New addiction medicine consult service improved hospital staff perceptions of care

The consult service provided management of withdrawal, medications such as methadone and buprenorphine, counseling and behavioral treatment, peer engagement and support, and linkages to community-based addiction care.


Implementation of an addiction medicine consultation service improved hospital staff members' perceptions of hospital care for patients with substance use disorder (SUD), a recent qualitative study found.

Between February and July 2016, researchers at one hospital in Portland, Ore., interviewed staff after implementation of an Improving Addiction Care Team (IMPACT), which included an interprofessional hospital-based addiction medicine service with rapid-access pathways to postdischarge treatment for SUD. IMPACT involves SUD assessments, management of withdrawal, medications such as methadone and buprenorphine, counseling and behavioral SUD treatment, peer engagement and support, and linkages to community-based addiction care.

Researchers interviewed a total of 34 hospital staff members (including physicians, nurses, social workers, residents, patient advocates, case managers, and pharmacists) who had experience caring for patients with SUD as well as exposure to IMPACT. Results were published online on April 25 by the Journal of Hospital Medicine.

Before IMPACT, staff members reported that hospital care ignored or avoided addressing addiction, and clinicians reported limited expertise and scarce treatment options. One attending said, “I would ask those questions [about SUD] before, but then … I had the information, but I couldn't do anything with it.” Failure to address addiction adversely affected patient care and clinician experience, as it led to untreated withdrawal, disruptive behaviors, and patients leaving against medical advice, respondents said.

After implementation of IMPACT, hospital staff reported that having hospital-based systems to address SUD reframed addiction as “a medical condition that actually has a treatment,” not a moral failing. The new system improved patient engagement and humanized care by treating withdrawal and directly communicating about SUD, they said. One attending emphasized the importance of using medications to treat hospitalized patients with addiction, stating that “Starting them on [methadone or buprenorphine-naloxone] and then making the next step in the outpatient world happen has been huge. That transition is so critical … that's been probably the biggest impact.”

Despite the success of IMPACT, survey respondents noted several key limitations, including that hospital-based interventions do not address poverty and have limited ability to address socioeconomic factors. They also noted that IMPACT had limited ability to ease the boredom and isolation patients feel during prolonged hospitalization.

The authors also noted limitations of the study, such as its single-center design and the possibility that staff perspectives on care before IMPACT were influenced by the intervention. Despite its limitations, the study has important implications, they said.

“For clinical practice, our findings highlight the importance of treating withdrawal to address challenging patient behaviors and the value of integrating [medications for addiction] into the hospital setting. … By implementing SUD improvements, hospitals can support staff and reduce burnout, better engage patients, improve care, and reduce stigma from this devastating disease,” the authors wrote.