Expert Panel Consensus on the Effectiveness and Implementation of Models to Support Posthospitalization Care Transitions for People With Substance Use Disorders.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Journal of Addiction Medicine Pub Date : 2024-09-02 DOI:10.1097/ADM.0000000000001369
Michael A Incze, Sophia Huebler, Kathryn Szczotka, Sean Grant, Stefan G Kertesz, Adam J Gordon
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Abstract

Objectives: Hospitals are increasingly offering treatment for substance use disorders (SUDs) during medical admissions. However, there is a lack of consensus on the best approach to facilitating a successful transition to long-term medical and SUD care after hospitalization. We aimed to establish a hierarchy of existing SUD care transition models in 2 categories-effectiveness and implementation-using an expert consensus approach.

Methods: We conducted a modified online Delphi study that convened 25 interdisciplinary clinicians with experience facilitating posthospitalization care transitions for patients with SUD. Panelists rated 10 prespecified posthospitalization care transition models according to 6 criteria concerning each model's anticipated effectiveness (eg, linkage to care, treatment retention) and implementation (eg, feasibility, acceptability). Ratings were made on a 9-point bidirectional scale. Group consensus was determined using the interpercentile range adjusted for symmetry.

Results: After 3 rounds of the Delphi process (96% retention across all 3 rounds), consensus was reached on all 60 rating criteria. Interdisciplinary addiction consult teams (ACTs) and in-reach from partnering outpatient clinics were rated highest for effectiveness. Interdisciplinary ACTs and bridge clinics were rated highest for implementation. Screening, brief intervention, and referral to treatment; protocol implementation; and postdischarge outreach received the lowest ratings overall. Feasibility of implementation was perceived as the largest challenge for all highly rated models.

Conclusions: An expert consensus approach including diverse clinician stakeholders found that interdisciplinary ACT, in-reach from partnering outpatient clinics, and bridge clinics had the greatest potential to enhance posthospitalization care transitions for patients with SUD when considering both perceived effectiveness and implementation.

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专家小组就支持药物使用失调患者住院后护理过渡模式的有效性和实施达成共识。
目的:越来越多的医院在病人住院期间提供药物使用障碍 (SUD) 治疗。然而,对于促进住院后成功过渡到长期医疗和药物滥用治疗的最佳方法,目前还缺乏共识。我们的目标是采用专家共识法,将现有的 SUD 护理过渡模式分为有效性和实施性两个类别,并建立一个层次结构:我们开展了一项经过修改的在线德尔菲研究,召集了 25 名具有促进 SUD 患者住院后护理过渡经验的跨学科临床医生。专家组成员根据每种模式的预期效果(如与护理的联系、治疗的保持)和实施情况(如可行性、可接受性)等 6 项标准,对 10 种预先指定的入院后护理过渡模式进行评分。评分采用 9 分双向量表。根据对称性调整后的百分位间范围确定小组共识:经过三轮德尔菲程序(三轮程序的保留率均为 96%),就所有 60 项评分标准达成了共识。跨学科戒毒咨询小组(ACTs)和合作门诊诊所的内联有效性被评为最高。跨学科戒毒咨询小组和桥接诊所的实施率最高。筛查、简单干预和转诊治疗、协议实施和出院后外联的总体评分最低。在所有评分较高的模式中,实施的可行性被认为是最大的挑战:通过专家共识法(包括不同的临床医生利益相关者)发现,跨学科 ACT、合作门诊诊所的内联和桥梁诊所在加强 SUD 患者出院后的护理过渡方面具有最大的潜力,这要同时考虑到感知效果和实施情况。
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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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