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Role of the Hospital in the 21st Century Opioid Overdose Epidemic

The Addiction Medicine Consult Service

Priest, Kelsey C., MPH; McCarty, Dennis, PhD

doi: 10.1097/ADM.0000000000000496
Original Research

Objective: The aim of the study was to explore and describe the structure and design elements of addiction medicine consult (AMC) services within selected US hospitals.

Methods: As part of a larger mixed methods study, 10 qualitative semi-structured telephone interviews were completed with board-certified addiction medicine physicians affiliated with the Addiction Medicine Foundation's Addiction Medicine Fellowship Programs at 9 US hospitals. Interviews were transcribed, coded, and analyzed using a directed content analysis.

Results: Interviews completed with established AMC services in 9 hospitals probed AMC structure and design commonalities and differences across 4 domains: (1) availability and coverage, (2) team composition, (3) scope and responsibility, and (4) financing. Only 1 service provided weekend consults and most services did not provide coverage in the emergency department. Interprofessional teams were common with a variety of discipline combinations. AMC service scope and responsibility, generally, included 3 types of activities: (1) education and culture change, (2) the delivery of psychosocial and medical services, and (3) hospital guidance document development. Finally, most AMC services existed within a fragile financial environment with idiosyncratic arrangements.

Conclusions: As opioid use disorder (OUD)-related hospitalizations increase stakeholders look to innovative care delivery mechanisms to improve care and outcomes for persons with OUD. The implementation of an AMC service may be an organizational intervention for achieving these aims. Understanding the shared and different approaches to AMC service structure and design is an important first step for delivery systems interested in implementing or expanding these services.

Oregon Health & Science University (OHSU) and Portland State University School of Public Health (KCP, DM), School of Medicine, MD/PhD Program, OHSU (KCP), Department of Psychiatry, School of Medicine, OHSU, Portland, OR (DM).

Send correspondence to Kelsey C. Priest, MPH, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code: L357, Portland, OR 97239. E-mail:; Twitter@kelseycpriest.

Received 12 August, 2018

Accepted 5 December, 2018

Awards from the National Institute on Drug Abuse (F30-DA044700UG, UG1 DA-015815) supported the design, implementation, and analysis of this study.

The Greenlick Family Scholarship Fund provided additional support.

The authors report no conflicts of interests to declare.

© 2019 American Society of Addiction Medicine