Initiating Medications During Hospitalization and Strategies for Ensuring Linkage at Discharge for Patients With...

Area of Science:

• Addiction Medicine
• Public Health
• Health Services Research

Background:

• Hospitalization offers a crucial window for initiating medications for opioid use disorder (MOUD) to improve long-term outcomes for patients with opioid use disorder (OUD).
• Despite evidence showing inpatient MOUD initiation reduces mortality and relapse, many patients struggle with post-discharge follow-up care.
• Systemic barriers, particularly for rural and minoritized populations, hinder continuity of care despite policy advancements like X-waiver elimination.

Purpose of the Study:

• To synthesize evidence from 52 studies on hospital discharge practices for patients with OUD initiated on MOUD.
• To identify best practices that support continued treatment and recovery post-hospitalization.
• To propose a framework for ensuring MOUD continuity of care.

Main Methods:

• A scoping review of 52 studies examining hospital discharge practices for patients with OUD receiving MOUD.
• Analysis of facilitators for MOUD initiation and transitional care strategies.
• Identification of barriers to care and effective linkage strategies.

Main Results:

• Inpatient addiction consultation, standardized protocols, and clinician education facilitate MOUD initiation.
• Transitional care strategies (e.g., bridge clinics, peer navigation, telemedicine, structured discharge planning) improve outpatient linkage, reduce readmissions, and enhance treatment retention.
• Multidisciplinary, patient-centered discharge pathways integrating medical treatment with social support are critical for effective care linkage.

Conclusions:

• Implementing six pillars of MOUD continuity—early initiation, warm handoffs, peer support, bridge care models, telemedicine integration, and addressing social determinants—is essential for closing care gaps.
• Addressing both structural and individual barriers is necessary for effective linkage strategies.
• Patient-centered discharge pathways are critical for improving outcomes in the evolving landscape of MOUD treatment.