Integrated Care on Leaving Hospital Against Medical Advice Among HIV-Infected People with Substance Use Disorders

IntroductionPeople with serious mental illness (SMI) and/or substance use disorders (SUDs) have an elevated risk of premature mortality compared with the general population. This has been attributed to higher rates of chronic illness among these individuals, but also to inequities in healthcare access and treatment. Integrated care has the potential to improve the health of people with SMI/SUDs. The aims of this scoping review are to: (1) identify empirical investigations of interventions designed to integrate care for people with SMI/SUDs; (2) describe the underlying theories, models and frameworks of integrated care that informed their development; and (3) determine the degree to which interventions address dimensions of a comprehensive and validated framework of integrated care.Methods and analysisGuidelines for best practice and reporting of scoping reviews will be followed using the framework of Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review checklist. An iterative and systematic search of peer-reviewed publications reporting empirical research findings will be conducted. This literature will be identified by searching five databases: Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus. The search will be restricted to articles published between January 2000 and April 2019. Two reviewers will independently screen publications in two successive stages of title and abstract screening, followed by full-text screening of eligible publications. A tabular summary and narrative synthesis will be completed using data extracted from each included study. A framework synthesis will also be conducted, with descriptions of interventions mapped against a theoretical framework of integrated care.Ethics and disseminationThis review will identify the extent and nature of empirical investigations evaluating interventions to integrate care for people with SMI/SUDs. Ethical approval was not required. A team of relevant stakeholders, including people with lived experience of mental health conditions, has been established. This team will be engaged throughout the review and will ensure that the findings are widely disseminated. Dissemination will include publication of the review in a peer-reviewed journal. The review protocol has been registered through Open Science Framework and can be accessed athttps://osf.io/njkph/

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Evaluating culturally and linguistically integrated care for Latinx adults with mental and substance use disorders

Ethnicity and Health ◽

10.1080/13557858.2019.1685653 ◽

2019 ◽

pp. 1-13

Author(s):

Angela Wangari Walter ◽

Cesar Morocho ◽

Deborah Chassler ◽

Jessica Sousa ◽

Diliana De Jesús ◽

...

Keyword(s):

Substance Use ◽

Integrated Care ◽

Substance Use Disorders

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780. Inpatient Addiction Medicine Consultations at the Urban/Rural Frontier: Improving Quality of Care and Linkage to Outpatient Services for Patients with Substance Use Disorder in Central Kentucky

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.848 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S346-S346

Author(s):

Laura Fanucchi ◽

Devin Oller

Keyword(s):

Substance Use ◽

Substance Use Disorder ◽

Medical Advice ◽

Outpatient Services ◽

Addiction Medicine ◽

Against Medical Advice ◽

Opioid Treatment ◽

Rural Counties ◽

Discharge Against Medical Advice ◽

The University

Abstract Background When persons with opioid use disorder (OUD) are hospitalized with medical complications (e,g. endocarditis, viral hepatitis) they frequently do not receive medications for the underlying OUD. In recent years, a number of hospitals have implemented addiction medicine consultation (AMC) services to help address this treatment gap, though these are all in large urban centers. AMCs provide comprehensive substance use disorder (SUD) assessments, manage SUDs, initiate pharmacotherapy for OUD, and arrange linkage to ongoing treatment. The aim of this study was to describe the initial implementation and outcomes of a new AMC at the University of Kentucky Hospital, a 945-bed tertiary referral center with a large rural catchment. Methods The Addiction Consultation and Education Service(ACES) began October, 2018 and was comprised of several physicians and an APRN. A patient navigator assisted with prior authorizations and outpatient linkage. ACES referred to a new bridge clinic at the University for ongoing office-based opioid treatment as well as to community programs and licensed opioid treatment programs. Patient demographics, SUD diagnoses, and comorbidities (including details of the injection-related infections) are collected from the electronic health record, as well as key process metrics including: time-to-consultation and medication initiation, length of stay(LOS), discharge against medical advice(AMA), and details of linkage to outpatient services. Results From October-December, 91 patients were seen, 73 met DSM-5 criteria for OUD, 82 had a medical complication of SUD, and 53 lived in rural counties (Rural-Urban Continuum Codes 4–9). Average LOS was 19.5 days. Among OUD patients, 71% underwent buprenorphine/naloxone induction, 9% were started on methadone. Less than 6% of patients started on buprenorphine or methadone left against medical advice. Conclusion AMCs are a key part of providing comprehensive care for persons hospitalized with infectious complications of substance use. Initiating medication for OUD likely decreases rates of discharge against medical advice. Compared with other AMCs, a greater percentage of patients seen by ACES resided in rural counties. Establishing a bridge clinic prior to starting an AMC is critical to ensure ongoing care. Disclosures All authors: No reported disclosures.

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Providing Integrated Care for Pain and Addiction (DRAFT)

10.1093/med/9780190265366.003.0005 ◽

2018 ◽

Author(s):

Alan A. Wartenberg

Keyword(s):

Substance Use ◽

Integrated Care ◽

Substance Use Disorders ◽

Multidisciplinary Approach ◽

Current Standard ◽

Addiction Medicine ◽

Additional Information ◽

Pain Syndromes ◽

Assessment And Treatment ◽

The Common

The central premise of this chapter on providing integrated care for both pain and addiction is that all patients presenting with pain are at risk for development of substance use disorders. Assessment and treatment of the complex interplay between pain syndromes and substance use disorders proceed most productively by employing an integrated model, with a multidisciplinary approach and with employment of multiple diagnostic instruments. The author describes an integrated care model as it applies to each of the common substances of use: opioids, tobacco, alcohol, benzodiazepines, cannabinoids, barbiturates, and stimulants. The basis for a decision to refer for evaluation or treatment is described. The chapter concludes with an argument for collaboration between disciplines, notably pain medicine and addiction medicine, as being the current standard of acceptable care for patients whose illnesses dwell in both camps. A separate text box provides additional information and resources bearing on this chapter’s topics.

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