Vani Ray M.D. , Mindy R. Waite Ph.D. , Frank C. Spexarth R.Ph. , Sandra Korman M.S. , Susan Berget M.S.N., R.N. , Soumya Kodali M.D. , David Kress M.D. , Neil Guenther M.D. , Vishnubhakta S. Murthy M.D.
{"title":"静脉用药相关性感染性心内膜炎住院患者的成瘾管理","authors":"Vani Ray M.D. , Mindy R. Waite Ph.D. , Frank C. Spexarth R.Ph. , Sandra Korman M.S. , Susan Berget M.S.N., R.N. , Soumya Kodali M.D. , David Kress M.D. , Neil Guenther M.D. , Vishnubhakta S. Murthy M.D.","doi":"10.1016/j.psym.2020.06.019","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Infections related to intravenous drug use and opioid use disorders (OUDs) are increasing nationwide. Endocarditis is a recognized complication of intravenous drug use, and inpatient treatment typically focuses on infection management without attention to underlying addiction.</p></div><div><h3>Objective</h3><p>A comprehensive intervention for inpatients with infective endocarditis and intravenous drug use was implemented by a multidisciplinary team at a large midwestern hospital. The team included behavioral health/addiction medicine, infectious disease, pain medicine, cardiothoracic surgery, pharmacy, and nursing to address the OUD while managing the infection. The intervention was assessed by measuring the initiation of medication-assisted treatment and endocarditis-related readmissions.</p></div><div><h3>Methods</h3><p>Patients were identified from the medical records using discharge diagnosis codes for OUDs and infective endocarditis. In addition to medical management of infective endocarditis, the multidisciplinary intervention included early involvement of addiction medicine and the pain management at the time of admission. Patient interventions included education, motivational interviewing, behavioral health engagement, collaborative pain management, individual/family therapy, medication evaluation, and initiation of medication-assisted treatment. Caregivers were also educated on OUDs and ways to support patients undergoing interventions.</p></div><div><h3>Results</h3><p>Both the historical control group (<em>N</em> = 37) and the intervention group (<em>N</em> = 33) were comparable in age, gender, race, marital status, psychiatric history, and smoking but differed by employment status, religious affiliation, and use of psychiatric medications. At discharge, 18.9% of the control group and 54.5% in the intervention group were initiated on medication-assisted treatment for OUDs. No differences in readmission rates were found.</p></div><div><h3>Conclusion</h3><p>Multidisciplinary teams for treating inpatients with intravenous drug use and infective endocarditis are feasible and can increase the uptake of OUD-specific treatment.</p></div>","PeriodicalId":20746,"journal":{"name":"Psychosomatics","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.psym.2020.06.019","citationCount":"9","resultStr":"{\"title\":\"Addiction Management in Hospitalized Patients With Intravenous Drug Use–Associated Infective Endocarditis\",\"authors\":\"Vani Ray M.D. , Mindy R. Waite Ph.D. , Frank C. Spexarth R.Ph. , Sandra Korman M.S. , Susan Berget M.S.N., R.N. , Soumya Kodali M.D. , David Kress M.D. , Neil Guenther M.D. , Vishnubhakta S. Murthy M.D.\",\"doi\":\"10.1016/j.psym.2020.06.019\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Infections related to intravenous drug use and opioid use disorders (OUDs) are increasing nationwide. Endocarditis is a recognized complication of intravenous drug use, and inpatient treatment typically focuses on infection management without attention to underlying addiction.</p></div><div><h3>Objective</h3><p>A comprehensive intervention for inpatients with infective endocarditis and intravenous drug use was implemented by a multidisciplinary team at a large midwestern hospital. The team included behavioral health/addiction medicine, infectious disease, pain medicine, cardiothoracic surgery, pharmacy, and nursing to address the OUD while managing the infection. The intervention was assessed by measuring the initiation of medication-assisted treatment and endocarditis-related readmissions.</p></div><div><h3>Methods</h3><p>Patients were identified from the medical records using discharge diagnosis codes for OUDs and infective endocarditis. In addition to medical management of infective endocarditis, the multidisciplinary intervention included early involvement of addiction medicine and the pain management at the time of admission. Patient interventions included education, motivational interviewing, behavioral health engagement, collaborative pain management, individual/family therapy, medication evaluation, and initiation of medication-assisted treatment. Caregivers were also educated on OUDs and ways to support patients undergoing interventions.</p></div><div><h3>Results</h3><p>Both the historical control group (<em>N</em> = 37) and the intervention group (<em>N</em> = 33) were comparable in age, gender, race, marital status, psychiatric history, and smoking but differed by employment status, religious affiliation, and use of psychiatric medications. At discharge, 18.9% of the control group and 54.5% in the intervention group were initiated on medication-assisted treatment for OUDs. No differences in readmission rates were found.</p></div><div><h3>Conclusion</h3><p>Multidisciplinary teams for treating inpatients with intravenous drug use and infective endocarditis are feasible and can increase the uptake of OUD-specific treatment.</p></div>\",\"PeriodicalId\":20746,\"journal\":{\"name\":\"Psychosomatics\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2020-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.psym.2020.06.019\",\"citationCount\":\"9\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Psychosomatics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S003331822030205X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Psychosomatics","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S003331822030205X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
Addiction Management in Hospitalized Patients With Intravenous Drug Use–Associated Infective Endocarditis
Background
Infections related to intravenous drug use and opioid use disorders (OUDs) are increasing nationwide. Endocarditis is a recognized complication of intravenous drug use, and inpatient treatment typically focuses on infection management without attention to underlying addiction.
Objective
A comprehensive intervention for inpatients with infective endocarditis and intravenous drug use was implemented by a multidisciplinary team at a large midwestern hospital. The team included behavioral health/addiction medicine, infectious disease, pain medicine, cardiothoracic surgery, pharmacy, and nursing to address the OUD while managing the infection. The intervention was assessed by measuring the initiation of medication-assisted treatment and endocarditis-related readmissions.
Methods
Patients were identified from the medical records using discharge diagnosis codes for OUDs and infective endocarditis. In addition to medical management of infective endocarditis, the multidisciplinary intervention included early involvement of addiction medicine and the pain management at the time of admission. Patient interventions included education, motivational interviewing, behavioral health engagement, collaborative pain management, individual/family therapy, medication evaluation, and initiation of medication-assisted treatment. Caregivers were also educated on OUDs and ways to support patients undergoing interventions.
Results
Both the historical control group (N = 37) and the intervention group (N = 33) were comparable in age, gender, race, marital status, psychiatric history, and smoking but differed by employment status, religious affiliation, and use of psychiatric medications. At discharge, 18.9% of the control group and 54.5% in the intervention group were initiated on medication-assisted treatment for OUDs. No differences in readmission rates were found.
Conclusion
Multidisciplinary teams for treating inpatients with intravenous drug use and infective endocarditis are feasible and can increase the uptake of OUD-specific treatment.
期刊介绍：
The mission of Psychosomatics is to be the leading psychiatry journal focused on the care of patients with comorbid medical and psychiatric illnesses. The scope of Psychosomatics includes original research, review articles and clinical reports that address psychiatric aspects of medical illnesses and their management. Areas of particular interest include: the effect of co-morbid psychiatric conditions on the management of medical illness; the psychiatric management of patients with comorbid medical illness; educational content for physicians and others specializing in consultation-liaison (C-L) psychiatry; and, the provision of psychiatric services to medical populations, including integrated care.
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