Abstract
Background
Patients who present to the hospital for infectious complications of intravenous opioid
use are at high risk for against-medical-advice discharge and readmissions. The role
of medication-assisted treatment for inpatients is not clear. We aimed to assess outcomes
prior to and after rollout of an inpatient buprenorphine-based opioid use disorder
protocol, as well as to assess outcomes in general for medication-assisted therapy.
Methods
This was a retrospective observational cohort study at our community hospital in New
Hampshire. The medical record was searched for inpatients with a complication of intravenous
opioid use. We searched for admissions 11 months prior to and after the November 2018
buprenorphine protocol rollout.
Results
Rates of medication-assisted therapy usage and buprenorphine linkage increased significantly
after protocol rollout. Rates of against-medical-advice discharge did not decrease
after protocol rollout, nor did readmissions. However, when evaluating the entire
group of patients regardless of date of presentation or protocol use, against-medical-advice
discharge rates were substantially lower for patients receiving medication-assisted
therapy compared with those receiving supportive care only (30.0% vs 59.6%). Readmissions
rates were lower for patients who were discharged with any form of ongoing medication-assisted
therapy compared with those who were not (30-day all-cause readmissions 18.8% vs 35.1%;
30-day opioid-related readmissions 10.1% vs 29.9%; 90-day all-cause readmissions 27.3%
vs 42.7%; 90-day opioid-related readmissions 15.1% vs 33.3%).
Conclusions
There is a strong association between medication-assisted therapy and reduced against-medical-advice
discharge rates. Additionally, maintenance medication-assisted therapy at time of
discharge is strongly associated with reduced readmissions rates.
Keywords
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References
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Article info
Publication history
Published online: May 19, 2020
Footnotes
Funding: None.
Conflict of Interest: None of the authors has any conflicts of interest to disclose.
Authorship: All authors had access to the data and a role in writing the manuscript.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Corrigendum to ‘Effect of Inpatient Medication-Assisted Therapy on Against-Medical-Advice Discharge and Readmission Rates’ The American Journal of Medicine (2020) 1343-1349The American Journal of MedicineVol. 135Issue 6
