Thomas D Brothers1, John Fraser2, Emily MacAdam1, Brendan Morgan3, Jordan Francheville1, Aditya Nidumolu4, Christopher Cheung3, Samuel Hickcox5, David Saunders6,7, Tiffany O'Donnell8,9, Leah Genge2,6,9, Duncan Webster1,10. 1. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. 2. Mobile Outreach Street Health, North End Community Health Centre, Halifax, Nova Scotia, Canada. 3. Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. 4. Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. 5. Mental Health and Addictions, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada. 6. Direction 180, Halifax, Nova Scotia, Canada. 7. The Open Door Clinic, Dartmouth, Nova Scotia, Canada. 8. Hospitalist Medicine Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada. 9. Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. 10. Division of Infectious Diseases, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
Abstract
Background: To evaluate a novel, unofficial, trainee-organized, hospital addiction medicine consultation service (AMCS), we aimed to assess whether it was (1) acceptable to hospital providers and patients, (2) feasible to organize and deliver, and (3) impacted patient care. Methods: We performed a retrospective descriptive study of all AMCS consultations over the first 16 months. We determined acceptability via the number of referrals received from admitting services, and the proportion of referred patients who consented to consultation. We evaluated feasibility via continuation/growth of the service over time, and the proportion of referrals successfully completed before hospital discharge. As most referrals related to opioid use disorder, we determined impact through the proportion of eligible patients offered and initiated on opioid agonist therapy (OAT) in hospital, and the proportion of patients who filled their outpatient prescription or attended their first visit with their outpatient OAT prescriber. Results: The unofficial AMCS grew to involve six hospital-based residents and five supervising community-based addiction physicians. The service received 59 referrals, primarily related to injection opioid use, for 50 unique patients from 12 different admitting services. 90% of patients were seen before discharge, and 98% agreed to addiction medicine consultation. Among 34 patients with active moderate-severe opioid use disorder who were not already on OAT, 82% initiated OAT in hospital and 89% of these patients continued after discharge. Conclusions: Established in response to identified gaps in patient care and learning opportunities, a novel, unofficial, trainee-organized AMCS was acceptable, feasible, and positively impacted patient care over the first 16 months. This trainee-organized, unofficial AMCS could be used as a model for other hospitals that do not yet have an official AMCS.
Background: To evaluate a novel, unofficial, trainee-organized, hospital addiction medicine consultation service (AMCS), we aimed to assess whether it was (1) acceptable to hospital providers and patients, (2) feasible to organize and deliver, and (3) impacted patient care. Methods: We performed a retrospective descriptive study of all AMCS consultations over the first 16 months. We determined acceptability via the number of referrals received from admitting services, and the proportion of referred patients who consented to consultation. We evaluated feasibility via continuation/growth of the service over time, and the proportion of referrals successfully completed before hospital discharge. As most referrals related to opioid use disorder, we determined impact through the proportion of eligible patients offered and initiated on opioid agonist therapy (OAT) in hospital, and the proportion of patients who filled their outpatient prescription or attended their first visit with their outpatient OAT prescriber. Results: The unofficial AMCS grew to involve six hospital-based residents and five supervising community-based addiction physicians. The service received 59 referrals, primarily related to injection opioid use, for 50 unique patients from 12 different admitting services. 90% of patients were seen before discharge, and 98% agreed to addiction medicine consultation. Among 34 patients with active moderate-severe opioid use disorder who were not already on OAT, 82% initiated OAT in hospital and 89% of these patients continued after discharge. Conclusions: Established in response to identified gaps in patient care and learning opportunities, a novel, unofficial, trainee-organized AMCS was acceptable, feasible, and positively impacted patient care over the first 16 months. This trainee-organized, unofficial AMCS could be used as a model for other hospitals that do not yet have an official AMCS.
Entities:
Keywords:
Inpatient; acute care; endocarditis; epidural abscess; substance use disorder
Authors: Thomas D Brothers; Dan Lewer; Nicola Jones; Samantha Colledge-Frisby; Michael Farrell; Matthew Hickman; Duncan Webster; Andrew Hayward; Louisa Degenhardt Journal: PLoS Med Date: 2022-07-19 Impact factor: 11.613
Authors: Thomas D Brothers; Kimiko Mosseler; Susan Kirkland; Patti Melanson; Lisa Barrett; Duncan Webster Journal: PLoS One Date: 2022-01-26 Impact factor: 3.240
Authors: Susan L Calcaterra; Steve Lockhart; Catherine Callister; Kaitlyn Hoover; Ingrid A Binswanger Journal: J Gen Intern Med Date: 2022-01-03 Impact factor: 6.473
Authors: Thomas D Brothers; Malcolm Leaman; Matthew Bonn; Dan Lewer; Jacqueline Atkinson; John Fraser; Amy Gillis; Michael Gniewek; Leisha Hawker; Heather Hayman; Peter Jorna; David Martell; Tiffany O'Donnell; Helen Rivers-Bowerman; Leah Genge Journal: Drug Alcohol Depend Date: 2022-04-07 Impact factor: 4.852