The Development and Implementation of a Hospitalist-Directed Addiction Medicine Consultation Service to Address a Treatment Gap

Introduction Hospitalizations related to the consequences of substance use are rising yet most hospitalized patients with substance use disorder do not receive evidence-based addiction treatment. Opportunities to leverage the hospitalist workforce could close this treatment gap. Aim To describe the development, implementation, and evaluation of a hospitalist-directed addiction consultation service (ACS) to provide in-hospital addiction treatment. Setting Six hundred fifty-bed university hospital in Aurora, Colorado. Program Description Hospitalists completed buprenorphine waiver training, participated in a 13-part addiction lecture series, and completed a minimum of 40 hours of online addiction training. Hospitalists participated in shadow shifts with an addiction-trained physician. Dedicated addiction social workers developed relationships with local addiction treatment services. Program Evaluation Metrics Physician-related metrics included education, training, and clinical time spent in addiction practice. Patient and encounter-related metrics included a description of ACS care provision. Results Eleven hospitalists completed an average of 95 hours of addiction-related didactics. Once addiction training was complete, hospitalists spent an average of 30 days over 12 months staffing a weekday ACS. Between October 2019 and November 2020, the ACS completed 1620 consultations on 1350 unique patients. Alcohol was the most common substance (n = 1279; 79%), followed by tobacco (979; 60.4%), methamphetamines/amphetamines (n = 494; 30.5%), and opioids (n = 400; 24.7%). Naltrexone was the most frequently prescribed medication (n = 350; 21.6%), followed by acamprosate (n = 93; 5.7%), and buprenorphine (n = 77, 4.8%). Trauma was a frequent discharge diagnoses (n = 1564; 96.5%). Leaving prior to treatment completion was commonly noted (n = 120, 7.4%). The ACS completed 47 in-hospital methadone enrollments. Discussion The hospitalist-directed ACS is a promising clinical initiative that could be implemented to expand hospital-based addiction treatment. Future research is needed to understand challenges to disseminating this model into other hospital settings, and to evaluate intended and unintended effects of broad implementation.

Automated summary

The study describes the development, implementation, and evaluation of a hospitalist-directed addiction consultation service in a university hospital in Aurora, Colorado. Results show that the service completed a high volume of consultations and treatments, but patients often left before completing treatment.