\u201cOPTIONS-DC\u201d, a feasible discharge planning conference to expand infection treatment options for people with substance use disorder

Monica K Sikka,Jessica Gregg,Taylor Vega,Luke Strnad,Honora Englander,Sara Gore

doi:10.1186/s12879-021-06514-9

Abstract

BackgroundSerious bacterial infections associated with substance use often result in long hospitalizations, premature discharges, and high costs. Out-of-hospital treatment options in people with substance use disorder (SUD) are often limited.MethodsWe describe a novel multidisciplinary and interprofessional care conference, “OPTIONS-DC,” to identify treatment options agreeable to both patients and providers using the frameworks of harm reduction and patient-centered care. We retrospectively reviewed charts of patients who had an OPTIONS-DC between February 2018 and July 2019 and used content analysis to understand the conferences’ effects on antibiotic treatment options.ResultsFifty patients had an OPTIONS-DC during the study window. Forty-two (84%) had some intravenous (IV) substance use and 44 (88%) had an active substance use disorder. Participants’ primary substances included opioids (65%) or methamphetamines (28%). On average, conferences lasted 28 min. OPTIONS-DC providers recommended out-of-hospital antibiotic treatment options for 34 (68%) of patients. OPTIONS-DC recommended first line therapy of IV antibiotics for 35 (70%) patients, long-acting injectable antibiotics for 14 (28%), and oral therapy for 1 (2%). 35 (70%) patients that had an OPTIONS-DC completed an antibiotic course and 6 (12%) left the hospital prematurely. OPTIONS-DC expanded treatment options by exposing and contextualizing SUD, psychosocial risk and protective factors; incorporating patient preferences; and allowing providers to tailor antibiotic and SUD recommendations.ConclusionsOPTIONS-DC is a feasible intervention that allows providers to integrate principles of harm reduction and offer patient-centered choices among patients needing prolonged antibiotic treatment.

Highlights

Serious bacterial infections associated with substance use often result in long hospitalizations, premature discharges, and high costs
Before OPTIONS-DC, the addiction consult service (ACS), infectious diseases (ID), and outpatient parenteral antimicrobial therapy (OPAT) teams commonly cared for the same patients but lacked standardized processes to identify post-hospital treatment options and support shared decision-making with patients
Conference development and description As key stakeholders from OPAT, ACS, and ID, we developed OPTIONS-DC after unsuccessful efforts at providing integrated antibiotic infusion in residential treatment [7], ongoing patient and provider concerns that existing systems were failing patients, and having a series of patients leave the hospital before completing recommended antibiotic therapy

Summary

Introduction

Serious bacterial infections associated with substance use often result in long hospitalizations, premature discharges, and high costs. Out-of-hospital treatment options in people with substance use disorder (SUD) are often limited. Serious bacterial infections resulting from complications of substance use are rising amidst a substance use epidemic across the United States [1, 2]. Many patients do not or cannot stay in the hospital for weeks [9]. Preferences of patients with SUD are often disregarded or ignored and instead treatment plans reflect provider priorities [3]. This can lead to premature discharges, under-treated infections, and readmissions. Current care models often overlook this complex dynamic [10,11,12,13]

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Results

Conclusion