Review Showcases Key Postdischarge Strategies for Substance Use Treatment Success

Word "addiction" surrounded by medication, syringe | Image Credit: Belinda Pretorius - stock.adobe.com

A scoping review focused on cumulated scholarly literature surrounding patients with substance use disorders (SUDs) highlighted the role transition strategies play in effective care interventions used to support patients after inpatient hospital. Opioids are the most common substance associated with SUDs, which are usually treated with medications for opioid use disorder assisting with detox, such as methadone or buprenorphine.

The authors aimed to analyze gaps in patients with opioid use disorder (OUD) and other SUDs seeking treatment resources. Initial therapies tend to be inpatient hospitalization or emergency department (ED) stays. However, there is a confined amount of data regarding the transition from hospital treatment to ongoing services for patients. The review integrated the literature based on current transition strategies used to determine the patients’ aftercare and classified them by similar characteristics.

Research was found using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis for Scoping Review checklist. Databases included articles between January 1, 2000, to October 2, 2021. Further information required descriptions of rehabilitations or programs for adult patients with SUDs, post-hospital follow-up outcomes, and any practices mentioned where patient support transitioned from acute care to community SUD treatment.

A total of 45 studies were reviewed based on the applicable criteria. A majority of the studies were American (n = 38; 84.4%) and were observational study (n = 19; 42.2%). The review materials included patients with SUDs, specifically opioid use (n = 32; 71.1%). Results from the 45 studies had analyzed 20 inpatient hospital interventions (38%) compared to the 28 who experienced emergency department interventions (56%).

Transition strategies were sought out among the publications, determining patterns in the most suitable. Predischarge transitions were labeled as discussion of treatment options, scheduled appointments, a provider list, an electronic referral, and an unspecified linkage to treatment. Bridge prescription, transportation assistance, follow-up calls/texts, care navigation, and peer support were the most common postdischarge transition methods. The main predischarge transition for patients with SUDs was scheduling an appointment, with 57% (n = 16) of ED interventions and 50% (n = 10) of inpatient interventions.

The Consolidated Framework for Implementation Research applied 5 domains when organizing barriers and facilitators known as intervention characteristics, inner setting, outer setting, individual characteristics, and implementation process. The implementation process was seldom mentioned in the reviewed research regarding barriers and facilitators.

The barriers of the intervention characteristics were identified in many studies as limited finances for program funds, logistics, and communication management of hospitals with community treatment teams as follow up care, as well as complications maintaining these relationships. Proposed discussions were based on the utilization of existing resources of local providers, employing the same providers to acute-care settings to build trust, and foster communication between staff and providers.

Obstacles noticed among the literature related to the inner setting and individual characteristics of patients with SUDs included low staff presence, bias against the SUD population, and the failure to manage withdrawal. Suggested solutions were educational sessions for hospital staff to improve awareness on interventions and address harm reduction benefits. Nonmedical staff were advised to educate audiences as a social worker, a recovered individual, or external staff.

The outer setting domain addressed staff turnover rates, scarce availability in certain populations, and few hours of operation at treatment centers as barriers. Patients with SUDs encounter risk of employment, housing, and transportation instability, as well as legal involvement and medical issues. Financial services were major barriers discussed because insurance coverage ranges based on the services and plan, leaving some populations few resources. Facilitators were the admittance of patients’ preferred treatment options, integrating insurance plans to include SUD care, and distributing money to support social challenges after patients leave the hospital.

Study limitations are the reliance on peer-reviewed articles, using only some of the components of complex and heterogeneous interventions. Research also ranged between a 20-year span, leaving room for changes in the clinical approaches addressing SUDs. Lastly, the data extracted were from an evolving field of study, meaning some published information may be missing.

The scoping review applied literature in the investigation of SUD care transition strategies following acute-care settings as a defining factor of effective treatment intervention. The authors concluded the review, “Improving our knowledge of care transition strategies is not only important in the context of acute-care interventions but can serve to improve transitions of care among patients with SUD across multiple touchpoints.”

Reference

Krawczyk N, Rivera BD, Chang JE, et al. Strategies to support substance use disorder care transitions from acute-care to community-based settings: a scoping review and typology. Addict Sci Clin Pract. 2023;18(1):67. doi:10.1186/s13722-023-00422-w