Kays Lindsey B, Steltenpohl Emily D, McPheeters Chelsey M, Frederick Emily K, Bishop Laura B
University of Louisville Hospital, Louisville, KY, USA.
Hosp Pharm. 2022 Feb;57(1):88-92. doi: 10.1177/0018578720985439. Epub 2020 Dec 29.
Evidence shows that patients with opioid use disorder (OUD) have an increased rate of discharge against medical advice (DAMA) as well as higher rates of hospital readmission. Therefore, the objective of this study was to determine if inpatient initiation of buprenorphine/naloxone in patients with OUD is associated with decreased rates of DAMA. This was a single center retrospective cohort study conducted at a level 1, academic medical center. The study included patients with OUD admitted to the Internal Medicine service from January through May of both 2018 and 2019 for an admitting diagnosis other than opioid withdrawal. The primary endpoint was rate of DAMA among OUD patients not initiated on opioid agonist therapy compared to those initiated on buprenorphine/naloxone. The secondary endpoint was the association between factors of the initiation process on rates of DAMA. Patients were excluded if they were discharged in less than 24 hours or received intermittent administration of buprenorphine/naloxone. The rate of DAMA in OUD patients not initiated on buprenorphine/naloxone was 13.85% compared to 2.56% in those initiated on buprenorphine/naloxone ( = .048). In OUD patients initiated on buprenorphine/naloxone, the rate of DAMA was significantly lower than those who were not. This data supports the importance of optimizing the opportunity to initiate buprenorphine/naloxone in the acute care setting to minimize withdrawal symptoms therefore reducing the rate of DAMA. Ultimately increasing the ability to adequately treat the primary reason for admission and potentially decreasing readmission rates. Further studies are needed to evaluate this impact as this study is limited to a small sample size therefore lacking adequate power.
有证据表明，患有阿片类药物使用障碍（OUD）的患者违反医嘱出院（DAMA）的比率增加，且再次入院率更高。因此，本研究的目的是确定在患有OUD的患者中住院开始使用丁丙诺啡/纳洛酮是否与降低DAMA比率相关。这是一项在一级学术医疗中心进行的单中心回顾性队列研究。该研究纳入了2018年和2019年1月至5月因阿片类药物戒断以外的入院诊断而入住内科的患有OUD的患者。主要终点是未开始使用阿片类激动剂治疗的OUD患者与开始使用丁丙诺啡/纳洛酮的患者相比的DAMA比率。次要终点是开始治疗过程的因素与DAMA比率之间的关联。如果患者在不到24小时内出院或接受丁丙诺啡/纳洛酮的间歇性给药，则将其排除。未开始使用丁丙诺啡/纳洛酮的OUD患者的DAMA比率为13.85%，而开始使用丁丙诺啡/纳洛酮的患者为2.56%（P = 0.048）。在开始使用丁丙诺啡/纳洛酮的OUD患者中，DAMA比率明显低于未使用的患者。这些数据支持了在急性护理环境中优化开始使用丁丙诺啡/纳洛酮的机会以最小化戒断症状从而降低DAMA比率的重要性。最终提高充分治疗入院主要原因的能力并可能降低再次入院率。由于本研究仅限于小样本量，因此缺乏足够的效力，需要进一步研究来评估这种影响。
