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Which patients receive an addiction consult? A preliminary analysis of the INREACH (INpatient REadmission post-Addiction Consult Help) study.
J Subst Abuse Treat. 2019 11; 106:35-42.JS

Abstract

INTRODUCTION

Despite the high prevalence and significant health risks of substance use disorders (SUDs), a minority of individuals with SUDs receive treatment of any kind. The aims of this study are to describe inpatients with an SUD who receive an addiction consult at a large urban safety net hospital and explore characteristics associated with receiving an addiction consult.

METHODS

This is a retrospective cohort study of all adult patients with a discharge diagnosis of an SUD from July 2015 to July 2016. A generalized estimating equation (GEE) logistic regression model was used to explore patient factors associated with receipt of an addiction consult, such as demographics, social, medical, and SUD characteristics.

RESULTS

A total of 3905 patients with SUD diagnoses with 5979 hospitalization encounters were included in this study. There were 694 addiction consults (11.6%, 95% CI: 10.71% to 12.5%) across all of the encounters and 576 unique patients that received consults. Patients with opioid use disorder had higher odds of receiving a consult (Adjusted Odds Ratio: 6.39, 95% CI 5.14-7.94), as did patients with acute complications from their substance use (AOR: 1.64, 95% CI 1.34-2.02), patients with human immunodeficiency virus (HIV) (AOR: 2.06, 95% CI 1.59-2.67), and homeless patients (AOR: 1.31, 95% CI 1.08-1.59). Patients with a psychiatry consult had higher odds of receiving an addiction consult (AOR: 1.75, 95% CI 1.37-2.23), and so did patients receiving benzodiazepines and/or phenobarbital (AOR: 1.88, 95% CI 1.55-2.28). Older patients (AOR: 0.82, 95% CI 0.76-0.88 per 10 year increase) had lower odds of receiving a consult, as did patients with an overdose diagnosis (AOR: 0.71, 95% CI 0.53-0.96).

CONCLUSION

A minority of inpatients with SUD received an addiction consult, however, inpatients with opioid use disorder, acute complications (medical, mental health) and homelessness had higher odds of receiving an addiction consult. Patients surviving overdose, a severe acute complication of substance use, had lower odds of receiving a consult and, thus, warrant development of care pathways to provide overdose prevention and addiction treatment engagement.

Authors+Show Affiliations

Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, United States. Electronic address: mjdamico@bu.edu.Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, United States; Boston Medical Center Grayken Center for Addiction, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Avenue, 2nd floor, Boston, MA 02118, United States. Electronic address: alexander.walley@bmc.org.Boston University School of Public Health, Department of Biostatistics, 801 Massachusetts Avenue, 3rd floor, Boston, MA 02118, United States. Electronic address: dmcheng@bu.edu.Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, 85 East Newton St, Boston, MA 02118, United States. Electronic address: lsforman@bu.edu.Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, United States; Boston Medical Center Grayken Center for Addiction, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Avenue, 2nd floor, Boston, MA 02118, United States. Electronic address: danny.regan@bmc.org.Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, United States; Boston Medical Center Grayken Center for Addiction, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Avenue, 2nd floor, Boston, MA 02118, United States. Electronic address: alexandra.yurkovic@bmc.org.Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, United States; Boston Medical Center Grayken Center for Addiction, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Avenue, 2nd floor, Boston, MA 02118, United States; Boston University School of Public Health, Department of Community Health Sciences, 801 Massachusetts Avenue, 4th floor, Boston, MA 02118, United States. Electronic address: jsamet@bu.edu.Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, United States; Boston Medical Center Grayken Center for Addiction, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Avenue, 2nd floor, Boston, MA 02118, United States. Electronic address: zoe.weinstein@bmc.org.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31540609

