Managing acutely ill substance-abusing patients in an integrated day hospital outpatient program

Medical therapies, complications, and overall treatment outcomes

Thomas P. O'Toole, Alicia Conde-Martel, J Hunter Young, Jennifer Price, George Bigelow, Daniel E Ford

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Substance-abusing adults are admitted to hospitals for medical complications from their drug and alcohol use at substantially higher rates than the general public; yet, their care is often defined by against medical advice (AMA) discharges and low rates of referral to addiction treatment programs. METHODS: We present findings from a chart review of consecutive admissions to an integrated medical-substance abuse treatment program designed for acutely ill, hospitalized substance using adults. We specifically looked at factors associated with program completion and medical complications in this cohort of at-risk adults. RESULTS: Overall, 83 patient cases were studied. The mean age was 41.2 years; most were African American (73.5%), male (68.7%), and homeless (77.1%). Heroin (96.4%) and cocaine (88.0%), followed by alcohol (44.6%) were the most commonly used substances before admission. The most common admitting diagnoses were infectious endocarditis (43.4%), abscess or nonhealing ulcer (18.1%), and osteomyelitis (13.3%) with intravenous antibiotic (68.7%), physical therapy (48.2%), or wound care (41.0%), the most commonly prescribed care on the integrated care/day hospital unit. The mean length of stay in the day hospital was 12.4 days. Overall, 69.9% of patients successfully completed their medical therapy, and 63.9% were successfully referred to an outpatient substance abuse treatment program. Only 10.8% required an unscheduled hospital readmission and 15.7% required an after-hours emergency department visit during their stay. CONCLUSION: Outpatient/day hospital-based integrated treatment is a viable option for medically ill substance-abusing adults who would otherwise be hospitalized and is associated with higher than expected completion rates and low rate of complications. Co-locating the unit at a hospital and integrating extensive social supports appear to be key components to this model.

Original languageEnglish (US)
Pages (from-to)570-576
Number of pages7
JournalJournal of General Internal Medicine
Volume21
Issue number6
DOIs
StatePublished - Jun 2006

Fingerprint

Outpatients
Substance-Related Disorders
Therapeutics
Alcohols
Patient Readmission
Hospital Units
Heroin
Osteomyelitis
Endocarditis
Cocaine
Social Support
African Americans
Abscess
Ulcer
Hospital Emergency Service
Length of Stay
Referral and Consultation
Anti-Bacterial Agents
Wounds and Injuries
Pharmaceutical Preparations

Keywords

  • Health services delivery
  • Homeless
  • Medical complications
  • Substance abuse
  • Treatment outcomes

ASJC Scopus subject areas

  • Internal Medicine

Cite this

@article{40c06fe960d9475d80ebc07202902af0,
title = "Managing acutely ill substance-abusing patients in an integrated day hospital outpatient program: Medical therapies, complications, and overall treatment outcomes",
abstract = "BACKGROUND: Substance-abusing adults are admitted to hospitals for medical complications from their drug and alcohol use at substantially higher rates than the general public; yet, their care is often defined by against medical advice (AMA) discharges and low rates of referral to addiction treatment programs. METHODS: We present findings from a chart review of consecutive admissions to an integrated medical-substance abuse treatment program designed for acutely ill, hospitalized substance using adults. We specifically looked at factors associated with program completion and medical complications in this cohort of at-risk adults. RESULTS: Overall, 83 patient cases were studied. The mean age was 41.2 years; most were African American (73.5{\%}), male (68.7{\%}), and homeless (77.1{\%}). Heroin (96.4{\%}) and cocaine (88.0{\%}), followed by alcohol (44.6{\%}) were the most commonly used substances before admission. The most common admitting diagnoses were infectious endocarditis (43.4{\%}), abscess or nonhealing ulcer (18.1{\%}), and osteomyelitis (13.3{\%}) with intravenous antibiotic (68.7{\%}), physical therapy (48.2{\%}), or wound care (41.0{\%}), the most commonly prescribed care on the integrated care/day hospital unit. The mean length of stay in the day hospital was 12.4 days. Overall, 69.9{\%} of patients successfully completed their medical therapy, and 63.9{\%} were successfully referred to an outpatient substance abuse treatment program. Only 10.8{\%} required an unscheduled hospital readmission and 15.7{\%} required an after-hours emergency department visit during their stay. CONCLUSION: Outpatient/day hospital-based integrated treatment is a viable option for medically ill substance-abusing adults who would otherwise be hospitalized and is associated with higher than expected completion rates and low rate of complications. Co-locating the unit at a hospital and integrating extensive social supports appear to be key components to this model.",
keywords = "Health services delivery, Homeless, Medical complications, Substance abuse, Treatment outcomes",
author = "O'Toole, {Thomas P.} and Alicia Conde-Martel and Young, {J Hunter} and Jennifer Price and George Bigelow and Ford, {Daniel E}",
year = "2006",
month = "6",
doi = "10.1111/j.1525-1497.2006.00398.x",
language = "English (US)",
volume = "21",
pages = "570--576",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "6",

}

TY - JOUR

T1 - Managing acutely ill substance-abusing patients in an integrated day hospital outpatient program

T2 - Medical therapies, complications, and overall treatment outcomes

AU - O'Toole, Thomas P.

