Measuring the Impact of a Multi-Site In-Hospital Intervention for Opioid Use Disorder Treatment Provision: A Survey of Hospital-Based Clinicians.

Abstract

Opioid-related hospitalizations are highly prevalent. Hospital-based clinicians are well positioned to initiate medications for opioid use disorder (MOUD) among hospitalized adults with OUD. Measure the perceived impact of a multi-site and multi-faceted OUD intervention to expand provision of hospital-based OUD treatment, including MOUD. Compared pre- and post-OUD intervention survey results of hospital-based clinicians practicing across 12 hospitals following implementation of an OUD intervention. Survey questions were grouped into six domains: evidence to treat OUD; hospital processes to screen for unhealthy substance use and refer to post-discharge OUD treatment; MOUD initiation; readiness to initiate MOUD; current practices to initiate MOUD; and leadership prioritization of OUD treatment. We calculated mean summary scores across domains and measured changes across pre- and post-OUD intervention surveys. We analyzed open-ended survey questions using a team-based content analysis to identify and quantify key concepts. Of the 213 post-OUD intervention survey respondents (61% response rate), 110 (52%) also completed the pre-survey. Compared to the pre-survey, in the post-survey, more respondents reported believing that the evidence to treat OUD was valid (p < 0.001), reported higher satisfaction with hospital processes to screen and refer to OUD treatment (p < 0.001), reported fewer concerns regarding MOUD initiation (buprenorphine: p < 0.001; methadone: p < 0.001), reported that leadership prioritized OUD treatment (p < 0.001), and reported higher readiness to initiate MOUD (buprenorphine: p < 0.001; methadone: p < 0.001). Fewer respondents reported barriers to initiate buprenorphine (p = 0.002) or methadone (p < 0.001) in the hospital. Emergent key concepts from open-ended questions included a need for ongoing education and training to treat OUD and a need for access to addiction specialists (n = 50%; n = 28% of write-in responses, respectively). Interventions to facilitate in-hospital OUD treatment should address local barriers to providing this care, including ensuring access to addiction specialists and providing routine and accessible education to hospital-based clinicians.