scholarly journals 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

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.

Discharge against Medical Advice in Some Paediatric Wards

1988 ◽  
Vol 18 (3) ◽  
pp. 125-127 ◽  
Author(s):  
H S Goyea
Keyword(s):  
Hospital Care ◽  
Preventive Health Care ◽  
Medical Advice ◽  
Preventive Health ◽  
Against Medical Advice ◽  
The Poor ◽  
Discharge Against Medical Advice ◽  
The Cost ◽  
The University ◽  
Family Opposition

Sixty-four cases of discharge against medical advice (DAMA) from 3 paediatric units in the University of Benin Teaching Hospital within a period of 18 months were analysed. The incidence was highest among the very young, even when they were still very ill. Financial problems accounted for 65.6% of the cases. Other reasons included difficulties related to the siblings (9.4%), the wish to try traditional methods (7.8%), family opposition (1.6%) and distance from the hospital (4.1%). It is recommended that greater attention be given to preventive health care, and placing the cost of hospital care within the reach of the poor. Improved communication is also recommended as a way of helping parents seek alternatives to DAMA.

Discharge against Medical Advice

2002 ◽  
Vol 32 (3) ◽  
pp. 149-151 ◽  
Author(s):  
E C Ohanaka
Keyword(s):  
Clinical Condition ◽  
Medical Advice ◽  
Surgical Patients ◽  
Long Bones ◽  
Age Group ◽  
Common Condition ◽  
Against Medical Advice ◽  
Discharge Against Medical Advice ◽  
The University ◽  
Age Range

An audit of surgical patients who requested discharge against medical advice over a 5 year period (July 1996–July 2001) at the University of Benin Teaching Hospital showed that 78 patients (66 males and 12 females) were involved. The age range was 3 days to 85 years (mean 37.86 years). The 21–40 age group was the most involved. Trauma in general accounted for the most common clinical condition that caused a patient to discharge against medical advice (64 or 82%), while fracture involving the long bones was the most common condition (37 or 47.4%). The plausible reasons for this practice have been outlined including measures that may help to reduce discharge against medical advice in a developing country.

scholarly journals Substance Use Disorder: A Model for Integration in Undergraduate Medical Education

2021 ◽  
Vol 8 ◽  
pp. 238212052110258
Author(s):  
Haritha Pavuluri ◽  
Nicolas Poupore ◽  
William Michael Schmidt ◽  
Samantha Gabrielle Boniface ◽  
Meenu Jindal ◽  
...  
Keyword(s):  
Medical Education ◽  
Substance Use ◽  
South Carolina ◽  
Substance Use Disorder ◽  
The United States ◽  
University Of South Carolina ◽  
Community Recovery ◽  
School Of Medicine ◽  
Treatment Gaps ◽  
The University

Substance Use Disorder (SUD) is a debilitating chronic illness with significant morbidity and mortality across the United States. The AAMC and LCME have supported the efforts for more effective medical education of SUD to address the existing stigma, knowledge, and treatment gaps. The Coronavirus 2019 (COVID-19) pandemic and associated social, economic, and behavioral impacts have added to this urgency. The University of South Carolina School of Medicine Greenville (USCSOMG), in collaboration with community organizations, has successfully implemented an integrated SUD education curriculum for medical students. Students learn about SUD in basic sciences, receive case-based education during clinical exercises, and are provided the opportunity to become a recovery coach and participate in the patient and family recovery meetings through this curriculum during preclinical years. During the clinical years, SUD education is enhanced with exposure to Medication for Addition Treatment (MAT). Students also partake in the care coordination of patients with SUD between the hospital and community recovery organizations. All students receive MAT waiver training in their final year and are prepared to prescribe treatment for SUD upon graduation. The experiences in this integrated curriculum integration can perhaps assist other organizations to implement similar components and empower the next generation of physicians to be competent and effective in treating patients with SUD.

scholarly journals 309. The Impact of Addiction Medicine Consultation on Discharges Against Medical Advice in Patients with Opioid Use Disorder and Staphylococcus Aureus Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S152-S152
Author(s):  
Stephanie Spivack ◽  
Daniel Mueller ◽  
Peter Axelrod ◽  
Joseph D’Orazio
Keyword(s):  
Staphylococcus Aureus ◽  
Patient Population ◽  
Medical Advice ◽  
Index Admission ◽  
Opioid Use ◽  
Urban Hospital ◽  
Addiction Medicine ◽  
Against Medical Advice ◽  
Number Of Patients ◽  
The Impact

