scholarly journals 28. The Paradox of an Integrated MAT OPAT Program

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S137-S137
Author(s):  
Paula Eckardt ◽  
Jessica Reed ◽  
Claudia P Vicencio ◽  
Alberto Augsten
Keyword(s):  
Drug Use ◽  
Behavioral Health ◽  
Healthcare System ◽  
Standard Of Care ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
History Of ◽  
Picc Line ◽  
Iv Drug Use ◽  
To Receive

Abstract Background Patients with substance use disorders (SUD), specifically opioid use disorder (OUD) and injection drug use (IDU) utilize healthcare resources for prolonged inpatient treatment of serious infections stemming from their addictions. For a variety of reasons, physicians treating these patients refuse to send these patients home to receive outpatient parenteral antimicrobial therapy (OPAT), and instead keep the patient in the hospital for several weeks or longer to complete treatment for the injection-related infections. Patients who do not have history of IDU are sent home with a PICC line to receive OPAT once they are no longer acutely ill and therefore no longer meet criteria to remain inpatient, which is the established standard of care. Patients with OUD and IDU are not allowed the same standard of care, and furthermore do not receive adequate, if any, therapy for their primary problem and reason for their serious infection – the addiction. Flow chart of the MAT-OPAT process Methods Medication-assisted treatment (MAT) with buprenorphine-naloxone has been approved for treating adults with opioid use disorder as part of a comprehensive treatment program that also includes counseling and behavioral therapy. Until now in our healthcare system there has been no comprehensive and integrated program to safely discharge patients with OUD and IDU to receive OPAT via a PICC line, while simultaneously treating their addiction. We describe the implementation of a MAT-OPAT program. Please refer to the chart included. Results We present a successful case of a 36-year-old male with a history of endocarditis associated with IV drug use and the intervention of the Healthcare System to link the patient to appropriate Infectious disease, behavioral health and medication adherence treatment for opioid abuse. The patient completed the IV antibiotic therapy and remained enrolled in the behavioral health program with a successful outcome. Conclusion MAT-OPAT implementation in large healthcare system with continuous outpatient support that includes Infectious Disease services, behavioral health and drug abuse rehabilitation therapy can be a successful strategy to minimize readmisión, cost and complications in patients with history of IV drug use and infections that require prolonged intravenous antibiotic therapy. Disclosures All Authors: No reported disclosures

Championing Change to Save Lives: A Call to Action to Implement Reforms to Increase Use of Medications to Treat Opioid Use Disorder in Correctional Settings

2020 ◽  
pp. 073401682098162
Author(s):  
Sonia L. Canzater ◽  
Regina M. LaBelle
Keyword(s):  
Standard Of Care ◽  
Opioid Use Disorder ◽  
Correctional Facilities ◽  
Evidence Based ◽  
Opioid Use ◽  
Call To Action ◽  
Evidence Based Treatment ◽  
High Prevalence ◽  
Correctional Settings ◽  
Overdose Deaths

The disproportional rates of opioid use disorder (OUD) in U.S. correctional facilities make them prime intervention points to treat OUD utilizing medication to treat opioid use disorder (MOUD), the evidence-based clinical standard of care. MOUD has been shown to be effective to support recovery and reduce recurrence of OUD, overdose deaths, and recidivism for justice-involved persons both while incarcerated and once they reenter their communities. Despite the high prevalence, most jails and prisons do not offer MOUD. Litigation has spurred expanded access in more facilities, but widespread MOUD access can only become a reality through a comprehensive effort of corrections officials, medical experts, advocates, legislators, and other champions to raise awareness and affect ideological and policy change. It is a legal and ethical imperative that the lives of justice-involved persons not be jeopardized by the lack of evidence-based treatment for OUD in correctional settings.

scholarly journals 1268. Dalbavancin for the Treatment of Infections due to Staphylococcus aureus

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S650-S651
Author(s):  
Amber C Streifel ◽  
Ellie Sukerman ◽  
Monica Sikka ◽  
Jina Makadia ◽  
James Lewis ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Outcomes ◽  
Adverse Drug Events ◽  
Joint Infection ◽  
Standard Of Care ◽  
Clinical Endpoints ◽  
History Of ◽  
Antibiotic Failure ◽  
Iv Drug Use ◽  
Infection Recurrence