Citation

D'Amico, Maria J., et al. "Which Patients Receive an Addiction Consult? a Preliminary Analysis of the INREACH (INpatient REadmission post-Addiction Consult Help) Study." Journal of Substance Abuse Treatment, vol. 106, 2019, pp. 35-42.
D'Amico MJ, Walley AY, Cheng DM, et al. Which patients receive an addiction consult? A preliminary analysis of the INREACH (INpatient REadmission post-Addiction Consult Help) study. J Subst Abuse Treat. 2019;106:35-42.
D'Amico, M. J., Walley, A. Y., Cheng, D. M., Forman, L. S., Regan, D., Yurkovic, A., Samet, J. H., & Weinstein, Z. M. (2019). Which patients receive an addiction consult? A preliminary analysis of the INREACH (INpatient REadmission post-Addiction Consult Help) study. Journal of Substance Abuse Treatment, 106, 35-42. https://doi.org/10.1016/j.jsat.2019.08.013
D'Amico MJ, et al. Which Patients Receive an Addiction Consult? a Preliminary Analysis of the INREACH (INpatient REadmission post-Addiction Consult Help) Study. J Subst Abuse Treat. 2019;106:35-42. PubMed PMID: 31540609.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Which patients receive an addiction consult? A preliminary analysis of the INREACH (INpatient REadmission post-Addiction Consult Help) study. AU - D'Amico,Maria J, AU - Walley,Alexander Y, AU - Cheng,Debbie M, AU - Forman,Leah S, AU - Regan,Danny, AU - Yurkovic,Alexandra, AU - Samet,Jeffrey H, AU - Weinstein,Zoe M, Y1 - 2019/08/20/ PY - 2019/03/19/received PY - 2019/06/17/revised PY - 2019/08/17/accepted PY - 2019/9/22/entrez PY - 2019/9/22/pubmed PY - 2020/9/5/medline SP - 35 EP - 42 JF - Journal of substance abuse treatment JO - J Subst Abuse Treat VL - 106 N2 - INTRODUCTION: Despite the high prevalence and significant health risks of substance use disorders (SUDs), a minority of individuals with SUDs receive treatment of any kind. The aims of this study are to describe inpatients with an SUD who receive an addiction consult at a large urban safety net hospital and explore characteristics associated with receiving an addiction consult. METHODS: This is a retrospective cohort study of all adult patients with a discharge diagnosis of an SUD from July 2015 to July 2016. A generalized estimating equation (GEE) logistic regression model was used to explore patient factors associated with receipt of an addiction consult, such as demographics, social, medical, and SUD characteristics. RESULTS: A total of 3905 patients with SUD diagnoses with 5979 hospitalization encounters were included in this study. There were 694 addiction consults (11.6%, 95% CI: 10.71% to 12.5%) across all of the encounters and 576 unique patients that received consults. Patients with opioid use disorder had higher odds of receiving a consult (Adjusted Odds Ratio: 6.39, 95% CI 5.14-7.94), as did patients with acute complications from their substance use (AOR: 1.64, 95% CI 1.34-2.02), patients with human immunodeficiency virus (HIV) (AOR: 2.06, 95% CI 1.59-2.67), and homeless patients (AOR: 1.31, 95% CI 1.08-1.59). Patients with a psychiatry consult had higher odds of receiving an addiction consult (AOR: 1.75, 95% CI 1.37-2.23), and so did patients receiving benzodiazepines and/or phenobarbital (AOR: 1.88, 95% CI 1.55-2.28). Older patients (AOR: 0.82, 95% CI 0.76-0.88 per 10 year increase) had lower odds of receiving a consult, as did patients with an overdose diagnosis (AOR: 0.71, 95% CI 0.53-0.96). CONCLUSION: A minority of inpatients with SUD received an addiction consult, however, inpatients with opioid use disorder, acute complications (medical, mental health) and homelessness had higher odds of receiving an addiction consult. Patients surviving overdose, a severe acute complication of substance use, had lower odds of receiving a consult and, thus, warrant development of care pathways to provide overdose prevention and addiction treatment engagement. SN - 1873-6483 UR - https://www.unboundmedicine.com/medline/citation/31540609/Which_patients_receive_an_addiction_consult_A_preliminary_analysis_of_the_INREACH__INpatient_REadmission_post_Addiction_Consult_Help__study_ DB - PRIME DP - Unbound Medicine ER -