Improving Linkage for Patients With Injection-Drug-Use-Related Endocarditis and Osteomyelitis to Medications for Opioid Use Disorder Through a Telephone Intervention.

Cheyenne Harris, Payel Jhoom Roy, Ann M Mitchell, Maighdlin W Anderson
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Abstract

Abstract: The opioid overdose crisis has continued to worsen, with a concomitant increase in serious injection-related infections, such as endocarditis and osteomyelitis. Usual care of these infections involves long-term intravenous antibiotics, typically administered via a peripherally inserted central venous catheter (PICC) at home. In patients with a history of opioid use disorder who inject drugs, a PICC has long been viewed as a high-risk intervention that may contribute to illicit substance use due to ease of venous access; thus, providers are often uncomfortable discharging these patients home to complete their antibiotics. As a result, many patients remain hospitalized or are discharge to skilled nursing facilities (SNFs) in order to complete their antibiotics. Challenges to this model include difficulty finding SNFs that will accept these patients, inability for these SNFs to continue their medication for opioid use disorder (MOUD), and inability to coordinate care with outpatient MOUD providers at SNF discharge. This quality improvement project sought to increase linkage to outpatient MOUD on SNF discharge via a telephone intervention. A total of 11 patients qualified for this intervention. Although patients were still in an SNF, 4/7 (57.1%) of patients were successfully contacted. Once they were discharged from the SNF, only 3/10 (30.0%) of patients were successfully reached. Of those 30.0% who were contacted, all of them had attended their outpatient MOUD appointment. We suggest that future linkage interventions in this population may benefit from utilizing existing care team members to facilitate linkage, to maximize the rapport built during an inpatient stay.

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通过电话干预改善注射吸毒相关心内膜炎和骨髓炎患者与阿片类药物使用障碍药物治疗的联系。
摘要:阿片类药物过量危机持续恶化,与注射相关的严重感染也随之增加,如心内膜炎和骨髓炎。这些感染的常规治疗包括长期静脉注射抗生素,通常是在家中通过外周置入中心静脉导管(PICC)给药。对于有阿片类药物使用障碍史的注射毒品患者来说,PICC 长期以来一直被视为一种高风险干预措施,由于静脉通路的便利性,它可能会助长非法药物的使用;因此,医疗服务提供者通常不愿意让这些患者出院回家完成抗生素治疗。因此,许多患者继续住院或出院到专业护理机构 (SNF) 以完成抗生素治疗。这种模式面临的挑战包括:很难找到愿意接收这些患者的 SNF,这些 SNF 无法继续为患者提供阿片类药物使用障碍 (MOUD) 的药物治疗,以及在 SNF 出院时无法与门诊 MOUD 提供者协调护理。该质量改进项目旨在通过电话干预措施,在 SNF 出院时增加与门诊 MOUD 的联系。共有 11 名患者符合干预条件。尽管患者仍住在 SNF,但有 4/7 (57.1%) 的患者成功取得了联系。出院后,只有 3/10(30.0%)的患者成功联系到了他们。在这 30.0% 被联系上的患者中,他们都参加了 MOUD 的门诊预约。我们建议,未来在这一人群中采取的联系干预措施可能会受益于利用现有的护理团队成员来促进联系,从而最大限度地利用住院期间建立的融洽关系。
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