Section of Addiction Medicine in Division of General Internal Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
J Gen Intern Med. 2022 Aug;37(11):2821-2833. doi: 10.1007/s11606-022-07618-x. Epub 2022 May 9.
There is pressing need to improve hospital-based addiction care. Various models for integrating substance use disorder care into hospital settings exist, but there is no framework for describing, selecting, or comparing models. We sought to fill that gap by constructing a taxonomy of hospital-based addiction care models based on scoping literature review and key informant interviews.
Methods included a scoping review of the literature on US hospital-based addiction care models and interventions for adults, published between January 2000 and July 2021. We conducted semi-structured interviews with 15 key informants experienced in leading, implementing, evaluating, andpracticing hospital-based addiction care to explore model characteristics, including their perceived strengths, limitations, and implementation considerations. We synthesized findings from the literature review and interviews to construct a taxonomy of model types.
Searches identified 2,849 unique abstracts. Of these, we reviewed 280 full text articles, of which 76 were included in the final review. We added 8 references from reference lists and informant interviews, and 4 gray literature sources. We identified six distinct hospital-based addiction care models. Those classified as addiction consult models include (1) interprofessional addiction consult services, (2) psychiatry consult liaison services, and (3) individual consultant models. Those classified as practice-based models, wherein general hospital staff integrate addiction care into usual practice, include (4) hospital-based opioid treatment and (5) hospital-based alcohol treatment. The final type was (6) community-based in-reach, wherein community providers deliver care. Models vary in their target patient population, staffing, and core clinical and systems change activities. Limitations include that some models have overlapping characteristics and variable ways of delivering core components.
A taxonomy provides hospital clinicians and administrators, researchers, and policy-makers with a framework to describe, compare, and select models for implementing hospital-based addiction care and measure outcomes.
提高医院成瘾治疗服务水平的需求迫在眉睫。将物质使用障碍治疗纳入医院环境的各种模式已经存在，但缺乏描述、选择或比较这些模式的框架。我们试图通过对基于文献回顾和关键知情人访谈的美国医院成瘾治疗模式和干预措施进行范围界定审查来填补这一空白。
我们对 2000 年 1 月至 2021 年 7 月期间发表的关于美国医院成瘾治疗模式和干预措施的文献进行了范围界定审查。我们对 15 名在领导、实施、评估和实践医院成瘾治疗方面经验丰富的关键知情人进行了半结构化访谈，以探讨模型特征，包括其认为的优势、局限性和实施注意事项。我们对文献综述和访谈的结果进行综合，构建了一个模型类型分类法。
检索共确定了 2849 篇摘要。在这 2849 篇摘要中，我们回顾了 280 篇全文文章，其中 76 篇被纳入最终审查。我们从参考文献列表和知情人访谈中添加了 8 篇参考文献和 4 篇灰色文献来源。我们确定了 6 种不同的基于医院的成瘾治疗模式。被归类为成瘾咨询模式的包括（1）多专业成瘾咨询服务，（2）精神病学咨询联络服务，和（3）个人咨询模式。被归类为基于实践的模式，即一般医院工作人员将成瘾治疗纳入常规实践的包括（4）基于医院的阿片类药物治疗和（5）基于医院的酒精治疗。最后一种是（6）社区内展，即社区提供者提供治疗。这些模式在目标患者人群、人员配备以及核心临床和系统变革活动方面存在差异。局限性包括一些模式具有重叠的特征和提供核心组件的不同方式。
分类法为医院临床医生和管理人员、研究人员和政策制定者提供了一个框架，用于描述、比较和选择实施医院成瘾治疗的模式，并衡量结果。
