Proactive Addiction Consultation for Hospitalized Patients With Opioid Use Disorder: A Pilot Study.

Abstract

Background: Opioid use disorder (OUD) negatively impacts individuals, communities, and health care systems with significant morbidity and mortality. There is a need for early intervention with hospitalized patients with OUD to improve health outcomes. Proactive consultation-liaison psychiatry, with and without electronic health record tools, is an effective way to reach more patients in need and to improve health services outcomes. The impact of proactive addiction consultation is unknown.

Objective: To describe a pilot study examining the effects of proactive addiction consultation on service delivery and clinical outcomes for hospitalized patients with opioid use disorder.

Methods: This quasi-randomized, controlled pilot study tested whether, in hospitalized patients with likely OUD, early identification and prompts to initiate consultation resulted in an increased proportion of consultations completed as compared to usual care. Secondary outcomes included initiation of medication for OUD, leaving against medical advice, emergency room utilization, and hospital readmission. An electronic health record-generated daily report was used to identify patients admitted to the hospital in the previous day with diagnoses synonymous with OUD (e.g., opioid abuse and opioid dependence) or often associated with a co-occurring OUD (e.g., bacterial endocarditis and accidental overdose). Individuals confirmed through further chart review as having a high likelihood of OUD were assigned to intervention versus treatment-as-usual in a standardized fashion. The intervention consisted of our research team suggesting an addiction consultation if the patient agreed. Primary teams for the treatment-as-usual participants were not contacted, and consultations were only completed if the primary team independently requested them.

Results: Participants randomized to the intervention arm were significantly more likely to receive an addiction consultation (54.8% vs. 16.2%, P < 0.0001). There were no significant differences between the 2 groups in secondary outcomes. Secondary analyses showed that participants who received an addiction consultation (independent of group assignment) were significantly more likely to receive medication for OUD than those who did not (61.2% vs. 29.3%, P < 0.0001).

Conclusions: A proactive model suggesting addiction consultation in patients with likely opioid use disorder resulted in an increased proportion of completed consultations as compared to usual care. Addiction consultations were associated with initiation or continuation of medication for OUD, demonstrating the value of addiction consultation services in the hospital. More research is needed to show the potential impact of addiction consultation services on health outcomes.