Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2019

Open Access 01-12-2019 | Addiction | Study protocol

Study protocol for a pragmatic trial of the Consult for Addiction Treatment and Care in Hospitals (CATCH) model for engaging patients in opioid use disorder treatment

Authors: Jennifer McNeely, Andrea B. Troxel, Hillary V. Kunins, Donna Shelley, Joshua D. Lee, Alexander Walley, Zoe M. Weinstein, John Billings, Nichola J. Davis, Roopa Kalyanaraman Marcello, Bruce R. Schackman, Charles Barron, Luke Bergmann

Published in: Addiction Science & Clinical Practice | Issue 1/2019

Login to get access

Abstract

Background

Treatment for opioid use disorder (OUD) is highly effective, yet it remains dramatically underutilized. Individuals with OUD have disproportionately high rates of hospitalization and low rates of addiction treatment. Hospital-based addiction consult services offer a potential solution by using multidisciplinary teams to evaluate patients, initiate medication for addiction treatment (MAT) in the hospital, and connect patients to post-discharge care. We are studying the effectiveness of an addiction consult model [Consult for Addiction Treatment and Care in Hospitals (CATCH)] as a strategy for engaging patients with OUD in treatment as the program rolls out in the largest municipal hospital system in the US. The primary aim is to evaluate the effectiveness of CATCH in increasing post-discharge initiation and engagement in MAT. Secondary aims are to assess treatment retention, frequency of acute care utilization and overdose deaths and their associated costs, and implementation outcomes.

Methods

A pragmatic trial at six hospitals, conducted in collaboration with the municipal hospital system and department of health, will be implemented to study the CATCH intervention. Guided by the RE-AIM evaluation framework, this hybrid effectiveness-implementation study (Type 1) focuses primarily on effectiveness and also measures implementation outcomes to inform the intervention’s adoption and sustainability. A stepped-wedge cluster randomized trial design will determine the impact of CATCH on treatment outcomes in comparison to usual care for a control period, followed by a 12-month intervention period and a 6- to 18-month maintenance period at each hospital. A mixed methods approach will primarily utilize administrative data to measure outcomes, while interviews and focus groups with staff and patients will provide additional information on implementation fidelity and barriers to delivering MAT to patients with OUD.

