(172) Models of Addiction Medicine in C-L Psychiatry

Location: Griffin Hall

Trainee Involvement: Yes

Presenting Author(s)

BS

Brent Schnipke, MD (he/him/his)

Instructor of Psychiatry, Division of Consultation-Liaison Psychiatry
Northwestern University
Chicago, Illinois, United States

Co-Author(s)

Lisa Rosenthal, MD, FACLP, DFAPA

Professor
Northwestern
chicago, Illinois, United States
Simon A. Sidelnik, M.D.

Director Addiction Consultation-Liaison Psychiatry
NYU Grossman School of Medicine
New York, New York, United States
RC

Rachel Caravella, MD (she/her/hers)

Director, CL Psychiatry Service, NYU Manhattan Campuses
NYU Langone Health
New York, New York, United States
Christine Finn, MD

Vice Chair for Clinical Services
Dartmouth Health
Lebanon, New Hampshire, United States

Background/Significance: The hospital setting is an opportune moment to engage patients with substance use disorders and help facilitate urgent medical care. While the care of patients often involves multiple specialties, Addiction Consultation Services (ACS) provide valuable expertise in managing patients with complex medical and psychosocial needs (1-2). While there is growing evidence for the effectiveness of ACS, little is known about the models of ACS, including how those based primarily within Psychiatry Consultation-Liaison Services . The poster will review existing literature around benefits of ACS and provide valuable information regarding models of care.

Methods: We reviewed the existing literature on ACS models in hospital systems and summarize the evidence supporting their benefit. We also informally surveyed the ACLP Directors Listserv to learn about current models operating around the country.

Results: Various models of inpatient ACS exist and there is evidence to support improved outcomes, reduced staff burnout and education, and cost savings (3-4). Twelve CL directors responded to the listserv inquiry representing services from nine states (Colorado, Hawaii, Illinois, Pennsylvania, Massachusetts, New Hampshire, New York, Texas, Wisconsin). Hospitals have various implementation strategies, ranging from complete absence of psychiatry involvement or with separate consultation services to fully within an existing CL psychiatry service.

Discussion and Conclusion/Implications: CL-trained Psychiatrists are uniquely equipped to lead Addiction Consultation Services. As found in a survey of CL programs across the country, there are multiple models of providing addiction consultation in hospital settings including freestanding services and those embedded within CL Psychiatry Services. There are additional variations in staffing including addiction medicine internists, addiction psychiatrists, social work, nurse practitioners, or peer recovery specialists. This study describes existing models of care and helps provides guidance in establishing new Addiction Consultation Services.

References:

1. Callister C, Lockhart S, Holtrop JS, Hoover K, Calcaterra SL. Experiences with an addiction consultation service on care provided to hospitalized patients with opioid use disorder: a qualitative study of hospitalists, nurses, pharmacists, and social workers. Subst Abus.

2. Marcovitz D, Nisavic M, Bearnot B. Staffing an addiction consult service: Psychiatrists, internists, or both? Gen Hosp Psychiatry. 2019 Mar-Apr;57:41-43. doi: 10.1016/j.genhosppsych.2019.01.005. Epub 2019 Jan 30. PMID: 30738996

3. Priest KC, McCarty D. Making the business case for an addiction medicine consult service: a qualitative analysis. BMC Health Serv Res. 2019 Nov 8;19(1):822. doi: 10.1186/s12913-019-4670-4. PMID: 31703741; PMCID: PMC6842195.

4. Priest KC, McCarty D. Role of the Hospital in the 21st Century Opioid Overdose Epidemic: The Addiction Medicine Consult Service. J Addict Med. 2019 Mar/Apr;13(2):104-112. doi: 10.1097/ADM.0000000000000496. PMID: 30608266; PMCID: PMC6417955.