Oral Papers: Addiction, Pain, & Transplant II
Background: The rate of persons who use opioids presenting to emergency healthcare systems with serious infections (e.g., endocarditis) is rising (Ronan, 2016). Despite lengthy hospital stays for IV antibiotic treatment and numerous opportunities for patient contact, few healthcare systems initiate medication-assisted treatment (MAT) for opioids let alone provide comprehensive addiction treatment during these hospitalizations. Accordingly, the current study aimed to assess the effectiveness of an inpatient substance use group implemented by an Addiction Consultation-Liaison (C-L) service in increasing outpatient MAT follow-up rates among opioid users hospitalized for opioid-related infections. Methods: Patients with opioid-related infections who are admitted to a medical service at an urban hospital in the Mountain West are inducted on MAT by an Addiction C-L service. These patients are also screened for appropriateness/interest in participating in a weekly substance use group during their IV antibiotic hospitalization. At baseline and prior to discharge, knowledge about substance use/addiction, mental health, co-occurring disorders, mindfulness for addiction, MAT, and outpatient MAT follow-up plans were assessed. Immediate (i.e., day after discharge), 1-month, and 6-month follow-up rates were obtained via chart review and patient/provider contact. During their hospitalization, patients participated in a weekly, 1-hour substance use group covering psychoeducation, mindfulness, and motivational enhancement in addition to their MAT maintenance and individual check-ins. Results: Thus far, N = 17 inpatients have participated in the group and discharged from the hospital after completing their IV antibiotic treatment. Discharge questionnaires were not obtained from 2 of these patients. While sample size remains low for reliable data analyses, an exact McNemar test demonstrated preliminary significant gains in knowledge about addiction/substance use (p = .008), mental health (p = .004), co-occurring disorders (p = .031), and mindfulness for addiction (p = .002). In addition, all 15 patients were able to identify a follow-up plan at discharge and immediate outpatient MAT follow-up has been confirmed for 14 of the 17 patients (82.4%). Of the 14 that immediately followed-up, 100% have been retained in outpatient MAT thus far. Data collection is ongoing. Discussion: Integrated healthcare systems are well positioned to initiate MAT and provide psychosocial addiction treatment in a controlled environment for patients who use opioids and are completing long-term IV antibiotic hospitalizations (Donro, 2016). MAT inductions with provision of a group intervention in the inpatient setting may be an effective strategy in improving relevant knowledge, outpatient follow-up rates, and continuity of care for these patients, in addition to reducing subsequent inpatient hospitalizations for similar complications. Conclusion: Addiction C-L Services can play an integral role in providing integrated, comprehensive treatment to persons who use opioids completing long-term IV antibiotic hospitalizations.