Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Division of Hospital Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
J Gen Intern Med. 2024 Nov;39(15):2961-2969. doi: 10.1007/s11606-024-08837-0. Epub 2024 Aug 13.
Despite rising hospitalizations for opioid use disorder (OUD), rates of inpatient medications for OUD (MOUD) initiation are low. Addiction consult services (ACSs) facilitate inpatient MOUD initiation and linkage to post-discharge MOUD, but few studies have rigorously examined ACS OUD outcomes.
To determine the association between ACS consultation and inpatient MOUD initiation, discharge MOUD provision, and post-discharge MOUD linkage.
Retrospective study comparing admissions that received an ACS consult and propensity score-matched historical control admissions.
One hundred admissions with an OUD-related diagnosis, of patients not currently receiving MOUD who received an ACS consult, and 100 matched historical controls.
Consultation from an interprofessional ACS offering expertise in MOUD initiation and linkage to post-discharge MOUD.
The primary outcome was inpatient MOUD initiation (methadone or buprenorphine). Secondary outcomes were inpatient buprenorphine initiation, inpatient methadone initiation, discharge prescription for buprenorphine, linkage to post-discharge MOUD (buprenorphine prescription within 60 days and new methadone administration at a methadone program within 30 days after discharge), patient-directed discharge, 30-day readmission, and 30-day emergency department (ED) visit.
Among 200 admissions with an OUD-related diagnosis, those that received an ACS consultation were significantly more likely to have inpatient MOUD initiation (OR 2.57 [CI 1.44-4.61]), inpatient buprenorphine initiation (OR 5.50 [2.14-14.15]), a discharge prescription for buprenorphine (OR 17.22 [3.94-75.13]), a buprenorphine prescription within 60 days (22.0% vs. 0.0%, p < 0.001; of those with inpatient buprenorphine initiation: 84.6% vs. 0.0%), and new methadone administration at a methadone program within 30 days after discharge (7.0% vs. 0.0%, p = 0.007; of those with inpatient methadone initiation: 19.4% vs. 0.0%). There were no significant differences in other secondary outcomes.
There was a strong association between ACS consultation and inpatient MOUD initiation and linkage to post-discharge MOUD. ACSs promote the delivery of evidence-based care for patients with OUD.
尽管阿片类药物使用障碍（OUD）的住院人数不断增加，但 OUD 的住院药物治疗（MOUD）的起始率仍然很低。成瘾咨询服务（ACS）有助于 OUD 的住院 MOUD 起始和与出院后 MOUD 的衔接，但很少有研究严格检查 ACS OUD 结果。
确定 ACS 咨询与住院 MOUD 起始、出院 MOUD 提供和出院后 MOUD 衔接之间的关联。
比较接受 ACS 咨询和倾向评分匹配的历史对照入院的回顾性研究。
100 名患有 OUD 相关诊断的入院患者，未接受 MOUD 治疗且接受 ACS 咨询的患者，以及 100 名匹配的历史对照患者。
由具有 MOUD 起始和与出院后 MOUD 衔接专业知识的多学科 ACS 提供咨询。
主要结果是住院 MOUD 起始（美沙酮或丁丙诺啡）。次要结果包括住院丁丙诺啡起始、住院美沙酮起始、出院丁丙诺啡处方、与出院后 MOUD 的衔接（出院后 60 天内开丁丙诺啡处方和 30 天内到美沙酮项目新开始美沙酮治疗）、患者导向出院、30 天再入院和 30 天急诊就诊。
在 200 名患有 OUD 相关诊断的入院患者中，接受 ACS 咨询的患者更有可能进行住院 MOUD 起始（OR 2.57 [CI 1.44-4.61]）、住院丁丙诺啡起始（OR 5.50 [2.14-14.15]）、出院丁丙诺啡处方（OR 17.22 [3.94-75.13]）、出院后 60 天内开丁丙诺啡处方（22.0%与 0.0%，p<0.001；其中住院丁丙诺啡起始患者：84.6%与 0.0%）和出院后 30 天内在美沙酮项目开始新的美沙酮治疗（7.0%与 0.0%，p=0.007；其中住院美沙酮起始患者：19.4%与 0.0%）。其他次要结果无显著差异。
ACS 咨询与住院 MOUD 起始和与出院后 MOUD 的衔接之间存在很强的关联。ACS 促进了 OUD 患者的循证护理的提供。
