and clinicians about substance use, and helping retain clients in care. Debate arose about who (e.g., in/outpatients vs. non-clients) should have access to hospital-based SIS and how implementation may shift organizational priorities/resources away from services not specific to drug use. Conclusions Our data showed widespread support of, and need for, hospital-based SIS among client stakeholders; however, attempts to reduce negative impacts on non-drug using clients need to be considered in the balance of implementation plans. Given the increased risks of morbidity and mortality for PLHIV who inject drugs as well as the problems in retaining them in care in a hospital setting, SIS is a key component of improving care for this marginalized group.

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Patient perspectives on a harm reduction-oriented addiction medicine consultation team implemented in a large acute care hospital

Cited by 45 publications

References 39 publications

Supervised consumption services for acute care hospital patients

Supervised consumption services for acute care hospital patients

Differences in length of stay and discharge destination among patients with substance use disorders: The effect of Substance Use Intervention Team (SUIT) consultation service

Feasibility, acceptability, concerns, and challenges of implementing supervised injection services at a specialty HIV hospital in Toronto, Canada: perspectives of people living with HIV

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