Division of Addiction Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York.
J Hosp Med. 2021 Jun;16(6):339-344. doi: 10.12788/jhm.3544.
Hospitalized patients with opioid use disorder (OUD) are rarely started on buprenorphine or methadone maintenance despite evidence that these medications reduce all-cause mortality, overdoses, and hospital readmissions.
To assess whether clinician education and a team of residents and hospitalist attendings waivered to prescribe buprenorphine increased the rate of starting patients with OUD on buprenorphine maintenance.
DESIGN, SETTING, AND PARTICIPANTS: Quality improvement study conducted at a large, urban, academic hospital in Maryland involving hospitalized patients with OUD on internal medicine resident services.
We developed a protocol for initiating buprenorphine maintenance, presented an educational conference, and started the resident-led Buprenorphine Bridge Team of residents and attendings waivered to prescribe buprenorphine to bridge patients from discharge to follow-up.
The percent of eligible inpatients with OUD initiated on buprenorphine maintenance, 24 weeks before and after the intervention; engagement in treatment after discharge; and resident knowledge and comfort with buprenorphine.
The rate of starting buprenorphine maintenance increased from 10% (30 of 305 eligible patients) to 24% (64 of 270 eligible patients) after the intervention, with interrupted time series analysis showing a significant increase in rate (14.4%; 95% CI, 3.6%-25.3%; P = .02). Engagement in treatment after discharge was unchanged (40%-46% engaged 30 days after discharge). Of 156 internal medicine residents, 89 (57%) completed the baseline survey and 66 (42%) completed the follow-up survey. Responses demonstrated improved resident knowledge and comfort with buprenorphine.
Internal medicine resident teams were more likely to start patients on buprenorphine maintenance after clinician education and implementation of a Buprenorphine Bridge Team.
尽管有证据表明美沙酮和丁丙诺啡等药物可降低全因死亡率、减少过量用药和住院再入院率，但患有阿片类药物使用障碍（OUD）的住院患者很少开始使用这些药物进行美沙酮或丁丙诺啡维持治疗。
评估临床医生教育和由住院医师和主治医生组成的团队来开具丁丙诺啡处方，是否能提高开始使用丁丙诺啡维持治疗 OUD 患者的比例。
设计、地点和参与者：这项在马里兰州一家大型城市学术医院进行的质量改进研究，涉及内科住院医师服务中的患有 OUD 的住院患者。
我们制定了丁丙诺啡维持治疗的启动方案，举办了一次教育会议，并成立了由住院医师和主治医生组成的丁丙诺啡桥接团队，他们可以开具丁丙诺啡处方，帮助患者从出院过渡到后续治疗。
干预前后 24 周内，有多少符合条件的 OUD 住院患者开始接受丁丙诺啡维持治疗；出院后的治疗参与度；以及住院医师对丁丙诺啡的了解和使用意愿。
在干预后，开始丁丙诺啡维持治疗的比例从 10%（305 名符合条件的患者中有 30 名）增加到 24%（270 名符合条件的患者中有 64 名），时间序列中断分析显示，这一比例有显著增加（14.4%；95%置信区间，3.6%-25.3%；P=0.02）。出院后治疗参与度保持不变（出院后 30 天，40%-46%的患者参与治疗）。156 名内科住院医师中，89 人（57%）完成了基线调查，66 人（42%）完成了随访调查。调查结果表明，住院医师对丁丙诺啡的了解和使用意愿有所提高。
临床医生教育和实施丁丙诺啡桥接团队后，内科住院医师团队更有可能开始让患者使用丁丙诺啡维持治疗。
