Implementation and Sustainability of Hospital-based Addiction Consultation Services

Substance use disorder (SUD) is prevalent among hospitalized patients, yet most acute care settings do not routinely provide evidence-based SUD treatment. Hospital-based addiction consultation services (ACSs) have emerged as a promising strategy to increase the use of medications for SUD and improve linkage to post-discharge care. However, despite evidence supporting ACS effectiveness, these programs remain difficult to sustain, and their growth has been concentrated in a relatively small minority of hospitals. Understanding the factors that enable ACS sustainment and the barriers programs encounter is critical to expanding evidence-based SUD treatment across the broader hospital landscape.

We conducted semi-structured interviews followed by surveys with 21 leaders and representatives of ACSs at 17 hospitals across the United States. Participants were identified through purposive and snowball sampling via addiction medicine professional networks and correspondence. Interviews explored reasons for ACS initiation, configuration, barriers, and factors supporting sustainment, guided by constructs from the Program Sustainability Assessment Tool (PSAT), including environmental support, funding stability, organizational capacity, strategic planning, partnerships, communications, monitoring, and evaluation. Survey items based on the PSAT asked participants to rate the extent to which their hospital had engaged in various activities related to implementation and sustainment of the ACS. We describe common themes based on qualitative coding of interview data and the analysis of median scores and interquartile ranges for each relevant PSAT domain.

Findings show that funding stability remains the lowest scored factor for ACS sustainability, with fee-for-service models and lack of adequate post-discharge treatment services as ongoing barriers. Workforce issues, hospital department friction, and external partnership challenges were also noted. Most ACSs are supported by diversified funding and cross-disciplinary staffing. High median survey scores in most domains reflect strong support for sustainment, but addressing ongoing barriers is crucial for long-term success of ACSs in improving care for hospital inpatients with SUDs.

Clinical trial number: not applicable.