Multi-method evaluation of a physician-led pilot addiction consult service

Introduction

Addiction consultation services are hospital-based specialist programs designed to support the care of patients with substance use disorders (SUDs). This study aimed to: (1) describe service volumes and patient demographics for a pilot addiction consultation program, (2) compare clinical outcomes between patients seen prior to and after program implementation, and (3) explore provider perceptions, referral patterns, and clinical practice.

Methods

Using the RE-AIM framework, we conducted a formative multi-method evaluation at a tertiary care hospital. Quantitative data about the uptake of the pilot program and clinical descriptions of three patient groups (consult patients, pre-program baseline patients, post-program non-consult patients) was collected through chart review. A provider survey with closed and open-ended questions was used to explore provider practice patterns, perceived needs, roles, and challenges.

Results

Most consult requests were from General Internal Medicine (136/181, 75.1 %). Consult orders were usually placed during service hours (169/181 93.4 %), with a median time between admission and consult request of 1 day (IQR 0–2). Consultation was linked to higher odds of receiving a pharmacotherapy prescription compared to baseline (OR 5.82 [95 % CI 3.05–11.99], p < 0.001) and patients not receiving consultation (OR 6.78 [95 % CI 2.76–20.75], p < 0.001). Survey findings highlighted non-addiction specialist providers' lack of confidence with substance use pharmacotherapy and consultation for counselling, resource navigation, and harm reduction.

Conclusions

The consult program demonstrated consistent uptake and was associated with increased access to pharmacotherapy for hospitalized patients, supporting improved inpatient addiction care. Non-addiction providers identified value in the consult program beyond pharmacotherapy and identified challenges with this patient population.