AU - Conde-Martel, Alicia

AU - Young, J Hunter

AU - Price, Jennifer

AU - Bigelow, George

AU - Ford, Daniel E

PY - 2006/6

Y1 - 2006/6

N2 - BACKGROUND: Substance-abusing adults are admitted to hospitals for medical complications from their drug and alcohol use at substantially higher rates than the general public; yet, their care is often defined by against medical advice (AMA) discharges and low rates of referral to addiction treatment programs. METHODS: We present findings from a chart review of consecutive admissions to an integrated medical-substance abuse treatment program designed for acutely ill, hospitalized substance using adults. We specifically looked at factors associated with program completion and medical complications in this cohort of at-risk adults. RESULTS: Overall, 83 patient cases were studied. The mean age was 41.2 years; most were African American (73.5%), male (68.7%), and homeless (77.1%). Heroin (96.4%) and cocaine (88.0%), followed by alcohol (44.6%) were the most commonly used substances before admission. The most common admitting diagnoses were infectious endocarditis (43.4%), abscess or nonhealing ulcer (18.1%), and osteomyelitis (13.3%) with intravenous antibiotic (68.7%), physical therapy (48.2%), or wound care (41.0%), the most commonly prescribed care on the integrated care/day hospital unit. The mean length of stay in the day hospital was 12.4 days. Overall, 69.9% of patients successfully completed their medical therapy, and 63.9% were successfully referred to an outpatient substance abuse treatment program. Only 10.8% required an unscheduled hospital readmission and 15.7% required an after-hours emergency department visit during their stay. CONCLUSION: Outpatient/day hospital-based integrated treatment is a viable option for medically ill substance-abusing adults who would otherwise be hospitalized and is associated with higher than expected completion rates and low rate of complications. Co-locating the unit at a hospital and integrating extensive social supports appear to be key components to this model.

AB - BACKGROUND: Substance-abusing adults are admitted to hospitals for medical complications from their drug and alcohol use at substantially higher rates than the general public; yet, their care is often defined by against medical advice (AMA) discharges and low rates of referral to addiction treatment programs. METHODS: We present findings from a chart review of consecutive admissions to an integrated medical-substance abuse treatment program designed for acutely ill, hospitalized substance using adults. We specifically looked at factors associated with program completion and medical complications in this cohort of at-risk adults. RESULTS: Overall, 83 patient cases were studied. The mean age was 41.2 years; most were African American (73.5%), male (68.7%), and homeless (77.1%). Heroin (96.4%) and cocaine (88.0%), followed by alcohol (44.6%) were the most commonly used substances before admission. The most common admitting diagnoses were infectious endocarditis (43.4%), abscess or nonhealing ulcer (18.1%), and osteomyelitis (13.3%) with intravenous antibiotic (68.7%), physical therapy (48.2%), or wound care (41.0%), the most commonly prescribed care on the integrated care/day hospital unit. The mean length of stay in the day hospital was 12.4 days. Overall, 69.9% of patients successfully completed their medical therapy, and 63.9% were successfully referred to an outpatient substance abuse treatment program. Only 10.8% required an unscheduled hospital readmission and 15.7% required an after-hours emergency department visit during their stay. CONCLUSION: Outpatient/day hospital-based integrated treatment is a viable option for medically ill substance-abusing adults who would otherwise be hospitalized and is associated with higher than expected completion rates and low rate of complications. Co-locating the unit at a hospital and integrating extensive social supports appear to be key components to this model.

KW - Health services delivery

KW - Homeless

KW - Medical complications

KW - Substance abuse

KW - Treatment outcomes

UR - http://www.scopus.com/inward/record.url?scp=33744471137&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33744471137&partnerID=8YFLogxK

U2 - 10.1111/j.1525-1497.2006.00398.x

DO - 10.1111/j.1525-1497.2006.00398.x

M3 - Article

VL - 21

SP - 570

EP - 576

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 6

ER -