From the Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (JZ); Department of Neuroscience, Thomas Jefferson University, Philadelphia, PA (NMH, ACL); and Department of Psychiatry, Thomas Jefferson University, Philadelphia, PA (RCS).
J Addict Med. 2023;17(1):e57-e63. doi: 10.1097/ADM.0000000000001053. Epub 2022 Aug 24.
Rising rates of hospitalization for patients with opioid use disorder (OUD) result in high rates of patient-directed discharge (PDD, also called "discharge against medical advice") and 30-day readmissions. Interdisciplinary addiction consult services are an emerging criterion standard to improve care for these patients, but these services are resource- and expertise-intensive. A set of withdrawal guidelines was developed to guide generalists in caring for patients with opioid withdrawal at a hospital without an addiction consult service.
Retrospective chart review was performed to determine PDD, 30-day readmission, and psychiatry consult rates for hospitalized patients with OUD during periods before (July 1, 2017, to March 31, 2018) and after (January 1, 2019, to July 31, 2019) the withdrawal guidelines were implemented. Information on the provision of opioid agonist therapy (OAT) was also obtained.
Use of OAT in patients with OUD increased significantly after guideline introduction, from 23.3% to 64.8% ( P < 0.001). Patient-directed discharge did not change, remaining at 14% before and after. Thirty-day readmissions increased 12.4% to 15.7% ( P = 0.05065). Receiving any OAT was associated with increased PDD and readmission, but only within the postintervention cohort.
A guideline to facilitate generalist management of opioid withdrawal in hospitalized patients improved the process of care, increasing the use of OAT and decreasing workload on the psychiatry consult services. Although increased inpatient OAT has been previously shown to decrease PDD, in this study PDD and readmission rates did not improve. Guidelines may be insufficient to impact these outcomes.
阿片类药物使用障碍（OUD）患者的住院率不断上升，导致患者定向出院（PDD，也称为“违反医嘱出院”）和 30 天再入院率居高不下。多学科成瘾咨询服务是改善此类患者护理的新兴标准，但这些服务需要大量资源和专业知识。我们制定了一套戒断指南，以指导没有成瘾咨询服务的医院的普通医生治疗阿片类药物戒断的患者。
我们对病历进行了回顾性分析，以确定在实施戒断指南之前（2017 年 7 月 1 日至 2018 年 3 月 31 日）和之后（2019 年 1 月 1 日至 2019 年 7 月 31 日），患有 OUD 的住院患者的 PDD、30 天再入院率和精神科咨询率，同时还获得了阿片类激动剂治疗（OAT）的提供情况。
指南出台后，OUD 患者中 OAT 的使用明显增加，从 23.3%增加到 64.8%（P<0.001）。PDD 没有变化，在指南出台前后都保持在 14%。30 天再入院率增加了 12.4%至 15.7%（P=0.05065）。接受任何 OAT 治疗与 PDD 和再入院增加相关，但仅在干预后队列中如此。
促进普通医生管理住院患者阿片类药物戒断的指南改善了治疗过程，增加了 OAT 的使用，减少了精神科咨询服务的工作量。尽管之前的研究表明增加住院 OAT 可降低 PDD，但在本研究中，PDD 和再入院率并未改善。指南可能不足以影响这些结果。
