Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Mobile Outreach Street Health, North End Community Health Centre, Halifax, Nova Scotia, Canada.
Subst Abus. 2021;42(4):433-437. doi: 10.1080/08897077.2020.1856291. Epub 2020 Dec 17.
To evaluate a novel, unofficial, trainee-organized, hospital addiction medicine consultation service (AMCS), we aimed to assess whether it was (1) acceptable to hospital providers and patients, (2) feasible to organize and deliver, and (3) impacted patient care. : We performed a retrospective descriptive study of all AMCS consultations over the first 16 months. We determined acceptability via the number of referrals received from admitting services, and the proportion of referred patients who consented to consultation. We evaluated feasibility via continuation/growth of the service over time, and the proportion of referrals successfully completed before hospital discharge. As most referrals related to opioid use disorder, we determined impact through the proportion of eligible patients offered and initiated on opioid agonist therapy (OAT) in hospital, and the proportion of patients who filled their outpatient prescription or attended their first visit with their outpatient OAT prescriber. : The unofficial AMCS grew to involve six hospital-based residents and five supervising community-based addiction physicians. The service received 59 referrals, primarily related to injection opioid use, for 50 unique patients from 12 different admitting services. 90% of patients were seen before discharge, and 98% agreed to addiction medicine consultation. Among 34 patients with active moderate-severe opioid use disorder who were not already on OAT, 82% initiated OAT in hospital and 89% of these patients continued after discharge. : Established in response to identified gaps in patient care and learning opportunities, a novel, unofficial, trainee-organized AMCS was acceptable, feasible, and positively impacted patient care over the first 16 months. This trainee-organized, unofficial AMCS could be used as a model for other hospitals that do not yet have an official AMCS.
为了评估一种新颖的、非官方的、由受训者组织的医院成瘾医学咨询服务（AMCS），我们旨在评估它是否（1）被医院提供者和患者接受，（2）可行的组织和实施，以及（3）对患者护理产生影响。我们对前 16 个月内所有 AMCS 咨询进行了回顾性描述性研究。我们通过从收治服务收到的转介数量以及同意咨询的转介患者比例来确定可接受性。我们通过服务随时间的延续/增长以及在出院前成功完成的转介比例来评估可行性。由于大多数转介与阿片类药物使用障碍有关，我们通过在医院提供和启动阿片类激动剂治疗（OAT）的合格患者比例以及在医院外开出 OAT 处方的患者比例或参加其门诊 OAT 处方医生的首次就诊来确定影响。非官方的 AMCS 发展到涉及六名医院住院医师和五名监督的社区成瘾医生。该服务从 12 个不同的收治服务收到 59 次转介，主要与注射阿片类药物使用有关，涉及 50 名不同的患者。90%的患者在出院前得到了诊治，98%的患者同意接受成瘾医学咨询。在 34 名患有活跃的中重度阿片类药物使用障碍且未接受 OAT 的患者中，82%的患者在医院开始接受 OAT，其中 89%的患者在出院后继续接受 OAT。在患者护理和学习机会方面存在明显差距的情况下，建立了新颖的、非官方的、由受训者组织的 AMCS，在最初的 16 个月内，它是可接受的、可行的，并对患者护理产生了积极影响。这种由受训者组织的、非官方的 AMCS 可以作为其他尚未设立正式 AMCS 的医院的模式。
