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Improving hospital-based opioid substitution therapy (iHOST): protocol for a mixed-methods evaluation
Dan Lewer1,2, Michael Brown3,4, Adam Burns5
1Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, England, BD9 6RJ, UK.
NIHR Open Research
|November 21, 2024
Summary
The iHOST project aims to improve opioid substitution therapy for hospital patients. This intervention seeks to reduce opioid withdrawal and patient-directed discharges, enhancing care for individuals with opioid use disorder.
Area of Science:
- Applied health research
- Public health interventions
- Opioid use disorder management
Background:
- Opioid substitution therapy (OST) improves outcomes for illicit opioid users but is often interrupted during hospital admissions.
- Interruptions lead to opioid withdrawal, patient-directed discharge, and increased healthcare costs.
- The iHOST project addresses these issues by developing and evaluating an intervention to improve OST in acute hospital settings.
Purpose of the Study:
- To develop and evaluate the iHOST intervention designed to enhance opioid substitution therapy for hospital inpatients.
- To assess the impact of the intervention on patient-directed discharge and emergency readmissions.
- To evaluate the acceptability and implementation of the intervention among patients and healthcare staff.
Main Methods:
- A mixed-methods approach combining a quasi-experimental quantitative study and a qualitative process evaluation.
- Quantitative analysis using difference-in-difference to compare outcomes (patient-directed discharge, 28-day readmission) between iHOST sites and control hospitals.
- Qualitative data collection through interviews, focus groups, and observations to explore intervention acceptability, barriers, facilitators, and contextual factors.
Main Results:
- The iHOST intervention, developed collaboratively with stakeholders, includes patient ID cards, a helpline, staff training, clinical guidelines, and champion roles.
- Anticipated improvements in care for hospital patients receiving community-based OST.
- Data collection and analysis are ongoing to determine the primary outcomes.
Conclusions:
- The iHOST project is expected to enhance care for hospital patients with opioid use disorder receiving OST.
- Findings will inform the wider implementation of improved hospital-based services for people who use drugs.
- Dissemination of results will impact services in the UK and internationally.
Keywords:
BuprenorphineHeroin DependenceHospitalsMethadoneOpiate Substitution TreatmentOpioid-Related DisordersStaff DevelopmentSubstance-Related DisordersMore Related Videos
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