Abstract Background People who inject drugs (PWID) are at risk for infectious complications of their injection practices, including Staphylococcus aureus (SA) bacteremia. Prolonged hospitalization is sometimes required; however, rates of discharges against medical advice (AMA) are elevated in this patient population. Inadequate control of pain and opioid withdrawal are commonly cited. Our aim was to assess the effectiveness of addiction medicine consultation for preventing AMA discharges. Methods We performed a retrospective chart review of adult PWID admitted to an urban hospital with SA bacteremia between August 2016 and May 2018. Demographics, HIV and HCV status, and presence or absence of addiction medicine consultation were recorded. We assessed whether discharges were planned or AMA; the number of hospitalizations at 30 days, 90 days, and 1 year from index admission; and death within one year. EpiInfo6 was used for data analysis. Results A total of 360 patients with SA bacteremia were reviewed. Of these, 101 reported intravenous opioid use at admission. Average age was 37 years, and 64% were male. HIV and HCV were present in 13% and 82% of patients, respectively. Addiction medicine was consulted on 29 patients. Of these, 4/29 (13.8%) left AMA, compared to 27/72 (37.5%) of patients without an addiction consult (RR = 0.3678 [95% CI = 0.1412 - 0.9583], p = 0.02). Patients receiving addiction medicine consultation averaged 0.17 readmissions within 30 days of their index admission, compared to 0.39 readmissions in the group without addiction medicine consult (p = 0.27). Readmissions at 90 days and 1 year were also lower but not statistically significant. At 1 year, 6 deaths were observed; 2 who had addiction medicine consultation and 4 who did not. Conclusion Consultation with an addiction medicine specialist significantly reduced the number of patients discharged AMA in a high-risk cohort of PWID presenting with SA bacteremia. Numerically fewer readmissions occurred after consultation, though this difference was not statistically significant. Mortality in both groups was low. There were high rates of HIV and HCV in this patient population, suggesting a particularly vulnerable patient population, which warrants further study. Disclosures All Authors: No reported disclosures

scholarly journals Why Do Patients Leave against Medical Advice? Reasons, Consequences, Prevention, and Interventions

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 111
Author(s):  
Asseel Albayati ◽  
Steven Douedi ◽  
Abbas Alshami ◽  
Mohammad A. Hossain ◽  
Shuvendu Sen ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Medical Advice ◽  
Preventive Strategies ◽  
Against Medical Advice ◽  
Cause Analysis ◽  
Persistent Problem ◽  
Root Cause ◽  
Discharge Against Medical Advice ◽  
Leaving Against Medical Advice

Background: A patient decides to leave the hospital against medical advice. Is this an erratic eccentric behavior of the patient, or a gap in the quality of care provided by the hospital? With a significant and increasing prevalence of up to 1–2% of all hospital admissions, leaving against medical advice affects both the patient and the healthcare provider. We hereby explore this persistent problem in the healthcare system. We searched Medline and PubMed within the last 10 years, using the keywords “discharge against medical advice,” “DAMA,” “leave against medical advice,” and “AMA.” We retrospectively reviewed 49 articles in our project. Ishikawa fishbone root cause analysis (RCA) was employed to explore reasons for leaving against medical advice (AMA). This report presents the results of the RCA and highlights the consequences of discharge against medical advice (DAMA). In addition, the article explores preventive strategies, as well as interventions to ameliorate leaving AMA.

scholarly journals A nationally representative study on discharge against medical advice among those living with epilepsy

Seizure ◽  
2021 ◽  
Vol 84 ◽  
pp. 84-90
Author(s):  
Parul Agarwal ◽  
Huaqing Xi ◽  
Nathalie Jette ◽  
Jung-yi Lin ◽  
Churl-Su Kwon ◽  
...  
Keyword(s):  
Medical Advice ◽  
Against Medical Advice ◽  
Representative Study ◽  
Discharge Against Medical Advice ◽  
Nationally Representative

scholarly journals Informal psychiatric patients requesting discharge

1994 ◽  
Vol 18 (4) ◽  
pp. 209-211
Author(s):  
Robin McGilp ◽  
Brian Kidd ◽  
Cameron Stark ◽  
Tom Henderson
Keyword(s):  
Substance Abuse ◽  
Psychiatric Patients ◽  
Medical Advice ◽  
Psychotic Illness ◽  
Against Medical Advice ◽  
The Past ◽  
History Of ◽  
Self Harm ◽  
Discharge Against Medical Advice ◽  
Retrospective Investigation

A retrospective investigation of case-notes compared 54 incidents of informal psychiatric in-patients being detained in hospital on an emergency basis with 66 incidents of discharge against medical advice (AMA). The characteristics of the two groups were compared. Detained patients were more likely to have been detained previously, to be suffering from a psychotic illness, and to have threats of violence or self-harm mentioned in their case-notes. AMA patients were more likely to have a history of substance abuse but were no more likely than the detained group to have been discharged AMA in the past. The results suggest that psychiatrists in this hospital are using current legislation on detention appropriately.

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