Inpatient addiction care is associated with increased vaccinations, medication for opioid use disorder and naloxone prescribing among patients with infective endocarditis in a rural state.
Eva J Farkas, Victoria Molina, Brittany Mohoney, Wendy Craig, Jessie Schaumberg, Amy McAuliffe, Kinna Thakarar
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引用次数: 0
Abstract
Background: Rural states have experienced increasing injection drug use (IDU)-associated infective endocarditis (IE). Inpatient addiction consult services can reduce morbidity associated with substance use and other infectious complications, such as IDU-IE. However data on the impact of such services on healthcare utilization are limited, particularly in rural communities.
Methods: This retrospective study assesses clinical and health service utilization data from index hospitalizations for IDU-IE before and after the implementation of the Integrated Medication for Addiction Treatment (IMAT) program at a tertiary care center in a rural state. We summarized data descriptively, stratified by both pre- and post-IMAT program implementation and IDU-IE and non-IDU IE. We also performed exploratory multivariable analyses assessing the association between IMAT program implementation and various outcomes. The primary outcomes were: 1) 90-day emergency department (ED) visits and 2) 30-day hospital readmissions post-discharge. Secondary outcomes included prescriptions at time of discharge for medication for opioid use disorder (MOUD), naloxone and key vaccinations.
Results: We identified n = 99 patients with IDU-IE. Comparing pre- and post-IMAT implementation, 30-day readmissions trended lower post-IMAT (18%) versus pre-IMAT (22%), although the difference was not significant (p = 0.7). 90-day ED visits remained stable (37%, p > 0.9). The proportion of MOUD prescribing (24% versus 80%), hepatitis B vaccination (29% versus 51%), and Tdap vaccination (7.3% versus 41%) increased significantly following IMAT implementation (p < 0.001, p = 0.037 and p < 0.001, respectively). In a regression analysis controlling for age, housing status, primary care provider, age, hepatitis C, cardiac device, Duke's criteria, valve affected, alcohol use disorder, payer, and vascular or infectious complications, the IMAT program was not significantly associated with the primary outcomes or with hepatitis B vaccination. However, the IMAT program was associated with increased MOUD prescribing (aOR: 110; CI:16-1500), naloxone prescribing (aOR 18; CI: 1.1-1600) hepatitis A vaccination (aOR: 5.3; CI: 1.2-32), and Tdap vaccination (aOR: 9.2; CI: 2.0-59).
Conclusions: Inpatient addiction services were associated with increased prescribing of MOUD, naloxone and key vaccinations, though the incidence of acute healthcare utilization did not change. These results highlight hospitalization as an opportunity to connect patients with IDU-IE to MOUD and preventative care, particularly in rural areas where access to such services may be limited.
期刊介绍：
Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings.
Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use.
Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations.
Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.
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