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Adapting inpatient addiction medicine consult services during the COVID-19 pandemic.
Addict Sci Clin Pract. 2021 02 24; 16(1):13.AS

Abstract

BACKGROUND

We describe addiction consult services (ACS) adaptations implemented during the Novel Coronavirus Disease 2019 (COVID-19) pandemic across four different North American sites: St. Paul's Hospital in Vancouver, British Columbia; Oregon Health & Sciences University in Portland, Oregon; Boston Medical Center in Boston, Massachusetts; and Yale New Haven Hospital in New Haven, Connecticut.

EXPERIENCES

ACS made system, treatment, harm reduction, and discharge planning adaptations. System changes included patient visits shifting to primarily telephone-based consultations and ACS leading regional COVID-19 emergency response efforts such as substance use treatment care coordination for people experiencing homelessness in COVID-19 isolation units and regional substance use treatment initiatives. Treatment adaptations included providing longer buprenorphine bridge prescriptions at discharge with telemedicine follow-up appointments and completing benzodiazepine tapers or benzodiazepine alternatives for people with alcohol use disorder who could safely detoxify in outpatient settings. We believe that regulatory changes to buprenorphine, and in Vancouver other medications for opioid use disorder, helped increase engagement for hospitalized patients, as many of the barriers preventing them from accessing care on an ongoing basis were reduced. COVID-19 specific harm reductions recommendations were adopted and disseminated to inpatients. Discharge planning changes included peer mentors and social workers increasing hospital in-reach and discharge outreach for high-risk patients, in some cases providing prepaid cell phones for patients without phones.

RECOMMENDATIONS FOR THE FUTURE

We believe that ACS were essential to hospitals' readiness to support patients that have been systematically marginilized during the pandemic. We suggest that hospitals invest in telehealth infrastructure within the hospital, and consider cellphone donations for people without cellphones, to help maintain access to care for vulnerable patients. In addition, we recommend hospital systems evaluate the impact of such interventions. As the economic strain on the healthcare system from COVID-19 threatens the very existence of ACS, overdose deaths continue rising across North America, highlighting the essential nature of these services. We believe it is imperative that health care systems continue investing in hospital-based ACS during public health crises.

Authors+Show Affiliations

Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA. Miriam.Harris@bmc.org. Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, Second Floor, Boston, MA, 02118, USA. Miriam.Harris@bmc.org.Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA. Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, Second Floor, Boston, MA, 02118, USA.British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, BC, Canada. Department of Medicine, University of British Columbia, Vancouver, BC, Canada.Division of Hospital Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR, USA.Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.Program in Addiction Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA.Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA. Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, Second Floor, Boston, MA, 02118, USA.

Pub Type(s)

Comparative Study
Editorial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

33627183

Citation

Harris, Miriam T H., et al. "Adapting Inpatient Addiction Medicine Consult Services During the COVID-19 Pandemic." Addiction Science & Clinical Practice, vol. 16, no. 1, 2021, p. 13.
Harris MTH, Peterkin A, Bach P, et al. Adapting inpatient addiction medicine consult services during the COVID-19 pandemic. Addict Sci Clin Pract. 2021;16(1):13.
Harris, M. T. H., Peterkin, A., Bach, P., Englander, H., Lapidus, E., Rolley, T., Weimer, M. B., & Weinstein, Z. M. (2021). Adapting inpatient addiction medicine consult services during the COVID-19 pandemic. Addiction Science & Clinical Practice, 16(1), 13. https://doi.org/10.1186/s13722-021-00221-1
Harris MTH, et al. Adapting Inpatient Addiction Medicine Consult Services During the COVID-19 Pandemic. Addict Sci Clin Pract. 2021 02 24;16(1):13. PubMed PMID: 33627183.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adapting inpatient addiction medicine consult services during the COVID-19 pandemic. AU - Harris,Miriam T H, AU - Peterkin,Alyssa, AU - Bach,Paxton, AU - Englander,Honora, AU - Lapidus,Emily, AU - Rolley,Theresa, AU - Weimer,Melissa B, AU - Weinstein,Zoe M, Y1 - 2021/02/24/ PY - 2020/11/01/received PY - 2021/02/04/accepted PY - 2021/2/25/entrez PY - 2021/2/26/pubmed PY - 2021/3/9/medline KW - Addiction KW - COVID-19 KW - Consult KW - Homelessness KW - Inpatient KW - Social-distancing KW - Substance use disorders SP - 13 EP - 13 JF - Addiction science & clinical practice JO - Addict Sci Clin Pract VL - 16 IS - 1 N2 - BACKGROUND: We describe addiction consult services (ACS) adaptations implemented during the Novel Coronavirus Disease 2019 (COVID-19) pandemic across four different North American sites: St. Paul's Hospital in Vancouver, British Columbia; Oregon Health & Sciences University in Portland, Oregon; Boston Medical Center in Boston, Massachusetts; and Yale New Haven Hospital in New Haven, Connecticut. EXPERIENCES: ACS made system, treatment, harm reduction, and discharge planning adaptations. System changes included patient visits shifting to primarily telephone-based consultations and ACS leading regional COVID-19 emergency response efforts such as substance use treatment care coordination for people experiencing homelessness in COVID-19 isolation units and regional substance use treatment initiatives. Treatment adaptations included providing longer buprenorphine bridge prescriptions at discharge with telemedicine follow-up appointments and completing benzodiazepine tapers or benzodiazepine alternatives for people with alcohol use disorder who could safely detoxify in outpatient settings. We believe that regulatory changes to buprenorphine, and in Vancouver other medications for opioid use disorder, helped increase engagement for hospitalized patients, as many of the barriers preventing them from accessing care on an ongoing basis were reduced. COVID-19 specific harm reductions recommendations were adopted and disseminated to inpatients. Discharge planning changes included peer mentors and social workers increasing hospital in-reach and discharge outreach for high-risk patients, in some cases providing prepaid cell phones for patients without phones. RECOMMENDATIONS FOR THE FUTURE: We believe that ACS were essential to hospitals' readiness to support patients that have been systematically marginilized during the pandemic. We suggest that hospitals invest in telehealth infrastructure within the hospital, and consider cellphone donations for people without cellphones, to help maintain access to care for vulnerable patients. In addition, we recommend hospital systems evaluate the impact of such interventions. As the economic strain on the healthcare system from COVID-19 threatens the very existence of ACS, overdose deaths continue rising across North America, highlighting the essential nature of these services. We believe it is imperative that health care systems continue investing in hospital-based ACS during public health crises. SN - 1940-0640 UR - https://www.unboundmedicine.com/medline/citation/33627183/Adapting_inpatient_addiction_medicine_consult_services_during_the_COVID_19_pandemic_ DB - PRIME DP - Unbound Medicine ER -