Abstract Background Dalbavancin is a lipoglycopeptide antibiotic active against gram-positive organisms. Its extended half-life allows for weekly dosing that can last 4 to 6 weeks with 2 doses. Although approved for treating skin and soft tissue infections, use for more complicated infections is appealing, particularly when daily intravenous antibiotics are impractical. S aureus is the most common cause of complex infections for which dalbavancin is considered at our institution, so we sought to better understand its use. Methods We conducted a retrospective study to describe dalbavancin use at our institution for infections caused by Staphylococcus aureus. We identified all patients ≥18 years who received ≥1 dose of dalbavancin. Infectious disease faculty reviewed charts for clinical characteristics and outcomes of the infections. Results Fifty-two patients with S. aureus infections (60% MRSA) were treated with at least a partial course of dalbavancin. Twenty-seven (52%) had a history of IV drug use (IDU) and the most common infections were bone and joint infection in 51% and bacteremia in 40% (Table 1). The most common dosing regimen was 1500 mg x 1 in 55% or 1500 mg weekly x 2 in 25% (Table 2). The most common reasons for use of dalbavancin were history of IDU in 48% and lack of a safe home environment in 21%. Suppressive oral antibiotics for the primary infection were prescribed to 3 patients after completing dalbavancin (2 received for other indications). Clinical outcomes include 15% of patients lost to follow-up, readmission due to infection recurrence or dalbavancin adverse effects in 12%, and overall infection recurrence or relapse by day 90 in 31% (Table 3). There were no severe dalbavancin-related adverse drug events. Table 1. Patient and Disease Characteristics Table 2. Dalbavancin Use Characteristics Table 3. Clinical Endpoints Conclusion While our results suggest dalbavancin is well tolerated, questions about relapse rates in the treatment of complicated S. aureus infections remain. Further research is needed to evaluate clinical outcomes for dalbavancin compared to standard of care antibiotics and to better elucidate whether relapses were related to true antibiotic failure versus other complexities of the S. aureus infections. Disclosures All Authors: No reported disclosures

scholarly journals Approaches for Implementing App-Based Digital Treatments for Drug Use Disorders Into Primary Care: A Qualitative, User-Centered Design Study of Patient Perspectives (Preprint)

2020 ◽  
Author(s):  
Joseph E Glass ◽  
Theresa E Matson ◽  
Catherine Lim ◽  
Andrea L Hartzler ◽  
Kilian Kimbel ◽  
...  
Keyword(s):  
Primary Care ◽  
Drug Use ◽  
Opioid Use Disorder ◽  
User Centered Design ◽  
Opioid Use ◽  
Kaiser Permanente ◽  
Secure Messaging ◽  
Phone Calls ◽  
Drug Use Disorders ◽  
User Centered

BACKGROUND Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs). However, their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. OBJECTIVE This study aims to increase the understanding of how patients with DUDs prefer to receive app-based treatments to inform the implementation of these treatments in primary care. METHODS The methods of user-centered design were combined with qualitative research methods to inform the design of workflows for offering app-based treatments in primary care. Adult patients (n=14) with past-year cannabis, stimulant, or opioid use disorder from 5 primary care clinics of Kaiser Permanente Washington in the Seattle area participated in this study. Semistructured interviews were recorded, transcribed, and analyzed using qualitative template analysis. The coding scheme included deductive codes based on interview topics, which primarily focused on workflow design. Inductive codes emerged from the data. RESULTS Participants wanted to learn about apps during visits where drug use was discussed and felt that app-related conversations should be incorporated into the existing care whenever possible, as opposed to creating new health care visits to facilitate the use of the app. Nearly all participants preferred receiving clinician support for using apps over using them without support. They desired a trusting, supportive relationship with a clinician who could guide them as they used the app. Participants wanted follow-up support via phone calls or secure messaging because these modes of communication were perceived as a convenient and low burden (eg, no copays or appointment travel). CONCLUSIONS A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients’ needs for structure, support in and outside of visits, and desire for convenience.

