Effect of Inpatient Medication-Assisted Therapy on Against-Medical-Advice Discharge and Readmission Rates



      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.


      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.


      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%).


      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.


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        • Larochelle MR
        • Bernson D
        • Land T
        • et al.
        Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study.
        Ann Intern Med. 2018; 169: 137-145
        • Hickman M
        • Steer C
        • Tilling K
        • et al.
        The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom.
        Addiction. 2018; 113: 1461-1476
      1. National Institute on Drug Abuse, National Institutes of Health. Opioid summaries by state. May 2019. Available at: Accessed January 20, 2020.

        • Liebschutz JM
        • Crooks D
        • Herman D
        • et al.
        Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial.
        JAMA Intern Med. 2014; 174: 1369-1376
        • Theisen-Toupal J
        • Ronan MV
        • Moore A
        • Rosenthal ES
        Inpatient management of opioid use disorder: a review for hospitalists.
        J Hosp Med. 2017; 12: 369-374
        • Chan ACH
        • Palepu A
        • Guh DP
        • et al.
        HIV-positive injection drug users who leave the hospital against medical advice: the mitigating role of methadone and social support.
        J Acquir Immune Defic Syndr. 2004; 35: 56-59
        • Southern WN
        • Shadi N
        • Arnsten JH
        Increased risk of mortality and readmission among patients discharged against medical advice.
        Am J Med. 2012; 125: 594-602

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