Monica K Sikka1, Sara Gore2, Taylor Vega3, Luke Strnad2,4, Jessica Gregg5,6, Honora Englander7,8. 1. Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L457, Portland, OR, 97239-3098, USA. sikka@ohsu.edu. 2. Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L457, Portland, OR, 97239-3098, USA. 3. School of Medicine, Oregon Health and Science University, Portland, OR, USA. 4. Epidemiology Programs, School of Public Health, Oregon Health and Science University and Portland State University, Portland, OR, USA. 5. Section of Addiction Medicine, Division of General Internal Medicine, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, BTE 119, Portland, OR, 97239-3098, USA. 6. Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA. 7. Section of Addiction Medicine, Division of General Internal Medicine, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, BTE 119, Portland, OR, 97239-3098, USA. englandh@ohsu.edu. 8. Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA. englandh@ohsu.edu.
Abstract
BACKGROUND: Serious bacterial infections associated with substance use often result in long hospitalizations, premature discharges, and high costs. Out-of-hospital treatment options in people with substance use disorder (SUD) are often limited. METHODS: We describe a novel multidisciplinary and interprofessional care conference, "OPTIONS-DC," to identify treatment options agreeable to both patients and providers using the frameworks of harm reduction and patient-centered care. We retrospectively reviewed charts of patients who had an OPTIONS-DC between February 2018 and July 2019 and used content analysis to understand the conferences' effects on antibiotic treatment options. RESULTS: Fifty patients had an OPTIONS-DC during the study window. Forty-two (84%) had some intravenous (IV) substance use and 44 (88%) had an active substance use disorder. Participants' primary substances included opioids (65%) or methamphetamines (28%). On average, conferences lasted 28 min. OPTIONS-DC providers recommended out-of-hospital antibiotic treatment options for 34 (68%) of patients. OPTIONS-DC recommended first line therapy of IV antibiotics for 35 (70%) patients, long-acting injectable antibiotics for 14 (28%), and oral therapy for 1 (2%). 35 (70%) patients that had an OPTIONS-DC completed an antibiotic course and 6 (12%) left the hospital prematurely. OPTIONS-DC expanded treatment options by exposing and contextualizing SUD, psychosocial risk and protective factors; incorporating patient preferences; and allowing providers to tailor antibiotic and SUD recommendations. CONCLUSIONS: OPTIONS-DC is a feasible intervention that allows providers to integrate principles of harm reduction and offer patient-centered choices among patients needing prolonged antibiotic treatment.
BACKGROUND: Serious bacterial infections associated with substance use often result in long hospitalizations, premature discharges, and high costs. Out-of-hospital treatment options in people with substance use disorder (SUD) are often limited. METHODS: We describe a novel multidisciplinary and interprofessional care conference, "OPTIONS-DC," to identify treatment options agreeable to both patients and providers using the frameworks of harm reduction and patient-centered care. We retrospectively reviewed charts of patients who had an OPTIONS-DC between February 2018 and July 2019 and used content analysis to understand the conferences' effects on antibiotic treatment options. RESULTS: Fifty patients had an OPTIONS-DC during the study window. Forty-two (84%) had some intravenous (IV) substance use and 44 (88%) had an active substance use disorder. Participants' primary substances included opioids (65%) or methamphetamines (28%). On average, conferences lasted 28 min. OPTIONS-DC providers recommended out-of-hospital antibiotic treatment options for 34 (68%) of patients. OPTIONS-DC recommended first line therapy of IV antibiotics for 35 (70%) patients, long-acting injectable antibiotics for 14 (28%), and oral therapy for 1 (2%). 35 (70%) patients that had an OPTIONS-DC completed an antibiotic course and 6 (12%) left the hospital prematurely. OPTIONS-DC expanded treatment options by exposing and contextualizing SUD, psychosocial risk and protective factors; incorporating patient preferences; and allowing providers to tailor antibiotic and SUD recommendations. CONCLUSIONS: OPTIONS-DC is a feasible intervention that allows providers to integrate principles of harm reduction and offer patient-centered choices among patients needing prolonged antibiotic treatment.
Authors: Joseph O Merrill; Lorna A Rhodes; Richard A Deyo; G Alan Marlatt; Katharine A Bradley Journal: J Gen Intern Med Date: 2002-05 Impact factor: 5.128
Authors: Nathanial S Nolan; Emily Gleason; Laura R Marks; Tracey Habrock-Bach; Stephen Y Liang; Michael J Durkin Journal: Front Psychiatry Date: 2022-06-21 Impact factor: 5.435
Authors: Christina G Rivera; Alison M Beieler; Lindsey M Childs-Kean; Nicolás Cortés-Penfield; Ann-Marie Idusuyi; Sara C Keller; Nipunie S Rajapakse; Keenan L Ryan; Leah H Yoke; Monica V Mahoney Journal: Open Forum Infect Dis Date: 2022-05-09 Impact factor: 4.423
Authors: Nichole Moore; Michael Kohut; Henry Stoddard; Debra Burris; Frank Chessa; Monica K Sikka; Daniel Solomon; Colleen M Kershaw; Ellen Eaton; Rebecca Hutchinson; Kathleen M Fairfield; Thomas J Stopka; Peter Friedmann; Kinna Thakarar Journal: Ther Adv Infect Dis Date: 2022-10-06