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- Title
Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement: A Randomized Clinical Trial.
- Authors
McNeely, Jennifer; Wang, Scarlett S.; Rostam Abadi, Yasna; Barron, Charles; Billings, John; Tarpey, Thaddeus; Fernando, Jasmine; Appleton, Noa; Fawole, Adetayo; Mazumdar, Medha; Weinstein, Zoe M.; Kalyanaraman Marcello, Roopa; Dolle, Johanna; Cooke, Caroline; Siddiqui, Samira; King, Carla
- Abstract
Key Points: Question: Do interprofessional hospital addiction consultation services increase initiation and engagement in medication for opioid use disorder (MOUD) treatment after discharge? Findings: In this stepped-wedge cluster randomized clinical trial of 2315 adults with opioid use disorder with hospitalizations in 6 New York, New York, public hospitals, rates of postdischarge MOUD were compared for patients admitted to hospitals providing an addiction consultation intervention vs usual care. Patients hospitalized during the intervention period had significantly higher odds of MOUD initiation (7.96 times higher) and 30-day MOUD treatment engagement (6.90 times higher). Meaning: The results of this trial found that interprofessional hospital addiction consultation services increased postdischarge MOUD use among patients with opioid use disorder who were not previously receiving MOUD treatment. Importance: Medications for opioid use disorder (MOUD) are highly effective, but only 22% of individuals in the US with opioid use disorder receive them. Hospitalization potentially provides an opportunity to initiate MOUD and link patients to ongoing treatment. Objective: To study the effectiveness of interprofessional hospital addiction consultation services in increasing MOUD treatment initiation and engagement. Design, Setting, and Participants: This pragmatic stepped-wedge cluster randomized implementation and effectiveness (hybrid type 1) trial was conducted in 6 public hospitals in New York, New York, and included 2315 adults with hospitalizations identified in Medicaid claims data between October 2017 and January 2021. Data analysis was conducted in December 2023. Hospitals were randomized to an intervention start date, and outcomes were compared during treatment as usual (TAU) and intervention conditions. Bayesian analysis accounted for the clustering of patients within hospitals and open cohort nature of the study. The addiction consultation service intervention was compared with TAU using posterior probabilities of model parameters from hierarchical logistic regression models that were adjusted for age, sex, and study period. Eligible participants had an admission or discharge diagnosis of opioid use disorder or opioid poisoning/adverse effects, were hospitalized at least 1 night in a medical/surgical inpatient unit, and were not receiving MOUD before hospitalization. Interventions: Hospitals implemented an addiction consultation service that provided inpatient specialty care for substance use disorders. Consultation teams comprised a medical clinician, social worker or addiction counselor, and peer counselor. Main Outcomes and Measures: The dual primary outcomes were (1) MOUD treatment initiation during the first 14 days after hospital discharge and (2) MOUD engagement for the 30 days following initiation. Results: Of 2315 adults, 628 (27.1%) were female, and the mean (SD) age was 47.0 (12.4) years. Initiation of MOUD was 11.0% in the Consult for Addiction Treatment and Care in Hospitals (CATCH) program vs 6.7% in TAU, engagement was 7.4% vs 5.3%, respectively, and continuation for 6 months was 3.2% vs 2.4%. Patients hospitalized during CATCH had 7.96 times higher odds of initiating MOUD (log-odds ratio, 2.07; 95% credible interval, 0.51-4.00) and 6.90 times higher odds of MOUD engagement (log-odds ratio, 1.93; 95% credible interval, 0.09-4.18). Conclusions: This randomized clinical trial found that interprofessional addiction consultation services significantly increased postdischarge MOUD initiation and engagement among patients with opioid use disorder. However, the observed rates of MOUD initiation and engagement were still low; further efforts are still needed to improve hospital-based and community-based services for MOUD treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT03611335 This randomized clinical trial examines the effectiveness of interprofessional hospital addiction consultation services in increasing medication for opioid use disorder treatment initiation and engagement.
- Publication
JAMA Internal Medicine, 2024, Vol 184, Issue 9, p1106
- ISSN
2168-6106
- Publication type
Article
- DOI
10.1001/jamainternmed.2024.3422