Building a hospital-based addiction medicine consultation service in Vancouver, Canada: the path taken and lessons learned.
Building a hospital-based addiction medicine consultation service in Vancouver, Canada: the path taken and lessons learned.
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DOI：
10.1111/add.15383
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发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
Nolan S
中科院分区：
文献类型：
--
作者：
Braithwaite V;Ti L;Fairbairn N;Ahamad K;McLean M;Harrison S;Wood E;Nolan S
为了改善急性护理环境中的循证成瘾护理，北美的许多医院正在开发住院成瘾药物咨询服务（AMCS）。加拿大温哥华的圣保罗医院拥有一个大型的跨学科AMCS。本研究旨在：（1）描述当前的临床护理模式及其随时间的演变;（2）评估随着时间的推移对AMCS咨询的要求;（3）强调既定的临床培训机会和教育课程;（4）提供一些经验教训。在加拿大温哥华一家拥有大型跨学科AMCS的城市学术医院进行的一项回顾性观察性分析，研究时间为2013年至2018年，研究对象为住院治疗的物质使用障碍患者。使用医院的电子病历收集数据。主要结果是随着时间的推移AMCS咨询的数量。2014年，医院的AMCS被重组为一个学术性的跨学科咨询服务。2013年（重组前1年）至2018年期间，咨询数量增加了228%（分别为1373对4507; P = 0.027）。超过一半的AMCS咨询来自急诊科，这一数字随着时间的推移而增加（2013年为55%，2018年为74%）。转诊患者主要为45 - 65岁的男性（所有5年中> 60%）。咨询的原因保持一致，包括：阿片类药物（33%），兴奋剂（30%），酒精（23%）和大麻使用（8%）。在加拿大温哥华的圣保罗医院于2014年重组为大型跨学科成瘾医学咨询服务（AMCS）后，AMCS的咨询请求数量增加了228%，其中超过一半的请求来自急诊科。约三分之二的咨询请求涉及类阿片或兴奋剂的使用。
To improve evidence-based addiction care in acute care settings, many hospitals across North America are developing an inpatient addiction medicine consultation service (AMCS). St Paul’s Hospital in Vancouver, Canada houses a large interdisciplinary AMCS. This study aimed to: (1) describe the current model of clinical care and its evolution over time; (2) evaluate requests for an AMCS consultation over time; (3) highlight the established clinical training opportunities and educational curriculum and (4) provide some lessons learned. A retrospective observational analysis in an urban, academic hospital in Vancouver, Canada with a large interdisciplinary AMCS, studied from 2013 to 2018, among individuals who presented to hospital and had a substance use disorder. Data were collected using the hospital’s electronic medical records. The primary outcome was number of AMCS consultations over time. In 2014 the hospital’s AMCS was restructured into an academic, interdisciplinary consultation service. A 228% increase in the number of consultations was observed between 2013 (1 year prior to restructuring) and 2018 (1373 versus 4507, respectively; P = 0.027). More than half of AMCS consultations originated from the emergency department, with this number increasing over time (55% in 2013 versus 74% in 2018). Referred patients were predominantly male (> 60% in all 5 years) between the ages of 45 and 65 years. Reasons for consultation remained consistent and included: opioids (33%), stimulants (30%), alcohol (23%) and cannabis use (8%). After St Paul’s Hospital in Vancouver, Canada was restructured in 2014 to a large, interdisciplinary addiction medicine consultation service (AMCS), the AMCS saw a 228% increase in the number of consultation requests with more than half of requests originating from the emergency department. Approximately two-thirds of consultation requests were for opioid or stimulant use.
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