Retention in outpatient follow-up after addiction-specialized interventions during non-psychiatric hospital admissions

Background

Substance use disorders (SUDs) remain an underdiagnosed and undertreated problem; the identification of patients in need of treatment and the encouragement of their participation in follow-up care are of paramount importance. Individuals with SUD may be admitted to specialized services within general hospitals, sometimes due to drug-related illnesses; at other times, SUDs may be a casual finding. Hospitalization provides an opportunity for patients to recognize the toxicity and dependence associated with their substance use. The impact of interventions by addiction-specialized teams on patients admitted to general hospitals remains poorly understood, with most studies focusing on alcohol consumption and yielding mixed results regarding subsequent linking to addiction-specialized services. It is pertinent to compile information about patients visited by addiction-specialized teams during hospitalization and their subsequent retention to follow-up programs in addiction units.

Methods

Results from a study conducted in the Hospital Clinic of Barcelona through retrospective data collection from January 2021 and December 2021 are presented. We examined the medical records of patients with SUD who underwent intervention by an addiction-specialized consultation team during hospitalization in a high-complexity general hospital for physical diseases. During the intervention, patients were encouraged to participate in outpatient follow-up at the Addictive Behaviours Unit. Our objectives included determining the characteristics of these patients and evaluating adherence and retention in outpatient follow-up care. Retention was measured at the initial visit, in the short term (six months), and in the long term (twelve months). Data collection included sociodemographic variables, clinical variables related to hospital admission, and clinical variables related to follow-up.

Results

Ninety-six patients were included, 71.9% (n=69) of those hospital admissions were directly related to substance use, with alcohol being the primary substance of use in 81.3% (n=78). Moreover, 42.7% (n=41) met the criteria for severe SUD according to DSM5. Concerning follow-up, 89.6% (n=86) accepted the referral to outpatient treatment, and 65.6% (n=63) attended the first follow-up appointment. Short and long-term retention rates were 39.6% (n=38 ) at six months and 29.2% (n=28) at twelve months.

Conclusions

Based on the collected data, many patients accepted the referral to outpatient treatment, and a noteworthy majority attended the initial visit. Nevertheless, the proportion retained in follow-up at 6-12 months was considerably lower. Addressing underdiagnosed substance use is vital for fostering patient engagement and a hospital admission can serve as an opportunity for patients to initiate treatment. However, it is essential to continue working on specialized interventions, utilizing motivational interviewing, to enhance engagement in follow-up care.