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Addiction consultation services - Linking hospitalized patients to outpatient addiction treatment.
J Subst Abuse Treat. 2017 08; 79:1-5.JS

Abstract

BACKGROUND

Approximately 15% of hospitalized patients have an active substance use disorder (SUD). Starting treatment for SUD, including medications, during acute hospitalizations can engage patients in addiction care. In July 2015, the Boston Medical Center Addiction Consult Service (ACS), began providing inpatient diagnostic, management, and discharge linkage consultations. We describe this implementation.

METHODS

The ACS staff recorded SUDs diagnoses and medication recommendations and tracked follow-up data for affiliated outpatient office-based addiction clinics and methadone maintenance programs. We assessed the number of consults, SUDs diagnoses, medications recommended and initiated, and outpatient addiction clinic follow-up.

RESULTS

Over 26weeks, the BMC ACS completed 337 consults: 78% had an opioid use disorder (UD), 37% an alcohol UD, 28% a cocaine UD, 9% a benzodiazepine UD, 3% a cannabinoid (including K2) UD, and <1% a methamphetamine UD. Methadone was initiated in 70 inpatients and buprenorphine in 40 inpatients. Naltrexone was recommended 45 times (for opioid UD, alcohol UD, or both). Of the patients initiated on methadone, 76% linked to methadone clinic, with 54%, 39%, and 29% still retained at 30, 90, and 180days, respectively. For buprenorphine, 49% linked to clinic, with 39%, 27%, and 18% retained at 30, 90, and 180days, respectively. For naltrexone, 26% linked to clinic, all with alcohol UD alone.

CONCLUSIONS

A new inpatient addiction consultation service diagnosed and treated hospitalized patients with substance use disorders and linked them to outpatient addiction treatment care. Initiating addiction medications, particularly opioid agonists, was feasible in the inpatient setting. Optimal linkage and retention of hospitalized patients to post-discharge addiction care warrants further innovation and program development.

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Authors+Show Affiliations

Trowbridge P
Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA; Spectrum Health Center for Integrative Medicine, 75 Sheldon Blvd SE, Grand Rapids, MI, USA. Electronic address: paul.trowbridge@spectrumhealth.org.
Weinstein ZM
Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA.
Kerensky T
Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA.
Roy P
Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA.
Regan D
Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA.
Samet JH
Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA.
Walley AY
Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA.

MeSH

AftercareAmbulatory CareBehavior, AddictiveBostonContinuity of Patient CareHospitalizationHumansReferral and ConsultationSubstance-Related Disorders

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28673521

Clinical Trial Links

EXHIT ENTRE Comparative Effectiveness Trial
EXHIT ENTRE Implementation Trial of High Intensity Versus Low Intensity Strategy

Citation

Trowbridge, Paul, et al. "Addiction Consultation Services - Linking Hospitalized Patients to Outpatient Addiction Treatment." Journal of Substance Abuse Treatment, vol. 79, 2017, pp. 1-5.
Trowbridge P, Weinstein ZM, Kerensky T, et al. Addiction consultation services - Linking hospitalized patients to outpatient addiction treatment. J Subst Abuse Treat. 2017;79:1-5.
Trowbridge, P., Weinstein, Z. M., Kerensky, T., Roy, P., Regan, D., Samet, J. H., & Walley, A. Y. (2017). Addiction consultation services - Linking hospitalized patients to outpatient addiction treatment. Journal of Substance Abuse Treatment, 79, 1-5. https://doi.org/10.1016/j.jsat.2017.05.007
Trowbridge P, et al. Addiction Consultation Services - Linking Hospitalized Patients to Outpatient Addiction Treatment. J Subst Abuse Treat. 2017;79:1-5. PubMed PMID: 28673521.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Addiction consultation services - Linking hospitalized patients to outpatient addiction treatment. AU - Trowbridge,Paul, AU - Weinstein,Zoe M, AU - Kerensky,Todd, AU - Roy,Payel, AU - Regan,Danny, AU - Samet,Jeffrey H, AU - Walley,Alexander Y, Y1 - 2017/05/11/ PY - 2017/03/12/received PY - 2017/05/05/revised PY - 2017/05/09/accepted PY - 2017/7/5/entrez PY - 2017/7/5/pubmed PY - 2018/5/15/medline KW - Addiction consultation KW - Inpatient KW - Linkage to care KW - Opioid agonists treatment SP - 1 EP - 5 JF - Journal of substance abuse treatment JO - J Subst Abuse Treat VL - 79 N2 - BACKGROUND: Approximately 15% of hospitalized patients have an active substance use disorder (SUD). Starting treatment for SUD, including medications, during acute hospitalizations can engage patients in addiction care. In July 2015, the Boston Medical Center Addiction Consult Service (ACS), began providing inpatient diagnostic, management, and discharge linkage consultations. We describe this implementation. METHODS: The ACS staff recorded SUDs diagnoses and medication recommendations and tracked follow-up data for affiliated outpatient office-based addiction clinics and methadone maintenance programs. We assessed the number of consults, SUDs diagnoses, medications recommended and initiated, and outpatient addiction clinic follow-up. RESULTS: Over 26weeks, the BMC ACS completed 337 consults: 78% had an opioid use disorder (UD), 37% an alcohol UD, 28% a cocaine UD, 9% a benzodiazepine UD, 3% a cannabinoid (including K2) UD, and <1% a methamphetamine UD. Methadone was initiated in 70 inpatients and buprenorphine in 40 inpatients. Naltrexone was recommended 45 times (for opioid UD, alcohol UD, or both). Of the patients initiated on methadone, 76% linked to methadone clinic, with 54%, 39%, and 29% still retained at 30, 90, and 180days, respectively. For buprenorphine, 49% linked to clinic, with 39%, 27%, and 18% retained at 30, 90, and 180days, respectively. For naltrexone, 26% linked to clinic, all with alcohol UD alone. CONCLUSIONS: A new inpatient addiction consultation service diagnosed and treated hospitalized patients with substance use disorders and linked them to outpatient addiction treatment care. Initiating addiction medications, particularly opioid agonists, was feasible in the inpatient setting. Optimal linkage and retention of hospitalized patients to post-discharge addiction care warrants further innovation and program development. SN - 1873-6483 UR - https://www.unboundmedicine.com/medline/citation/28673521/Addiction_consultation_services___Linking_hospitalized_patients_to_outpatient_addiction_treatment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0740-5472(17)30117-4 DB - PRIME DP - Unbound Medicine ER -