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
{"title":"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。","authors":"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","doi":"10.1111/ajad.13540","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and Objectives</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Conclusions and Scientific Significance</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":"33 5","pages":"543-550"},"PeriodicalIF":2.5000,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajad.13540","citationCount":"0","resultStr":"{\"title\":\"Impact of inpatient addiction psychiatry consultation on opioid use disorder outcomes\",\"authors\":\"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\",\"doi\":\"10.1111/ajad.13540\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background and Objectives</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions and Scientific Significance</h3>\\n \\n <p>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. 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Impact of inpatient addiction psychiatry consultation on opioid use disorder outcomes
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.
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.
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