TY - JOUR
T1 - Making the business case for an addiction medicine consult service
T2 - A qualitative analysis
AU - Priest, Kelsey C.
AU - McCarty, Dennis
N1 - Funding Information:
Training grants from the National Institute on Drug Abuse (F30 DA044700) and the Greenlick Family Scholarship Fund supported the time and efforts of Kelsey Priest. Awards from the National Institute on Drug Abuse (UG1 DA015815, R33 DA035640) supported Dennis McCarty. The funding organizations were not involved in the design of the study, data collection, data analysis, the interpretation of data, or in the writing of this manuscript.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/11/8
Y1 - 2019/11/8
N2 - Background: As the drug poisoning crisis worsens in North America and opioid use disorder (OUD)-related hospital admissions increase, policymakers and hospital administrators are beginning to recognize the important role of hospitals in the OUD care continuum. This study explores and describes how U.S. addiction medicine physicians created and presented business propositions to hospital administrators to support the development of addiction medicine consult (AMC) services. Methods: Fifteen qualitative interviews were completed with board-certified or board-eligible addiction medicine physicians from 14 U.S. hospitals. The interviews occurred as part of a broader mixed methods study exploring hospital service delivery for patients admitted with OUD. Using a directed content analysis, the transcribed interviews were coded, analyzed, and final themes consolidated. Results: Semi-structured interviews completed with addiction medicine physicians from established (n = 9) and developing (n = 5) AMC services at 14 U.S. hospitals explored how clinical champions persuaded hospital administrators to support AMC service development. Four elements were foundational to making the "business case": 1) describing the prevalence of substance use disorder (SUD) or OUD in the hospital; 2) identifying the negative financial impacts of not treating SUDs during hospitalization; 3) highlighting the ongoing care quality and treatment gap for hospitalized patients with SUDs; and 4) noting the success of other institutional AMC services. Study findings informed the creation of tools to support AMC service development: 1) an AMC service business case template, and 2) an AMC service design and operations resource list. Conclusions: OUD-related hospital admissions are unlikely to abate. Hospital administrators should consider innovative care delivery mechanisms to improve care for persons with OUD. AMC services may be a promising delivery mechanism to achieve this aim. For clinical and administrative champions, understanding how to communicate the potential effectiveness of this intervention to hospital leaders is an essential first step to AMC service creation.
AB - Background: As the drug poisoning crisis worsens in North America and opioid use disorder (OUD)-related hospital admissions increase, policymakers and hospital administrators are beginning to recognize the important role of hospitals in the OUD care continuum. This study explores and describes how U.S. addiction medicine physicians created and presented business propositions to hospital administrators to support the development of addiction medicine consult (AMC) services. Methods: Fifteen qualitative interviews were completed with board-certified or board-eligible addiction medicine physicians from 14 U.S. hospitals. The interviews occurred as part of a broader mixed methods study exploring hospital service delivery for patients admitted with OUD. Using a directed content analysis, the transcribed interviews were coded, analyzed, and final themes consolidated. Results: Semi-structured interviews completed with addiction medicine physicians from established (n = 9) and developing (n = 5) AMC services at 14 U.S. hospitals explored how clinical champions persuaded hospital administrators to support AMC service development. Four elements were foundational to making the "business case": 1) describing the prevalence of substance use disorder (SUD) or OUD in the hospital; 2) identifying the negative financial impacts of not treating SUDs during hospitalization; 3) highlighting the ongoing care quality and treatment gap for hospitalized patients with SUDs; and 4) noting the success of other institutional AMC services. Study findings informed the creation of tools to support AMC service development: 1) an AMC service business case template, and 2) an AMC service design and operations resource list. Conclusions: OUD-related hospital admissions are unlikely to abate. Hospital administrators should consider innovative care delivery mechanisms to improve care for persons with OUD. AMC services may be a promising delivery mechanism to achieve this aim. For clinical and administrative champions, understanding how to communicate the potential effectiveness of this intervention to hospital leaders is an essential first step to AMC service creation.
KW - Addiction consult service
KW - Addiction medicine consult service
KW - Buprenorphine/naloxone
KW - Consultation service
KW - Hospital leadership
KW - Hospital management
KW - Methadone
KW - Opioid agonist therapy
KW - Opioid use disorder
KW - Substance use disorder
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U2 - 10.1186/s12913-019-4670-4
DO - 10.1186/s12913-019-4670-4
M3 - Article
C2 - 31703741
AN - SCOPUS:85074730632
SN - 1472-6963
VL - 19
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 822
ER -