物质使用障碍咨询服务所诊治的住院患者的阿片类激动剂治疗启动及衔接
Opioid agonist treatment initiation and linkage for hospitalized patients seen by a substance use disorder consultation service.
作者信息
Nordeck Courtney D, Welsh Christopher, Schwartz Robert P, Mitchell Shannon Gwin, O'Grady Kevin E, Gryczynski Jan
机构信息
Friends Research Institute, Inc., Baltimore, MD, United States.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
出版信息
Drug Alcohol Depend Rep. 2022 Feb 7;2:100031. doi: 10.1016/j.dadr.2022.100031. eCollection 2022 Mar.
BACKGROUND
Facilitating opioid agonist treatment (OAT) for opioid use disorder (OUD) is an important role of hospital substance use disorder (SUD) consultation services. In the trial, hospital patients receiving SUD consultation who were randomly assigned to patient navigation services for 3 months post-discharge had fewer readmissions compared to usual care.
METHODS
This secondary analysis examined hospital-based OAT initiation (pre-randomization) and community-based OAT linkage (post-discharge) among NavSTAR trial participants with OUD (314). Associations between OAT initiation and linkage, and patient demographics, housing status, comorbid SUD diagnoses, recent substance use, and study condition were examined using multinomial and dichotomous logistic regression.
RESULTS
Overall, 57.6% initiated OAT during hospitalization (36.3% methadone, 21.3% buprenorphine). Compared to participants not initiating OAT, participants who received methadone were more likely to be female (Relative Risk Ratio [RRR]=2.05, 95% CI=1.11, 3.82, =0.02), while participants who received buprenorphine were more likely to report homelessness (RRR=2.57, 95% CI=1.24, 5.32, =0.01). Compared to participants initiating methadone, participants initiating buprenorphine were more likely to be non-White (RRR=3.89; 95% CI=1.55, 9.70; =0.004) and to report prior buprenorphine treatment (RRR=2.57; 95% CI=1.27, 5.20; =0.009). OAT linkage within 30-days post-discharge was associated with hospital-based buprenorphine initiation (Adjusted Odds Ratio [AOR]=3.86, 95% CI=1.73, 8.61, 0.001) and patient navigation intervention (AOR=2.97, 95% CI=1.60, 5.52, =0.001).
CONCLUSIONS
OAT initiation differed by sex, race, and housing status. Hospital-based OAT initiation and patient navigation were independently associated with linkage to community-based OAT. Hospitalization is a reachable moment to begin OAT to alleviate withdrawal and facilitate treatment continuity post-discharge.
背景
为阿片类物质使用障碍（OUD）提供阿片类激动剂治疗（OAT）是医院物质使用障碍（SUD）咨询服务的一项重要职责。在该试验中，与常规护理相比，接受SUD咨询的住院患者在出院后被随机分配接受为期3个月的患者导航服务，其再入院次数较少。
方法
这项二次分析研究了NavSTAR试验中314名患有OUD的参与者的医院内OAT启动（随机分组前）和社区OAT衔接（出院后）情况。使用多项和二分逻辑回归分析了OAT启动与衔接、患者人口统计学特征、住房状况、共病SUD诊断、近期物质使用情况以及研究条件之间的关联。
结果
总体而言，57.6%的患者在住院期间启动了OAT（36.3%使用美沙酮，21.3%使用丁丙诺啡）。与未启动OAT的参与者相比，接受美沙酮治疗的参与者更可能为女性（相对风险比[RRR]=2.05，95%置信区间=1.11，3.82，P=0.02），而接受丁丙诺啡治疗的参与者更可能报告无家可归（RRR=2.57，95%置信区间=1.24，5.32，P=0.01）。与启动美沙酮的参与者相比，启动丁丙诺啡的参与者更可能为非白人（RRR=3.89；95%置信区间=1.55，9.70；P=0.004）且报告曾接受丁丙诺啡治疗（RRR=2.57；95%置信区间=1.27，5.20；P=0.009）。出院后30天内的OAT衔接与医院内丁丙诺啡启动（调整优势比[AOR]=3.86，95%置信区间=1.73，8.61，P=0.001）和患者导航干预（AOR=2.97，95%置信区间=1.60，5.52，P=0.001）相关。
结论
OAT启动在性别、种族和住房状况方面存在差异。医院内OAT启动和患者导航与社区OAT衔接独立相关。住院是开始OAT以缓解戒断症状并促进出院后治疗连续性的一个可及时机。
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