Pilot randomized controlled trial of a hospital-based substance use treatment and recovery team (START) to improve initiation of medication for alcohol or opioid use disorder and linkage to follow-up care

被引:8
作者
Ober, Allison J. [1 ,4 ]
Osilla, Karen C. [2 ]
Klein, David J. [1 ]
Burgette, Lane F. [1 ]
Leamon, Isabel [1 ]
Mazer, Mia W. [3 ]
Messineo, Gabrielle [3 ]
Collier, Stacy [3 ]
Korouri, Samuel [3 ]
Watkins, Katherine E. [1 ]
Ishak, Waguih [3 ]
Nuckols, Teryl [3 ]
Danovitch, Itai [3 ]
机构
[1] RAND Corp, Santa Monica, CA USA
[2] Stanford Univ Sch Med, Palo Alto, CA USA
[3] Cedars Sinai Med Ctr, Los Angeles, CA USA
[4] RAND Corp, 1776 Main St, Santa Monica, CA 90407 USA
来源
JOURNAL OF SUBSTANCE USE & ADDICTION TREATMENT | 2023年 / 150卷
基金
美国国家卫生研究院;
关键词
Opioid use disorder (OUD); Medications for opioid use disorder (MOUD); Addiction consult team; Collaborative care; Linkage to follow-up; Inpatient; GENERALIZED ANXIETY DISORDER; COLLABORATIVE CARE; BUPRENORPHINE/NALOXONE TREATMENT; ADDICTION CONSULTATION; INFECTIVE ENDOCARDITIS; COST-EFFECTIVENESS; BRIEF INTERVENTION; INPATIENT; DEPRESSION; DEPENDENCE;
D O I
10.1016/j.josat.2023.209063
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Objectives: We conducted a pilot randomized controlled trial (RCT) to explore whether a hospital inpatient addiction consult team (Substance Use Treatment and Recovery Team [START]) based on collaborative care was feasible, acceptable to patients, and whether it could improve uptake of medication in the hospital and linkage to care after discharge, as well as reduce substance use and hospital readmission. The START consisted of an addiction medicine specialist and care manager who implemented a motivational and discharge planning intervention.Methods: We randomized inpatients age > 18 with a probable alcohol or opioid use disorder to receive START or usual care. We assessed feasibility and acceptability of START and the RCT, and we conducted an intent-to-treat analysis on data from the electronic medical record and patient interviews at baseline and 1-month postdischarge. The study compared RCT outcomes (medication for alcohol or opioid use disorder, linkage to followup care after discharge, substance use, hospital readmission) between arms by fitting logistic and linear regression models.Findings: Of 38 START patients, 97 % met with the addiction medicine specialist and care manager; 89 % received >8 of 10 intervention components. All patients receiving START found it to be somewhat or very acceptable. START patients had higher odds of initiating medication during the inpatient stay (OR 6.26, 95 % CI = 2.38-16.48, p < .001) and being linked to follow-up care (OR 5.76, 95 % CI = 1.86-17.86, p < .01) compared to usual care patients (N = 50). The study found no significant differences between groups in drinking or opioid use; patients in both groups reported using fewer substances at the 1-month follow-up.Conclusions: Pilot data suggest START and RCT implementation are feasible and acceptable and that START may facilitate medication initiation and linkage to follow-up for inpatients with an alcohol or opioid use disorder. A larger trial should assess effectiveness, covariates, and moderators of intervention effects.
引用
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页数:13
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