Chang Ji Eun, Cronin Cory E, Pagán José A, Simon Janet, Lindenfeld Zoe, Franz Berkeley
From the Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY (JEC, JAP, ZL); College of Health Sciences and Professions, Ohio University, Athens, OH (CC); Heritage College of Osteopathic Medicine, Ohio University, Athens, OH (JS, BF); and Ohio University Appalachian Institute to Advance Health Equity Science (BF, CEC).
J Addict Med. 2023;17(4):e217-e223. doi: 10.1097/ADM.0000000000001128. Epub 2022 Dec 22.
Hospitalizations are an important opportunity to address substance use through inpatient services, outpatient care, and community partnerships, yet the extent to which nonprofit hospitals prioritize such services across time remains unknown. The objective of this study is to examine trends in nonprofit hospitals' prioritization and implementation of substance use disorder (SUD) programs.
We assessed trends in hospital prioritization of substance use as a top five community need and hospital implementation of SUD programing at nonprofit hospitals between 2015 and 2021 using two waves (wave 1: 2015-2018; wave 2: 2019-2021) by examining hospital community benefit reports. We utilized t or χ 2 tests to understand whether there were significant differences in the prioritization and implementation of SUD programs across waves. We used multilevel logistic regression to evaluate the relation between prioritization and implementation of SUD programs, hospital and community characteristics, and wave.
Hospitals were less likely to have prioritized SUD but more likely to have implemented SUD programs in the most recent 3 years compared, even after adjusting for the local overdose rate and hospital- and community-level variables. Although most hospitals consistently prioritized and implemented SUD programs during the 2015-2021 period, a 11% removed and 15% never adopted SUD programs at all, despite an overall increase in overdose rates.
Our study identified gaps in hospital SUD infrastructure during a time of elevated need. Failing to address this gap reflects missed opportunities to engage vulnerable populations, provide linkages to treatment, and prevent complications of substance use.
住院治疗是通过住院服务、门诊护理和社区伙伴关系解决药物使用问题的重要契机，但非营利性医院在不同时期对这类服务的重视程度仍不明确。本研究的目的是考察非营利性医院对物质使用障碍（SUD）项目的重视程度和实施情况的趋势。
我们通过审查医院社区效益报告，利用两个时间段（时间段1：2015 - 2018年；时间段2：2019 - 2021年）评估了2015年至2021年期间非营利性医院将药物使用列为五大社区需求之一的重视程度趋势以及医院对SUD项目的实施情况。我们使用t检验或χ²检验来了解不同时间段SUD项目的重视程度和实施情况是否存在显著差异。我们使用多层逻辑回归来评估SUD项目的重视程度和实施情况、医院及社区特征与时间段之间的关系。
即使在调整了当地过量用药率以及医院和社区层面的变量之后，与之前相比，医院在最近3年里将SUD列为优先事项的可能性降低，但实施SUD项目的可能性增加。尽管在2015 - 2021年期间，大多数医院一直将SUD项目列为优先事项并予以实施，但尽管过量用药率总体上升，仍有11%的医院取消了该项目，15%的医院从未采用过SUD项目。
我们的研究发现，在需求增加的时期，医院SUD基础设施存在差距。未能解决这一差距意味着失去了接触弱势群体、提供治疗联系以及预防药物使用并发症的机会。
