Sponsor
Dr. Lovejoy reports grants from VA Health Services Research & Development during the conduct of the study and grants from National Institutes of Health outside the submitted work. Dr. Priest reports grants from National Institutes of Health and the Greenlick Family Scholarship Fund during the conduct of the study. Drs. Englander, McCarty, and Shull have nothing to disclose.
Published In
Journal of General Internal Medicine
Document Type
Post-Print
Publication Date
4-1-2020
Subjects
Opioid abuse -- Treatment, Drug addicts -- Rehabilitation, Opioids -- Agonists, Methadone maintenance, Buprenorphine -- Therapeutic use, United States. Veterans Health Administration
Abstract
Background
Hospitalization of patients with opioid use disorder (OUD) is increasing, yet little is known about opioid agonist therapy (OAT: methadone and buprenorphine) administration during admission.
Objective
Describe and examine patient- and hospital-level characteristics associated with OAT receipt during hospitalization in the Veterans Health Administration (VHA).
Participants
A total of 12,407 unique patients, ≥ 18 years old, with an OUD-related ICD-10 diagnosis within 12 months prior to or during index hospitalization in fiscal year 2017 from 109 VHA hospitals in the continental U.S.
Main Measure
OAT received during hospitalization.
Key Results
Few admissions received OAT (n = 1914; 15%) and when provided it was most often for withdrawal management (n = 834; 7%). Among patients not on OAT prior to admission who survived hospitalization (n = 10,969), 2.0% (n = 203) were newly initiated on OAT with linkage to care after hospital discharge. Hospitals varied in the frequency of OAT delivery (range, 0 to 43% of qualified admissions). Patients with pre-admission OAT (adjusted odds ratio [AOR] = 15.30; 95% CI [13.2, 17.7]), acute OUD diagnosis (AOR = 2.3; 95% CI [1.99, 2.66]), and male gender (AOR 1.52; 95% CI [1.16, 2.01]) had increased odds of OAT receipt. Patients who received non-OAT opioids (AOR 0.53; 95% CI [0.46, 0.61]) or surgical procedures (AOR 0.75; 95% CI [0.57, 0.99]) had decreased odds of OAT receipt. Large-sized (AOR = 2.0; 95% CI [1.39, 3.00]) and medium-sized (AOR = 1.9; 95% CI [1.33, 2.70]) hospitals were more likely to provide OAT.
Conclusions
In a sample of VHA inpatient medical admissions, OAT delivery was infrequent, varied across the health system, and was associated with specific patient and hospital characteristics. Policy and educational interventions should promote hospital-based OAT delivery.
DOI
10.1007/s11606-020-05815-0
Persistent Identifier
https://archives.pdx.edu/ds/psu/32781
Citation Details
Priest, K. C., Lovejoy, T. I., Englander, H., Shull, S., & McCarty, D. (2020). Opioid Agonist Therapy During Hospitalization Within the Veterans Health Administration: a Pragmatic Retrospective Cohort Analysis. Journal of General Internal Medicine.
Description
This is a post-peer-review, pre-copyedit version of an article published in the Journal of General Internal Medicine. The final authenticated version is available online at: http://dx.doi.org/ 10.1007/s11606-020-05815-0