Impact of inpatient addiction psychiatry consultation on opioid use disorder outcomes

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions Pub Date : 2024-03-28 DOI:10.1111/ajad.13540

Kristopher A. Kast MD, Thao D. V. Le PhD, Lisa S. Stewart MEd, MSN, Andrew D. Wiese PhD, MPH, India A. Reddy MD, PhD, Jonathan Smith MD, David E. Marcovitz MD, Thomas J. Reese PharmD, PhD

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引用次数: 0

Abstract

Background and Objectives

Addiction consultation services provide access to specialty addiction care during general hospital admission. This study assessed opioid use disorder (OUD) outcomes associated with addiction consultation.

Methods

Retrospective cohort study of individuals with OUD admitted to an academic medical center between 2018 and 2023. The exposure was addiction consultation. Outcomes included initiating medication for OUD (MOUD), hospital length of stay, before-medically-advised (BMA) discharge, and 30- and 90-day postdischarge acute care utilization.

Results

Of 26,766 admissions (10,501 patients) with OUD, 2826 addiction consultations were completed. Consultation cohort was more likely to be young, male, and White than controls. Consultation was associated with greater MOUD initiation (adjusted odds ratio [aOR], 5.07; 95% confidence interval [CI], 4.41–5.82), fewer emergency department visits at 30 (aOR, 0.78; 95% CI, 0.67–0.92) and 90 (aOR, 0.79; 95% CI, 0.69–0.89) days, and fewer hospitalizations at 30 (aOR, 0.65; 95% CI, 0.56 to 0.76) and 90 (aOR, 0.67; 95% CI, 0.59–0.76) days. Additionally, consultation patients were more likely to have a longer hospital stay and leave BMA.

Conclusions and Scientific Significance

Addiction consultation was associated with increased MOUD initiation and reduced postdischarge acute care utilization. This is the largest study to date showing a significant association between addiction psychiatry consultation and improved OUD outcomes when compared to controls. The observed reduction in postdischarge acute care utilization remains even after adjusting for MOUD initiation. Disparities in access to addiction consultation warrant further study.

查看原文本刊更多论文

住院成瘾精神病学咨询对阿片类药物使用障碍结果的影响。

背景和目标：成瘾咨询服务可在普通医院住院期间提供专业的成瘾治疗。本研究评估了与成瘾咨询相关的阿片类药物使用障碍（OUD）结果：回顾性队列研究，对象为 2018 年至 2023 年期间在一家学术医疗中心住院的 OUD 患者。暴露是成瘾咨询。结果包括开始服用治疗 OUD 的药物（MOUD）、住院时间、医学建议出院前（BMA）以及出院后 30 天和 90 天的急性护理利用率：在 26766 名入院的 OUD 患者（10501 名）中，完成了 2826 次成瘾咨询。与对照组相比，咨询人群中更多的是年轻人、男性和白人。咨询与更多的 MOUD 开始（调整赔率 [aOR]，5.07；95% 置信区间 [CI]，4.41-5.82）、30 岁时更少的急诊就诊（aOR，0.78；95% CI，0.67-0.92）和 90 天（aOR，0.79；95% CI，0.69-0.89），以及 30 天（aOR，0.65；95% CI，0.56-0.76）和 90 天（aOR，0.67；95% CI，0.59-0.76）住院次数减少。此外，会诊患者更有可能住院时间更长和离开 BMA：成瘾咨询与MOUD启动率的提高和出院后急症护理使用率的降低有关。与对照组相比，这是迄今为止规模最大的一项研究，它显示了成瘾精神病咨询与改善 OUD 治疗效果之间的显著关联。即使在调整了MOUD的启动因素后，观察到的出院后急症护理利用率降低的情况依然存在。在获得成瘾咨询方面存在的差异值得进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal on Addictions SUBSTANCE ABUSE-

CiteScore

5.00

自引率

0.00%

发文量

118

期刊介绍： The American Journal on Addictions is the official journal of the American Academy of Addiction Psychiatry. The Academy encourages research on the etiology, prevention, identification, and treatment of substance abuse; thus, the journal provides a forum for the dissemination of information in the extensive field of addiction. Each issue of this publication covers a wide variety of topics ranging from codependence to genetics, epidemiology to dual diagnostics, etiology to neuroscience, and much more. Features of the journal, all written by experts in the field, include special overview articles, clinical or basic research papers, clinical updates, and book reviews within the area of addictions.