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.

Using a mixed methods approach, we conducted semi-structured interviews and 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 suggest that funding stability and lack of adequate post-discharge treatment services are ongoing barriers to ACS sustainability. Most participating ACSs are supported by diversified funding and cross-disciplinary staffing, but fee-for-service models can limit funding for multidisciplinary roles. While high median survey scores across most PSAT domains reflect strong support for ACS sustainment, addressing financing barriers is crucial for long-term stability of ACSs in sustaining care for hospital inpatients with SUDs.

Clinical trial number: not applicable.