The impact of access to addiction specialist on attitudes, beliefs and hospital-based opioid use disorder related care: A survey of hospitalist physicians

Abstract

Background

Hospitalizations for complications related to opioid use disorder (OUD) are increasing. Hospitalists care for most hospitalized patients in the United States, yet little is known about their attitudes, beliefs, and clinical practices regarding OUD-related care.

Methods: We distributed an online survey to hospitalists in the United States to measure how access to addiction specialists affected attitudes and beliefs regarding hospital-based OUD care, OUD screening practices, naloxone prescribing, and buprenorphine initiation.

Results: Among 262 respondents, 67.9% (n = 178) reported having access to addiction specialists. While 84.5% (n = 221) reported often or always caring for patients with OUD, 48.2% (n = 126) rarely or never screened for OUD, 57.1% (n = 149) rarely or never prescribed or recommended naloxone as harm reduction, and 88.9% (n = 233) rarely or never initiated buprenorphine. In multivariable analyses, compared to hospitalists without access to addiction specialists, hospitalist with access to addiction specialists were more likely to feel supported to screen and refer patients to treatment (aOR = 4.4, 95% CI 2.1 − 9.1; ρ < 0.001), to be aware of local treatment resources (aOR = 3.4, 95% CI 1.8 − 6.3; ρ < 0.001), and refer patients to treatment (aOR = 3.0, 95% CI 1.7 − 5.6; ρ < 0.001).

Conclusions: Many hospitalists do not provide life-saving treatment to patients with OUD. Access to addiction specialists may increase provision of OUD-related care by hospitalists.

Keywords:

• Addiction hospitalists opioid use disorder (OUD)
• naloxone
• buprenorphine

Acknowledgements

Susan Calcaterra was funded as a Research in Addiction Medicine Scholar (RAMS) for the entirety of the study conceptualization, data analysis, and writing of the manuscript (NIDA grant R25DA033211). IA Binswanger is funded by the National Institute on Drug Abuse (R01DA042059). We acknowledge the Center for Innovative Design and Analysis (CIDA) for the analytic work. CIDA is supported in part by NIH/NCRR Colorado CCTSI Grant Number UL1 RR025780. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Authors’ contributions

SLC, IAB, EJE, and PGO conceived the study and designed the methods. BKM provided statistical advice on study design and analyzed the data. SLC drafted the manuscript. IAB, EJE, PGO, BKM, and SEW contributed substantially to the manuscript revisions. SLC takes responsibility for the paper as a whole.

Disclosure statement

No potential conflict of interest was reported by the author(s).