Clinical question: Can a multidisciplinary, hospitalist-led program improve care for hospitalized patients with opioid use disorder (OUD)?
Background: Despite rising opioid-related hospitalizations and deaths, hospitalists often fail to address substance use disorders or prescribe medications for opioid use disorder (MOUD). Lack of prescriber knowledge, provider beliefs about patients with substance use disorders, and additional training and waiver requirements have traditionally reduced provider engagement in prescribing MOUDs.
Study design: A single-arm, pre-post, interventional study
Setting: A single U.S. academic medical center
Synopsis: The multidisciplinary Project Caring for patients with Opioid Misuse through Evidence-based Treatment (COMET) was a comprehensive, two-year intervention launched in 2019 to address substance-use disorders in hospitalized patients with goals of increasing MOUD prescriptions and improving post-discharge care coordination. Project COMET was funded by the health system and engaged stakeholders including pharmacy, nursing, infectious disease, psychiatry, pain management, and community-based providers. Templates for documenting opioid use and withdrawal and an order set for prescribing buprenorphine and initiating methadone were implemented in the electronic health record. Fourteen hospitalists who completed X-waiver training and orientation were partnered with a social worker to guide patients during hospitalization and coordinate post-discharge care. 512 patients (median age 40, 57% male, 60% white, 31% Black, <1% Hispanic) were evaluated during the two-year study period. 88% of evaluated patients had an opioid-use–disorder diagnosis within 12 months prior to admission. High rates of comorbid pain, psychiatric illness, and infection were present in this cohort. 71% of patients received medications to manage opioid use disorder during admission. Comparing pre- and post-COMET prescribing habits showed that MOUD prescriptions rose from 36% to 57%, and prescriptions for buprenorphine and naloxone at discharge rose from 2% each to 20% and 26%, respectively. 64% of patients prescribed buprenorphine during admission were continued on this medication after discharge, and 83% of patients treated with methadone during hospitalization were referred to a methadone clinic.
Bottom line: This study successfully demonstrated the implementation of a multidisciplinary approach to changing hospitalist prescribing patterns and improving post-discharge care coordination when caring for patients with OUD.
Citation: Clifton D, et al. Implementation of a comprehensive hospitalist-led initiative to improve care for patients with opioid use disorder. J Hosp Med. 2022;17(6):427-36.
Dr. Frederick is an associate clinical professor of medicine in the division of hospital medicine and a physician advisor at the University of California, San Diego.