Demographic characteristics, medical and psychiatric history of patients with prescription opioid use disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S300-S301
Author(s):  
S. Herrera ◽  
A. Riquelme ◽  
T. León ◽  
M. Babul
Keyword(s):  
Opioid Analgesics ◽  
The United States ◽  
Opioid Use Disorder ◽  
Demographic Characteristics ◽  
Prescription Opioid ◽  
Psychiatric History ◽  
Opioid Use ◽  
History Of ◽  
Competing Interest ◽  
Prescription Opioid Misuse

IntroductionOver the past two decades the prescription of opioid analgesics has increased with a subsequent escalating in prescription opioid misuse. It is estimated that 4.5 million (2.5%) of the United States of America population abuse of pain relievers; opioids are among the most commonly.In Chile there are few reports about the prevalence of opioid use disorder.ObjectivesThe aim of this study is to describe the demographic characteristics, medical and psychiatric comorbidity of patients that suffer from opioid addiction.Patients and methodsThis transversal study examined data of 7 patients with opioid use disorder (OUD; DSM-5) that consulted at the addiction unit of “Red de Salud, Pontificia Universidad Católica de Chile”, between November 2013 and October 2015. Data included: demographics, medical and psychiatric history, laboratory and imaging tests.ResultsOf all the patients, 57% were men, 25 to 67 years of age, 43% between 35-40 years; 57% were married; 57% had completed studies at university. 43% had also alcohol use disorder, 28% marijuana, 28% cocaine and 28% benzodiazepines than in most cases began before OUD. In addition; 57% had medical comorbidity among which stand out obesity (17%), osteoarthritis (17%) and chronic low back pain (17%). Eighty-three percent require hospitalization. Twenty-eight percent had abnormal liver tests and one patient had positive hepatitis B core antibody. Opioids used were: morphine(14%), codeine (43%), tramadol (42%).ConclusionThese results emphasize on the misuse of prescription opioids analgesics, the complexity of patients with OUD and the prevalence of other substance use disorder that precedes and accompany OUD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals 315. Prenatal Hepatitis C Viral (HCV) Screening Practices and HCV-Associated Fetal, Neonatal and Pregnancy Outcomes in a Large Regional Healthcare System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S167-S167
Author(s):  
Tripti Adhikari ◽  
Rachel Scott ◽  
Utsav Timalsina ◽  
Ariunzaya Amgalan ◽  
Shari L Sawney ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prenatal Care ◽  
Pregnant Women ◽  
Behavioral Health ◽  
Healthcare System ◽  
Categorical Variables ◽  
Opioid Use ◽  
Screening Practices ◽  
Hcv Screening ◽  
In Pregnancy

Abstract Background Prevalence of HCV in pregnancy is 0.1–3.6%. AASLD and IDSA now recommend HCV screening in pregnancy although CDC, USPSTF, or ACOG still do not—though HCV can be perinatally transmitted and carries associated complications for the mother and fetus. Our study objectives were to analyze prenatal HCV screening practices at a large regional healthcare system and the prevalence of HCV-associated maternal and fetal/neonatal outcomes. Methods We performed a nested propensity score (PS) case–control study of pregnant women who tested HCV Ab+ in a cross-sectional study of women presenting for prenatal care at a large regional healthcare system from January 17 to December 18. We collected retrospective EHR data, including state of residency, HCV Ab, RNA, care engagement, HCV risk factors, comorbidities, maternal and fetal/neonatal morbidity, and neonatal HCV testing (when available). Mixed and generalized linear models were used to examine differences in continuous and categorical variables, respectively, between cases and controls Results 14,363 women were seen for prenatal care; 4,891 (34%) were HCV tested, 75 (1.5%) tested HCV Ab+. Demographic and comorbidity data are shown in Table 1. HCV Ab+ cases had more co-morbidities, including obesity, heart disease, opioid use, and behavioral health issues compared with the controls. HCV risk factors included IVDU (64%) and tattoos (24%) (Figure 1). Neither past/current pregnancy-related complications nor fetal or neonatal adverse events (Figure 2) were statistically significantly different except for cholestasis in HCV Ab+ cases (5.3 vs. 0%, P = 0.04). Conclusion Our study showed only one-third of pregnant women are currently HCV screened in our health system. Universal screening would likely increase the number of HCV-infected women identified. Early HCV detection, repeated testing, and behavioral health intervention of those at high-risk may decrease further horizontal and vertical transmission of HCV in pregnancy. Disclosures All authors: No reported disclosures.

scholarly journals Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Laura R Marks ◽  
Nathanial S Nolan ◽  
Linda Jiang ◽  
Dharushana Muthulingam ◽  
Stephen Y Liang ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Diagnosis Code ◽  
Opioid Use ◽  
Diagnosis Codes ◽  
All Cause Mortality ◽  
Icd 10

Abstract Background No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007). Conclusions Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.

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