Addiction Consult Service and Inpatient Outcomes Among Patients with OUD.

Abstract

Background: Despite rising hospitalizations for opioid use disorder (OUD), rates of inpatient medications for OUD (MOUD) initiation are low. Addiction consult services (ACSs) facilitate inpatient MOUD initiation and linkage to post-discharge MOUD, but few studies have rigorously examined ACS OUD outcomes.

Objective: To determine the association between ACS consultation and inpatient MOUD initiation, discharge MOUD provision, and post-discharge MOUD linkage.

Design: Retrospective study comparing admissions that received an ACS consult and propensity score-matched historical control admissions.

Subjects: One hundred admissions with an OUD-related diagnosis, of patients not currently receiving MOUD who received an ACS consult, and 100 matched historical controls.

Intervention: Consultation from an interprofessional ACS offering expertise in MOUD initiation and linkage to post-discharge MOUD.

Main measures: The primary outcome was inpatient MOUD initiation (methadone or buprenorphine). Secondary outcomes were inpatient buprenorphine initiation, inpatient methadone initiation, discharge prescription for buprenorphine, linkage to post-discharge MOUD (buprenorphine prescription within 60 days and new methadone administration at a methadone program within 30 days after discharge), patient-directed discharge, 30-day readmission, and 30-day emergency department (ED) visit.

Key results: Among 200 admissions with an OUD-related diagnosis, those that received an ACS consultation were significantly more likely to have inpatient MOUD initiation (OR 2.57 [CI 1.44-4.61]), inpatient buprenorphine initiation (OR 5.50 [2.14-14.15]), a discharge prescription for buprenorphine (OR 17.22 [3.94-75.13]), a buprenorphine prescription within 60 days (22.0% vs. 0.0%, p < 0.001; of those with inpatient buprenorphine initiation: 84.6% vs. 0.0%), and new methadone administration at a methadone program within 30 days after discharge (7.0% vs. 0.0%, p = 0.007; of those with inpatient methadone initiation: 19.4% vs. 0.0%). There were no significant differences in other secondary outcomes.

Conclusions: There was a strong association between ACS consultation and inpatient MOUD initiation and linkage to post-discharge MOUD. ACSs promote the delivery of evidence-based care for patients with OUD.