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

Medical therapies, complications, and overall treatment outcomes

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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.

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Author information

Authors and Affiliations

  1. University Hospital of Gran Canaria Dr. Negrin, Las Palmos, Canary Islands, Spain

    Alicia Conde-Martel MD, MPH

  2. Johns Hopkins Division of General Internal Medicine, Baltimore, MD, USA

    J. Hunter Young MD, MHS & Daniel E. Ford MD, MPH

  3. Department of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Jennifer Price MD

  4. Johns Hopkins Department of Psychiatry, Baltimore, MD, USA

    George Bigelow PhD

  5. Georgetown University School of Medicine, NE111 Med Dent Building, 3900 Reservoir Rd. NW, 20057, Washington, DC

    Thomas P. O'Toole MD

Authors
  1. Thomas P. O'Toole MD
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  2. Alicia Conde-Martel MD, MPH
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  3. J. Hunter Young MD, MHS
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  4. Jennifer Price MD
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  5. George Bigelow PhD
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  6. Daniel E. Ford MD, MPH
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Corresponding author

Correspondence to Thomas P. O'Toole MD.

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The authors have no conflicts of interest to report.

Dr. O’Toole is funded by a NIDA career development award K23DA13988-01.

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O'Toole, T.P., Conde-Martel, A., Young, J.H. et al. Managing acutely III substance-abusing patients in an integrated day hospital outpatient program. J Gen Intern Med 21, 570–576 (2006). https://doi.org/10.1111/j.1525-1497.2006.00398.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00398.x

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