Bundled intervention improves care for patients with infections, opioid use disorder
Patients with opioid use disorder who were hospitalized for serious infections experienced higher odds of clinical cure and retention in addiction care when they were treated with a bundled intervention, according to a study.
The bundled intervention included infectious disease consultation, addiction consultation, case management and medication for opioid use disorder (OUD). Patients in the study were also experiencing homelessness.
“From prior experience at our institution, we know patient engagement in medical treatment plans can be difficult in vulnerable populations, including those with OUD and those experiencing homelessness,” Alison M. Beieler PA-C, MPAS, a physician assistant at the infectious disease and travel medicine clinic at Harborview Medical Center in Seattle, told Healio.
“We have experienced a high loss-to-follow-up rate when treating patients for their severe infections, as well as frequent discharges against medical advice, and high rates of readmissions,” she said. “To try to improve successful treatment completion and clinical cure of infection, we engaged our addiction medicine colleagues to develop safe and ongoing care plans for patients after discharge.”
Beieler and colleagues performed a retrospective cohort study of 53 adult patients with OUD who were experiencing homelessness and who were sent to medical respite after hospital discharge for extended antibiotics. Among the 53 patients included in the study, there were 63 episodes of care.
Of these episodes, 92% involved an ID consult, 51% involved an addiction consult, 86% involved medications for OUD (MOUD) during admission and upon discharge, and 59% involved case management.
The study demonstrated that patients receiving all four interventions had higher odds of clinical cure (OR = 3.15; adjusted OR = 3.03) and successful retention in addiction care at 30 days (OR = 5.46; aOR = 6.36), Beieler and colleagues reported.
“Multidisciplinary management of vulnerable populations with severe infections is necessary to provide safe patient care,” Beieler said. “Involvement of both ID and addiction teams during inpatient admission to create patient-centered treatment plans, including prescription of antibiotics and MOUD, as well as referrals to case management, is key to supporting our patients during admission and post-discharge. Patients with OUD experiencing homelessness can be successfully supported through serious infections, but it requires appropriate resources.”