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Implementation and evaluation of a novel, unofficial, trainee-organized hospital addiction medicine consultation service.
Subst Abus. 2021; 42(4):433-437.SA

Abstract

Background: To evaluate a novel, unofficial, trainee-organized, hospital addiction medicine consultation service (AMCS), we aimed to assess whether it was (1) acceptable to hospital providers and patients, (2) feasible to organize and deliver, and (3) impacted patient care. Methods: We performed a retrospective descriptive study of all AMCS consultations over the first 16 months. We determined acceptability via the number of referrals received from admitting services, and the proportion of referred patients who consented to consultation. We evaluated feasibility via continuation/growth of the service over time, and the proportion of referrals successfully completed before hospital discharge. As most referrals related to opioid use disorder, we determined impact through the proportion of eligible patients offered and initiated on opioid agonist therapy (OAT) in hospital, and the proportion of patients who filled their outpatient prescription or attended their first visit with their outpatient OAT prescriber. Results: The unofficial AMCS grew to involve six hospital-based residents and five supervising community-based addiction physicians. The service received 59 referrals, primarily related to injection opioid use, for 50 unique patients from 12 different admitting services. 90% of patients were seen before discharge, and 98% agreed to addiction medicine consultation. Among 34 patients with active moderate-severe opioid use disorder who were not already on OAT, 82% initiated OAT in hospital and 89% of these patients continued after discharge. Conclusions: Established in response to identified gaps in patient care and learning opportunities, a novel, unofficial, trainee-organized AMCS was acceptable, feasible, and positively impacted patient care over the first 16 months. This trainee-organized, unofficial AMCS could be used as a model for other hospitals that do not yet have an official AMCS.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Brothers TD
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Fraser J
Mobile Outreach Street Health, North End Community Health Centre, Halifax, Nova Scotia, Canada.
MacAdam E
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Morgan B
Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Francheville J
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Nidumolu A
Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
Cheung C
Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Hickcox S
Mental Health and Addictions, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
Saunders D
Direction 180, Halifax, Nova Scotia, Canada. The Open Door Clinic, Dartmouth, Nova Scotia, Canada.
O'Donnell T
Hospitalist Medicine Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada. Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Genge L
Mobile Outreach Street Health, North End Community Health Centre, Halifax, Nova Scotia, Canada. Direction 180, Halifax, Nova Scotia, Canada. Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Webster D
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Division of Infectious Diseases, Saint John Regional Hospital, Saint John, New Brunswick, Canada.

MeSH

Addiction MedicineHospitalsHumansOpioid-Related DisordersReferral and ConsultationRetrospective Studies

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33332248

Citation

Brothers, Thomas D., et al. "Implementation and Evaluation of a Novel, Unofficial, Trainee-organized Hospital Addiction Medicine Consultation Service." Substance Abuse, vol. 42, no. 4, 2021, pp. 433-437.
Brothers TD, Fraser J, MacAdam E, et al. Implementation and evaluation of a novel, unofficial, trainee-organized hospital addiction medicine consultation service. Subst Abus. 2021;42(4):433-437.
Brothers, T. D., Fraser, J., MacAdam, E., Morgan, B., Francheville, J., Nidumolu, A., Cheung, C., Hickcox, S., Saunders, D., O'Donnell, T., Genge, L., & Webster, D. (2021). Implementation and evaluation of a novel, unofficial, trainee-organized hospital addiction medicine consultation service. Substance Abuse, 42(4), 433-437. https://doi.org/10.1080/08897077.2020.1856291
Brothers TD, et al. Implementation and Evaluation of a Novel, Unofficial, Trainee-organized Hospital Addiction Medicine Consultation Service. Subst Abus. 2021;42(4):433-437. PubMed PMID: 33332248.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implementation and evaluation of a novel, unofficial, trainee-organized hospital addiction medicine consultation service. AU - Brothers,Thomas D, AU - Fraser,John, AU - MacAdam,Emily, AU - Morgan,Brendan, AU - Francheville,Jordan, AU - Nidumolu,Aditya, AU - Cheung,Christopher, AU - Hickcox,Samuel, AU - Saunders,David, AU - O'Donnell,Tiffany, AU - Genge,Leah, AU - Webster,Duncan, Y1 - 2020/12/17/ PY - 2020/12/18/pubmed PY - 2022/3/15/medline PY - 2020/12/17/entrez KW - Inpatient KW - acute care KW - endocarditis KW - epidural abscess KW - substance use disorder SP - 433 EP - 437 JF - Substance abuse JO - Subst Abus VL - 42 IS - 4 N2 - Background: To evaluate a novel, unofficial, trainee-organized, hospital addiction medicine consultation service (AMCS), we aimed to assess whether it was (1) acceptable to hospital providers and patients, (2) feasible to organize and deliver, and (3) impacted patient care. Methods: We performed a retrospective descriptive study of all AMCS consultations over the first 16 months. We determined acceptability via the number of referrals received from admitting services, and the proportion of referred patients who consented to consultation. We evaluated feasibility via continuation/growth of the service over time, and the proportion of referrals successfully completed before hospital discharge. As most referrals related to opioid use disorder, we determined impact through the proportion of eligible patients offered and initiated on opioid agonist therapy (OAT) in hospital, and the proportion of patients who filled their outpatient prescription or attended their first visit with their outpatient OAT prescriber. Results: The unofficial AMCS grew to involve six hospital-based residents and five supervising community-based addiction physicians. The service received 59 referrals, primarily related to injection opioid use, for 50 unique patients from 12 different admitting services. 90% of patients were seen before discharge, and 98% agreed to addiction medicine consultation. Among 34 patients with active moderate-severe opioid use disorder who were not already on OAT, 82% initiated OAT in hospital and 89% of these patients continued after discharge. Conclusions: Established in response to identified gaps in patient care and learning opportunities, a novel, unofficial, trainee-organized AMCS was acceptable, feasible, and positively impacted patient care over the first 16 months. This trainee-organized, unofficial AMCS could be used as a model for other hospitals that do not yet have an official AMCS. SN - 1547-0164 UR - https://www.unboundmedicine.com/medline/citation/33332248/Implementation_and_evaluation_of_a_novel_unofficial_trainee_organized_hospital_addiction_medicine_consultation_service_ DB - PRIME DP - Unbound Medicine ER -