Sijie Jason Wang1, Elizabeth Wade2, Jennifer Towle3, Tabitha Hachey4, Jennifer Rioux4, Omrie Samuels5, Casey Bonner5, Christina Kirkpatrick6, Sandra O'Loughlin7, Keith Foster3. 1. Department of Hospital Medicine. Electronic address: Sjwang40@gmail.com. 2. Pharmacy Department, Concord Hospital, Concord, NH. 3. Pharmacy Department, Concord Hospital, Concord, NH; Massachusetts College of Pharmacy and Health Sciences, Manchester, NH. 4. New Era Medicine, Manchester, NH. 5. Massachusetts College of Pharmacy and Health Sciences, Manchester, NH. 6. Department of Hospital Medicine. 7. Department of Hospital Medicine; Department of Clinical Informatics, Concord Hospital Concord, NH.
Abstract
BACKGROUND: Patients who present to the hospital for infectious complications of intravenous opioid use are at high risk for against-medical-advice discharge and readmissions. The role of medication-assisted treatment for inpatients is not clear. We aimed to assess outcomes prior to and after rollout of an inpatient buprenorphine-based opioid use disorder protocol, as well as to assess outcomes in general for medication-assisted therapy. METHODS: This was a retrospective observational cohort study at our community hospital in New Hampshire. The medical record was searched for inpatients with a complication of intravenous opioid use. We searched for admissions 11 months prior to and after the November 2018 buprenorphine protocol rollout. RESULTS: Rates of medication-assisted therapy usage and buprenorphine linkage increased significantly after protocol rollout. Rates of against-medical-advice discharge did not decrease after protocol rollout, nor did readmissions. However, when evaluating the entire group of patients regardless of date of presentation or protocol use, against-medical-advice discharge rates were substantially lower for patients receiving medication-assisted therapy compared with those receiving supportive care only (30.0% vs 59.6%). Readmissions rates were lower for patients who were discharged with any form of ongoing medication-assisted therapy compared with those who were not (30-day all-cause readmissions 18.8% vs 35.1%; 30-day opioid-related readmissions 10.1% vs 29.9%; 90-day all-cause readmissions 27.3% vs 42.7%; 90-day opioid-related readmissions 15.1% vs 33.3%). CONCLUSIONS: There is a strong association between medication-assisted therapy and reduced against-medical-advice discharge rates. Additionally, maintenance medication-assisted therapy at time of discharge is strongly associated with reduced readmissions rates.
BACKGROUND: Patients who present to the hospital for infectious complications of intravenous opioid use are at high risk for against-medical-advice discharge and readmissions. The role of medication-assisted treatment for inpatients is not clear. We aimed to assess outcomes prior to and after rollout of an inpatient buprenorphine-based opioid use disorder protocol, as well as to assess outcomes in general for medication-assisted therapy. METHODS: This was a retrospective observational cohort study at our community hospital in New Hampshire. The medical record was searched for inpatients with a complication of intravenous opioid use. We searched for admissions 11 months prior to and after the November 2018 buprenorphine protocol rollout. RESULTS: Rates of medication-assisted therapy usage and buprenorphine linkage increased significantly after protocol rollout. Rates of against-medical-advice discharge did not decrease after protocol rollout, nor did readmissions. However, when evaluating the entire group of patients regardless of date of presentation or protocol use, against-medical-advice discharge rates were substantially lower for patients receiving medication-assisted therapy compared with those receiving supportive care only (30.0% vs 59.6%). Readmissions rates were lower for patients who were discharged with any form of ongoing medication-assisted therapy compared with those who were not (30-day all-cause readmissions 18.8% vs 35.1%; 30-day opioid-related readmissions 10.1% vs 29.9%; 90-day all-cause readmissions 27.3% vs 42.7%; 90-day opioid-related readmissions 15.1% vs 33.3%). CONCLUSIONS: There is a strong association between medication-assisted therapy and reduced against-medical-advice discharge rates. Additionally, maintenance medication-assisted therapy at time of discharge is strongly associated with reduced readmissions rates.
Authors: Maria A Corcorran; Jenell Stewart; Kristine Lan; Ayushi Gupta; Sara N Glick; Chetan Seshadri; Kevin J Koomalsingh; Edward F Gibbons; Robert D Harrington; Shireesha Dhanireddy; H Nina Kim Journal: Open Forum Infect Dis Date: 2022-03-29 Impact factor: 4.423
Authors: Magdalena Harris; Adam Holland; Dan Lewer; Michael Brown; Niamh Eastwood; Gary Sutton; Ben Sansom; Gabby Cruickshank; Molly Bradbury; Isabelle Guest; Jenny Scott Journal: BMC Med Date: 2022-04-14 Impact factor: 8.775