Predictors of Opioid and Alcohol Pharmacotherapy Initiation at Hospital Discharge Among Patients Seen by an Inpatient Addiction Consult Service.
Predictors of Opioid and Alcohol Pharmacotherapy Initiation at Hospital Discharge Among Patients Seen by an Inpatient Addiction Consult Service.
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DOI：
10.1097/adm.0000000000000611
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发表时间：
2020
影响因子：
5.5
通讯作者：
Korthuis PT
中科院分区：
文献类型：
--
作者：
Englander H;King C;Nicolaidis C;Collins D;Patten A;Gregg J;Korthuis PT
阿片类药物使用障碍（MOUD）和酒精使用障碍（MAUD）的药物是有效的，处方不足。以医院为基础的成瘾咨询服务可以使未接受治疗的成年人参与成瘾护理。了解哪些患者最有可能启动MOUD和MAUD可以为干预措施提供信息，并加深对医院在解决物质使用障碍（SUD）方面的作用的理解。确定住院期间与MOUD/MAUD启动相关的患者和咨询服务水平特征我们分析了来自改善成瘾护理团队（IMPACT）研究的数据，IMPACT是一家学术医疗中心的跨专业医院成瘾咨询服务。研究人员收集了2015年9月至2018年5月的患者调查和临床数据。我们使用逻辑回归来识别OUD、AUD或两者兼而有之的参与者中与开始用药相关的特征。候选变量包括患者人口统计学、社会决定因素和治疗相关因素。339名参与者患有中度至重度OUD、AUD或两者兼而有之，并且在入院时未接受MOUD/MAUD护理。既往美沙酮维持治疗（aOR 2.07，95%CI（1.17，3.66））、无家可归（aOR 2.63，95%CI（1.52，4.53））和伴侣物质使用（aOR 2.05，95%CI（1.12，3.76））与MOUD/MAUD启动相关。合并甲基苯丙胺使用障碍（aOR 0.32，95%CI（0.18，0.56））与MOUD/MAUD启动呈负相关。MOUD/MAUD启动与无家可归和伴侣药物使用的关联表明，住院可能是接触高度弱势群体的机会，进一步强调了提供基于医院的成瘾护理作为卫生系统战略的必要性。甲基苯丙胺与MOUD/MAUD的负相关值得进一步研究。
Medications for opioid use disorder (MOUD) and alcohol use disorder (MAUD) are effective and under-prescribed. Hospital-based addiction consult services can engage out-of-treatment adults in addictions care. Understanding which patients are most likely to initiate MOUD and MAUD can inform interventions and deepen understanding of hospitals’ role addressing substance use disorders (SUD). Determine patient- and consult-service level characteristics associated with MOUD/MAUD initiation during hospitalization We analyzed data from a study of the Improving Addiction Care Team (IMPACT), an interprofessional hospital-based addiction consult service at an academic medical center. Researchers collected patient surveys and clinical data from September 2015 to May 2018. We used logistic regression to identify characteristics associated with medication initiation among participants with OUD, AUD, or both. Candidate variables included patient demographics, social determinants, and treatment-related factors. 339 participants had moderate to severe OUD, AUD, or both and were not engaged in MOUD/MAUD care at admission. Past methadone maintenance treatment (aOR 2.07, 95%CI (1.17, 3.66)), homelessness (aOR 2.63, 95%CI (1.52, 4.53)), and partner substance use (aOR 2.05, 95%CI (1.12, 3.76) were associated with MOUD/MAUD initiation. Concurrent methamphetamine use disorder (aOR 0.32, 95%CI (0.18, 0.56)) was negatively associated with MOUD/MAUD initiation. The association of MOUD/MAUD initiation with homelessness and partner substance use suggests that hospitalization may be an opportunity to reach highly-vulnerable people, further underscoring the need to provide hospital-based addictions care as a health-system strategy. Methamphetamine’s negative association with MOUD/MAUD warrants further study.