Bundled intervention improves care for patients with an infection, opioid use disorder

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Patients with opioid use disorder who were hospitalized for severe infections had higher chances of clinical cure and continued addiction care when treated with a clustered intervention, according to one study.

The bundled intervention included counseling on infectious diseases, addiction counseling, case management and drugs for opioid use disorder (OUD). Patients in the study were also affected by homelessness.

“From previous experience at our facility, we know that involving patients in medical treatment plans in vulnerable populations, including those with OUD and the homeless, can be difficult.” Alison M. Beieler PA-C, MPAS, a medical assistant at the Infectious Disease and Travel Medicine Clinic at Harborview Medical Center in Seattle, Healio said.

“We have seen a high rate of loss of treatment for patients with severe infections, frequent discharges against medical advice and high readmission rates,” she said. “In order to improve the successful completion of treatment and the clinical healing of infections, we have engaged our colleagues in addiction medicine to develop safe and continuous care plans for patients after discharge.”

Beieler and colleagues conducted a retrospective cohort study of 53 adult patients with OUD who were homeless and who were sent on medical respite after hospital discharge because of prolonged antibiotics. There were 63 care episodes among the 53 patients included in the study.

Of these episodes, 92% related to ID counseling, 51% to addiction counseling, 86% related to medication for OUD (MOUD) during admission and discharge, and 59% included case management.

The study showed that patients who received all four interventions had a higher probability of clinical healing (OR = 3.15; adjusted OR = 3.03) and after 30 days (OR = 5.46; aOR = 6.36) successfully maintained addiction care (OR = 5.46; aOR = 6.36), reported Beieler and colleagues.

“Multidisciplinary management of vulnerable populations with severe infections is necessary for safe patient care,” said Beieler. “Involving ID and addiction teams during inpatient admission to create patient-centered treatment plans, including prescribing antibiotics and MOUD and forwarding them to case management, is key to supporting our patients during admission and after discharge. Homeless patients with OUD can be successfully supported by severe infections, but require appropriate resources.

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