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Interprofessional Hospital Addiction Consults Are Associated with Decreased Patient-Directed Discharges.

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Τίτλος: Interprofessional Hospital Addiction Consults Are Associated with Decreased Patient-Directed Discharges.
Συγγραφείς: E Buresh M; Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. mburesh2@Jhmi.edu., Kelly SM; Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA., Becker S; Yale School of Public Health, New Haven, CT, USA., Abdel Galil R; Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Falade-Nwulia O; Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Πηγή: Journal of general internal medicine [J Gen Intern Med] 2026 Jul; Vol. 41 (9), pp. 2428-2436. Date of Electronic Publication: 2025 Dec 10.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Springer Country of Publication: United States NLM ID: 8605834 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1497 (Electronic) Linking ISSN: 08848734 NLM ISO Abbreviation: J Gen Intern Med Subsets: MEDLINE
Imprint Name(s): Publication: Secaucus, NJ : Springer
Original Publication: [Philadelphia, PA] : Hanley & Belfus, [c1986-
Ιατρικοί όροι (MeSH): Substance-Related Disorders*/therapy , Substance-Related Disorders*/epidemiology , Patient Discharge*/statistics & numerical data , Patient Discharge*/trends , Referral and Consultation* , Interprofessional Relations*, Humans ; Retrospective Studies ; Female ; Male ; Middle Aged ; Adult ; Baltimore ; Cohort Studies
Περίληψη: Background: Hospitalizations related to substance use are increasing; however, up to 30% result in patient-directed discharge (PDD), which is associated with poor patient outcomes, including hospital readmission and death. Addiction consult services (ACS) are a growing intervention developed to improve the care of hospitalized patients with substance use disorder (SUD), but little is known about their impact on PDD.
Objective: To determine the association of ACS receipt on the odds of PDD among patients with SUD.
Design: Retrospective cohort study at an urban academic hospital in Baltimore, MD.
Participants: Patients with ICD-10 code for SUD diagnosis in the year prior to any hospitalization between 2018 and 2022.
Intervention: Receipt of ACS, stratified by team member conducting consult (addiction medicine provider (AMP), behavioral health social worker (BHSW), peer).
Main Measures: Primary outcome was odds of PDD among patients seen by ACS compared to those not seen by ACS. In secondary analyses, the odds of PDD stratified by SUD type and team member(s) conducting ACS consult (BHSW only, peer only, AMP only, AMP and HBS, AMP and peer vs. no ACS consult) were separately assessed in multivariable logistic regression models.
Key Results: Between 2018 and 2022, 9512 unique patients contributed to 16,283 hospitalizations. There were 3419 completed consults. Receipt of ACS was associated with significantly decreased odds of PDD [aOR 0.81, 95% CI (0.71, 0.93)]. Compared to patients not seen by ACS, there was a significantly lower odds of PDD for patients seen by BHSW only [aOR 0.61, 95% CI (0.44, 0.84)], peer only [aOR 0.49, 95% CI (0.38, 0.63)], and both AMP and peer [aOR 0.71, 95% CI (0.53, 0.94)].
Conclusions: Receipt of ACS consult was associated with decreased odds of PDD among hospitalized patients with SUD. Future work should explore how to optimize the use of different team members and the best use of ACS.
(© 2025. The Author(s), under exclusive licence to Society of General Internal Medicine.)
Competing Interests: Declarations. Human Ethics and Consent to Participate: This study was approved by the Johns Hopkins School of Medicine Institutional Review Board. As the study was a retrospective review of electronic medical records, a waiver of consent was obtained from the IRB. Conflict of Interest: Authors have no conflicts of interest.
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Contributed Indexing: Keywords: addiction consult service; patient-directed discharge; peer recovery coach; substance use disorder
Entry Date(s): Date Created: 20251210 Date Completed: 20260626 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13305066
DOI: 10.1007/s11606-025-10055-1
PMID: 41372665
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1525-1497
DOI:10.1007/s11606-025-10055-1