Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO (NSN, LRM, SYL, MJD); Division of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO (SYL).
J Addict Med. 2021 Apr 1;15(2):155-158. doi: 10.1097/ADM.0000000000000725.
To identify the incidence, characteristics, and factors associated with against medical advice (AMA) discharge among hospitalized patients with opioid use disorder (OUD) and injection related infections (eg, endocarditis, osteomyelitis, epidural abscesses).
This retrospective cohort study evaluated adults with OUD admitted to an academic medical center from January 1, 2016 to January 7, 2019 for an invasive injection related infection. Multivariable logistic regression was used to determine independent factors associated with AMA discharge.
Among 262 adults admitted with serious injection related infections and comorbid OUD, 138 received inpatient medications for opioid use disorder (MOUD). Univariate analysis showed a decreased odds ratio (OR) of AMA discharge when patients received MOUD inpatient (OR 0.55; 95% CI 0.34-0.91.). Adjusting for covariates associated with social determinants of health and other substance use, inpatient receipt of MOUD was associated with a decreased risk of AMA discharge (adjusted OR 0.49; 95% CI 0.028-0.84).
Among patients with OUD and serious injection related infections, inpatient initiation of MOUD is associated with decreased risk of AMA discharge.
确定患有阿片类药物使用障碍（OUD）和与注射相关感染（如心内膜炎、骨髓炎、硬膜外脓肿）的住院患者中拒绝医疗建议（AMA）出院的发生率、特征和相关因素。
本回顾性队列研究评估了 2016 年 1 月 1 日至 2019 年 1 月 7 日期间因侵袭性注射相关感染而入住学术医疗中心的患有 OUD 的成年人。多变量逻辑回归用于确定与 AMA 出院相关的独立因素。
在 262 名患有严重注射相关感染和合并 OUD 的成年人中，138 名接受了住院治疗的阿片类药物使用障碍药物治疗（MOUD）。单因素分析显示，当患者接受 MOUD 住院治疗时，AMA 出院的可能性降低（比值比 0.55；95%置信区间 0.34-0.91）。调整与社会决定因素和其他物质使用相关的协变量后，住院接受 MOUD 与 AMA 出院风险降低相关（调整比值比 0.49；95%置信区间 0.028-0.84）。
在患有 OUD 和严重注射相关感染的患者中，住院时开始 MOUD 与 AMA 出院风险降低相关。
