Role of the Hospital in the 21st Century Opioid Overdose Epidemic: The Addiction Medicine Consult Service
Role of the Hospital in the 21st Century Opioid Overdose Epidemic: The Addiction Medicine Consult Service
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DOI：
10.1097/adm.0000000000000496
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发表时间：
2019-03-01
影响因子：
5.5
通讯作者：
McCarty, Dennis
中科院分区：
文献类型：
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作者：
Priest, Kelsey C.;McCarty, Dennis
目的：该研究的目的是探索和描述的成瘾医学咨询（AMC）服务的结构和设计元素在选定的美国hospital.Methods：作为一个更大的混合方法研究的一部分，10个定性半结构化的电话采访完成了与董事会认证的成瘾医学医师隶属于成瘾医学基金会的成瘾医学奖学金计划在9家美国医院。访谈被转录，编码，并使用一个直接的内容analysis.Results分析：访谈完成与建立AMC服务在9家医院探讨AMC的结构和设计的共性和差异在4个领域：（1）可用性和覆盖面，（2）团队组成，（3）范围和责任，（4）融资。只有1个服务提供周末咨询，大多数服务不提供急诊室的服务。跨专业团队在各种学科组合中很常见。AMC的服务范围和职责一般包括3种类型的活动：（1）教育和文化变革，（2）提供心理社会和医疗服务，（3）制定医院指导文件。最后，大多数AMC服务存在于一个脆弱的金融环境与特质arrangements.Conclusions：作为阿片类药物使用障碍（OUD）相关的住院增加利益相关者期待创新的医疗服务机制，以改善护理和成果的人与OUD。AMC服务的实施可能是实现这些目标的组织干预。了解AMC服务结构和设计的共享和不同方法是有兴趣实施或扩展这些服务的交付系统的重要第一步。
Objective: The aim of the study was to explore and describe the structure and design elements of addiction medicine consult (AMC) services within selected US hospitals.Methods: As part of a larger mixed methods study, 10 qualitative semi-structured telephone interviews were completed with board-certified addiction medicine physicians affiliated with the Addiction Medicine Foundation's Addiction Medicine Fellowship Programs at 9 US hospitals. Interviews were transcribed, coded, and analyzed using a directed content analysis.Results: Interviews completed with established AMC services in 9 hospitals probed AMC structure and design commonalities and differences across 4 domains: (1) availability and coverage, (2) team composition, (3) scope and responsibility, and (4) financing. Only 1 service provided weekend consults and most services did not provide coverage in the emergency department. Interprofessional teams were common with a variety of discipline combinations. AMC service scope and responsibility, generally, included 3 types of activities: (1) education and culture change, (2) the delivery of psychosocial and medical services, and (3) hospital guidance document development. Finally, most AMC services existed within a fragile financial environment with idiosyncratic arrangements.Conclusions: As opioid use disorder (OUD)-related hospitalizations increase stakeholders look to innovative care delivery mechanisms to improve care and outcomes for persons with OUD. The implementation of an AMC service may be an organizational intervention for achieving these aims. Understanding the shared and different approaches to AMC service structure and design is an important first step for delivery systems interested in implementing or expanding these services.