Providing comprehensive diagnostic assessments, clinical recommendations, and discharge plans increases the likelihood that inpatients with opioid use disorder (OUD) will not only initiate medications for OUD during hospitalization but connect with OUD care after discharge, according to a study in JAMA Internal Medicine.
Allison J. Ober, Ph.D., of RAND Corporation in Santa Monica, California, and colleagues analyzed data from a clinical trial of the Substance Use Treatment and Recovery Team (START) addiction consult service. START is a collaborative care model in which an addiction medicine specialist and a case management team provide a tailored intervention based on motivational interviewing, addiction-focused discharge planning, and one month of follow-up calls.
The START study was conducted at three sites and included 325 adult inpatients who had a probable OUD diagnosis; 164 patients were randomized to START, while 161 received usual care, which consisted of each hospital’s practices for managing patients with OUD. For example, one site had an existing consultation-liaison service with psychiatrists and social workers who could discuss opioid use with patients.
Overall, 57.3% of patients receiving START initiated medications for OUD while they were hospitalized, compared with 26.7% of those who received usual care. In addition, 72% of START participants attended at least one OUD-related care visit within 30 days of discharge, compared with 48.1% of those who received usual care.
“The START [addiction consult service] model addresses key barriers to treating substance use disorders in hospital settings, including insufficient expertise within inpatient teams, low patient readiness, and the need for transitional care and outreach,” the researchers wrote. “By tackling these challenges, [this] model bridges critical gaps and enhances the likelihood of successful treatment for individuals with OUD.”
For related information, see the American Journal of Psychiatry article “Treatment of Opioid Use Disorder in the General Hospital.”
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