Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity
Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity
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DOI：
10.1007/s11606-017-4077-z
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发表时间：
2017-08-01
影响因子：
5.7
通讯作者：
Rigotti, Nancy A.
中科院分区：
文献类型：
--
作者：
Wakeman, Sarah E.;Metlay, Joshua P.;Rigotti, Nancy A.
酒精和药物的使用导致大量的发病率，死亡率和成本。患有酒精和药物使用障碍的个人在普通医疗机构中的比例过高。以医院为基础的干预措施提供了一个机会，与弱势群体，否则可能不会寻求治疗。以确定是否住院成瘾咨询改善出院后1个月的物质使用的结果。前瞻性准实验性评估比较30天出院后的结果之间的参与者谁是和没有看到成瘾咨询小组在住院期间在城市学术医院。390-九名住院成人谁筛选为高风险的酒精或药物使用障碍或谁是临床确定的主要护士作为有物质使用障碍。成瘾咨询从一个多学科的专业团队提供药物治疗开始，动机咨询，治疗计划，出院后30天酒精和药物使用的成瘾严重程度指数（ASI）综合评分和自我报告的戒酒情况。次要结果包括90天的物质使用测量和自我报告的医院和艾德利用率。在265名参与者中进行了30天的随访，干预组的药物或酒精使用的ASI综合评分比对照组下降更大（平均ASI-酒精减少0.24对比0.08，p < 0.001;平均ASI-药物减少0.05对比0.02，p = 0.003。）与对照组相比，干预组的禁欲天数也有更大的增加（+12.7天对+5.6天，p < 0.001）。在控制了年龄、性别、就业状况、吸烟状况和基线成瘾严重程度后，ASI-alcohol、ASI-drug和戒烟天数的差异仍具有统计学意义（分别为p = 0.018、0.018和0.02）。在敏感性分析中，假设失访患者的严重程度与基线相比没有变化，差异仍然具有统计学意义。在非随机队列的内科住院患者中，成瘾咨询降低了酒精和药物使用的成瘾严重程度，并增加了出院后第一个月的戒断天数。
Alcohol and drug use results in substantial morbidity, mortality, and cost. Individuals with alcohol and drug use disorders are overrepresented in general medical settings. Hospital-based interventions offer an opportunity to engage with a vulnerable population that may not otherwise seek treatment.To determine whether inpatient addiction consultation improves substance use outcomes 1 month after discharge.Prospective quasi-experimental evaluation comparing 30-day post-discharge outcomes between participants who were and were not seen by an addiction consult team during hospitalization at an urban academic hospital.Three hundred ninety-nine hospitalized adults who screened as high risk for having an alcohol or drug use disorder or who were clinically identified by the primary nurse as having a substance use disorder.Addiction consultation from a multidisciplinary specialty team offering pharmacotherapy initiation, motivational counseling, treatment planning, and direct linkage to ongoing addiction treatment.Addiction Severity Index (ASI) composite score for alcohol and drug use and self-reported abstinence at 30 days post-discharge. Secondary outcomes included 90-day substance use measures and self-reported hospital and ED utilization.Among 265 participants with 30-day follow-up, a greater reduction in the ASI composite score for drug or alcohol use was seen in the intervention group than in the control group (mean ASI-alcohol decreased by 0.24 vs. 0.08, p < 0.001; mean ASI-drug decreased by 0.05 vs. 0.02, p = 0.003.) There was also a greater increase in the number of days of abstinence in the intervention group versus the control group (+12.7 days vs. +5.6, p < 0.001). The differences in ASI-alcohol, ASI-drug, and days abstinent all remained statistically significant after controlling for age, gender, employment status, smoking status, and baseline addiction severity (p = 0.018, 0.018, and 0.02, respectively). In a sensitivity analysis, assuming that patients who were lost to follow-up had no change from baseline severity, the differences remained statistically significant.In a non-randomized cohort of medical inpatients, addiction consultation reduced addiction severity for alcohol and drug use and increased the number of days of abstinence in the first month after hospital discharge.