Aurora Behavioral Health Services, Advocate Aurora Health, Wauwatosa, WI.
Aurora Behavioral Health Services, Advocate Aurora Health, Wauwatosa, WI; Aurora Research Institute, Advocate Aurora Health, Wauwatosa, WI.
Psychosomatics. 2020 Nov-Dec;61(6):678-687. doi: 10.1016/j.psym.2020.06.019. Epub 2020 Jul 2.
Infections related to intravenous drug use and opioid use disorders (OUDs) are increasing nationwide. Endocarditis is a recognized complication of intravenous drug use, and inpatient treatment typically focuses on infection management without attention to underlying addiction.
A comprehensive intervention for inpatients with infective endocarditis and intravenous drug use was implemented by a multidisciplinary team at a large midwestern hospital. The team included behavioral health/addiction medicine, infectious disease, pain medicine, cardiothoracic surgery, pharmacy, and nursing to address the OUD while managing the infection. The intervention was assessed by measuring the initiation of medication-assisted treatment and endocarditis-related readmissions.
Patients were identified from the medical records using discharge diagnosis codes for OUDs and infective endocarditis. In addition to medical management of infective endocarditis, the multidisciplinary intervention included early involvement of addiction medicine and the pain management at the time of admission. Patient interventions included education, motivational interviewing, behavioral health engagement, collaborative pain management, individual/family therapy, medication evaluation, and initiation of medication-assisted treatment. Caregivers were also educated on OUDs and ways to support patients undergoing interventions.
Both the historical control group (N = 37) and the intervention group (N = 33) were comparable in age, gender, race, marital status, psychiatric history, and smoking but differed by employment status, religious affiliation, and use of psychiatric medications. At discharge, 18.9% of the control group and 54.5% in the intervention group were initiated on medication-assisted treatment for OUDs. No differences in readmission rates were found.
Multidisciplinary teams for treating inpatients with intravenous drug use and infective endocarditis are feasible and can increase the uptake of OUD-specific treatment.
与静脉注射药物使用和阿片类药物使用障碍（OUD）相关的感染在全国范围内不断增加。心内膜炎是静脉注射药物使用的一种公认并发症，住院治疗通常侧重于感染管理，而不关注潜在的成瘾问题。
中西部一家大型医院的多学科团队为患有感染性心内膜炎和静脉注射药物使用的住院患者实施了一项综合干预措施。该团队包括行为健康/成瘾医学、传染病、疼痛医学、心胸外科、药剂科和护理，以在管理感染的同时解决 OUD。通过测量开始药物辅助治疗和心内膜炎相关再入院的情况来评估干预措施。
通过使用 OUD 和感染性心内膜炎的出院诊断代码从病历中识别患者。除了感染性心内膜炎的医学管理外，多学科干预措施还包括早期介入成瘾医学和入院时的疼痛管理。患者干预措施包括教育、动机访谈、行为健康参与、协作疼痛管理、个体/家庭治疗、药物评估和开始药物辅助治疗。还向护理人员提供了 OUD 及其支持接受干预的患者的方法。
历史对照组（N=37）和干预组（N=33）在年龄、性别、种族、婚姻状况、精神病史和吸烟方面相似，但在就业状况、宗教信仰和使用精神科药物方面存在差异。出院时，对照组有 18.9%，干预组有 54.5%的患者开始接受 OUD 的药物辅助治疗。未发现再入院率的差异。
治疗静脉注射药物使用和感染性心内膜炎住院患者的多学科团队是可行的，可以增加 OUD 特定治疗的采用。
