Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore.
Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland.
AIDS. 2023 Oct 1;37(12):1799-1809. doi: 10.1097/QAD.0000000000003629. Epub 2023 Jun 20.
To evaluate the association between medication for opioid use disorder (MOUD) initiation and addiction consultation and outcomes for patients hospitalized with infectious complications of injecting opioids.
This was a retrospective cohort study performed at four academic medical centers in the United States. The participants were patients who had been hospitalized with infectious complications of injecting opioids in 2018. Three hundred and twenty-two patients were included and their individual patient records were manually reviewed to identify inpatient receipt of medication for opioid use disorder (MOUD), initiation of MOUD, and addiction consultation. The main outcomes of interest were premature discharge, MOUD on discharge, linkage to outpatient MOUD, one-year readmission and death.
Three hundred and twenty-two patients were predominately male (59%), white (66%), and median age 38 years, with 36% unstably housed, and 30% uninsured. One hundred and forty-five (45%) patients received MOUD during hospitalization, including only 65 (28%) patients not on baseline MOUD. Discharge was premature for 64 (20%) patients. In the year following discharge, 27 (9%) patients were linked to MOUD, and 159 (50%) patients had at least one readmission. Being on MOUD during hospitalization was significantly associated with higher odds of planned discharge [odds ratio (OR) 3.87, P < 0.0001], MOUD on discharge (OR 129.7, P < 0.0001), and linkage to outpatient MOUD (OR 1.25, P < 0.0001), however, was not associated with readmission. Study limitations were the retrospective nature of the study, so post-discharge data are likely underestimated.
There was dramatic undertreatment with MOUD from inpatient admission to outpatient linkage, and high rates of premature discharge and readmission. Engagement in addiction care during hospitalization is a critical first step in improving the care continuum for individuals with opioid use disorder; however, additional interventions may be needed to impact long-term outcomes like readmission.
评估阿片类药物使用障碍（MOUD）起始治疗和成瘾咨询与因注射阿片类药物感染并发症住院患者结局之间的关系。
这是一项在美国四家学术医疗中心进行的回顾性队列研究。参与者为 2018 年因注射阿片类药物感染并发症住院的患者。共纳入 322 例患者，对其个人病历进行人工审查，以确定住院期间接受阿片类药物使用障碍（MOUD）治疗、开始 MOUD 治疗和成瘾咨询的情况。主要观察指标为提前出院、出院时接受 MOUD 治疗、与门诊 MOUD 衔接、1 年再入院和死亡。
322 例患者中，男性占 59%（192 例），白人占 66%（212 例），中位年龄 38 岁，36%（117 例）居住不稳定，30%（97 例）没有保险。145 例（45%）患者在住院期间接受 MOUD 治疗，其中只有 65 例（28%）患者未接受基线 MOUD 治疗。64 例（20%）患者提前出院。出院后 1 年内，27 例（9%）患者与 MOUD 衔接，159 例（50%）患者至少有 1 次再入院。住院期间接受 MOUD 治疗与计划出院的可能性更高显著相关[比值比（OR）3.87，P ＜0.0001]、出院时接受 MOUD 治疗（OR 129.7，P ＜0.0001）和与门诊 MOUD 衔接（OR 1.25，P ＜0.0001），但与再入院无关。研究局限性在于研究的回顾性，因此出院后数据可能被低估。
从住院到门诊衔接，MOUD 的治疗严重不足，提前出院和再入院率较高。住院期间接受成瘾治疗是改善阿片类药物使用障碍患者治疗连续性的关键第一步；然而，可能需要采取其他干预措施来影响再入院等长期结局。