Discussion

Because of their great potential to reduce the negative health and economic consequences of untreated OUD, addiction consult models are proliferating in response to the opioid epidemic, despite the absence of a strong evidence base. This study will provide the first known rigorous evaluation of an addiction consult model in a large multi-site trial and promises to generate knowledge that can rapidly transform practice and inform the potential for widespread dissemination of these services.
Trial registration: NCT03611335
Literature
1.
US Department of Health and Human Services (HHS), Office of the Surgeon General. Facing Addiction in America. The surgeon general’s report on alcohol, drugs, and health. Washington, DC;2016.
2.
Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths-United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65(5051):1445–52.CrossRef
3.
4.
Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths-United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016;64(50–51):1378–82.CrossRef
5.
6.
7.
8.
Englander H, Weimer M, Solotaroff R, Nicolaidis C, Chan B, Velez C, et al. Planning and designing the improving addiction care team (IMPACT) for hospitalized adults with substance use disorder. J Hos Med. 2017;12(5):339–42.CrossRef
9.
Wakeman SE, Metlay JP, Chang Y, Herman GE, Rigotti NA. Inpatient addiction consultation for hospitalized patients increases post-discharge abstinence and reduces addiction severity. J Gen Intern Med. 2017;32:909.CrossRef
10.
Trowbridge P, Weinstein ZM, Kerensky T, Roy P, Regan D, Samet JH, et al. Addiction consultation services—linking hospitalized patients to outpatient addiction treatment. J Subst Abuse Treat. 2017;79:1–5.CrossRef
11.
Murphy MK, Chabon B, Delgado A, Newville H, Nicolson SE. Development of a substance abuse consultation and referral service in an academic medical center: challenges, achievements and dissemination. J Clin Psychol Med Set. 2009;16:77–86.CrossRef
12.
Owens PL, Barrett ML, Weiss AJ, Washington RE, Kronick R. Hospital inpatient utilization related to opioid overuse among adults, 1993–2012: statistical brief#177. Rockville: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs; 2006.
13.
McNeely J, Gourevitch MN, Paone D, Shah S, Wright S, Heller D. Estimating the prevalence of illicit opioid use in New York City using multiple data sources. BMC Public Health. 2012;12:443.CrossRef
14.
Naeger S, Mutter R, Ali MM, Mark T, Hughey L. Post-discharge treatment engagement among patients with an opioid-use disorder. J Subst Abuse Treat. 2016;69:64–71.CrossRef
15.
Lawrinson P, Ali R, Buavirat A, Chiamwongpaet S, Dvoryak S, Habrat B, et al. Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS. Addiction. 2008;103(9):1484–92.CrossRef
16.
Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009;8(3):Cd002209.
17.
Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550.CrossRef
18.
19.
20.
Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction. 2015;110(9):1404–15.CrossRef
21.
Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Revisiting our review of screening, brief intervention and referral to treatment (SBIRT): meta-analytical results still point to no efficacy in increasing the use of substance use disorder services. Addiction. 2016;111(1):181–3.CrossRef
22.
Saitz R, Cheng DM, Winter M, Kim TW, Meli SM, Allensworth-Davies D, et al. Chronic care management for dependence on alcohol and other drugs: the AHEAD randomized trial. JAMA J Am Med Assoc. 2013;310(11):1156–67.CrossRef
23.
Roy-Byrne P, Bumgardner K, Krupski A, Dunn C, Ries R, Donovan D, et al. Brief intervention for problem drug use in safety-net primary care settings a randomized clinical trial. JAMA J Am Med Assoc. 2014;312(5):492–501.CrossRef
24.
D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA J Am Med Assoc. 2015;313(16):1636–44.CrossRef
25.
Liebschutz JM, Crooks D, Herman D, Anderson B, Tsui J, Meshesha LZ, et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med. 2014;174(8):1369–76.CrossRef
26.
Aszalos R, McDuff DR, Weintraub E, Montoya I, Schwartz R. Engaging hospitalized heroin-dependent patients into substance abuse treatment. J Subst Abuse Treat. 1999;17(1–2):149–58.CrossRef
27.
Pecoraro A, Horton T, Ewen E, Becher J, Wright PA, Silverman B, et al. Early data from project engage: a program to identify and transition medically hospitalized patients into addictions treatment. Addict Sci Clin Pract. 2012;7:20.CrossRef
28.
Shanahan CW, Beers D, Alford DP, Brigandi E, Samet JH. A transitional opioid program to engage hospitalized drug users. J Gen Intern Med. 2010;25:803–8.CrossRef
29.
Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–7.CrossRef
30.
Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–26.CrossRef
31.
Glasgow RE, Lichtenstein E, Marcus AC. Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. Am J Public Health. 2003;93(8):1261–7.CrossRef
32.
March J, Kraemer HC, Trivedi M, Csernansky J, Davis J, Ketter TA, et al. What have we learned about trial design from NIMH-funded pragmatic trials? Neuropsychopharmacology. 2010;35(13):2491–501.CrossRef
33.
Tosh G, Soares-Weiser K, Adams CE. Pragmatic vs explanatory trials: the pragmascope tool to help measure differences in protocols of mental health randomized controlled trials. Dialogues Clin Neurosci. 2011;13(2):209–15.PubMedPubMedCentral
34.
Selby P, Brosky G, Oh PI, Raymond V, Ranger S. How pragmatic or explanatory is the randomized, controlled trial? The application and enhancement of the PRECIS tool to the evaluation of a smoking cessation trial. BMC Med Res Methodol. 2012;12(1):101.CrossRef
35.
Hemming K, Haines TP, Chilton PJ, Girling AJ, Lilford RJ. The stepped wedge cluster randomised trial: rationale, design, analysis, and reporting. BMJ. 2015;350:h391.CrossRef
36.
Brown CH, Curran G, Palinkas LA, Aarons GA, Wells KB, Jones L, et al. An overview of research and evaluation designs for dissemination and implementation. Annu Rev Public Health. 2017;38:1–22.CrossRef
37.
Barker D, McElduff P, D’Este C, Campbell MJ. Stepped wedge cluster randomised trials: a review of the statistical methodology used and available. BMC Med Res Methodol. 2016;16:69.CrossRef
38.
Zwarenstein M, Treweek S, Gagnier JJ, Altman DG, Tunis S, Haynes B, et al. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ. 2008;337:a2390.CrossRef
39.
40.
41.
Harocopos A, Allen B, Paone D. Circumstances and contexts of heroin initiation following non-medical opioid analgesic use in New York City. Int J Drug Policy. 2016;28:106–12.CrossRef
42.
Paone D, Tuazon E, Kattan J, Nolan ML, O’Brien DB, Dowell D, et al. Decrease in rate of opioid analgesic overdose deaths—Staten Island, New York City, 2011–2013. MMWR Morb Mortal Wkly Rep. 2015;64(18):491–4.PubMedPubMedCentral
43.
Paone D, Tuazon E, Stajic M, Sampson B, Allen B, Mantha S, et al. Buprenorphine infrequently found in fatal overdose in New York City. Drug Alcohol Depend. 2015;155:298–301.CrossRef
44.
Siegler A, Tuazon E, Bradley O’Brien D, Paone D. Unintentional opioid overdose deaths in New York City, 2005–2010: a place-based approach to reduce risk. Int J Drug Policy. 2014;25(3):569–74.CrossRef
45.
Mertens JR, Chi FW, Weisner CM, Satre DD, Ross TB, Allen S, et al. Physician versus non-physician delivery of alcohol screening, brief intervention and referral to treatment in adult primary care: the ADVISe cluster randomized controlled implementation trial. Addict Sci Clin Pract. 2015;10(1):26.CrossRef
46.
47.
48.
Harris AH, Humphreys K, Finney JW. Veterans affairs facility performance on Washington circle indicators and case mix-adjusted effectiveness. J Subst Abuse Treat. 2007;33(4):333–9.CrossRef
49.
50.
O’Toole TP, Conde-Martel A, Young JH, Price J, Bigelow G, Ford DE. Managing acutely ill substance-abusing patients in an integrated day hospital outpatient program: medical therapies, complications, and overall treatment outcomes. J Gen Intern Med. 2006;21(6):570–6.CrossRef
51.
Lee CS, Liebschutz JM, Anderson BJ, Stein MD. Hospitalized opioid-dependent patients: exploring predictors of buprenorphine treatment entry and retention after discharge. Am J Addict/Am Acad Psychiatr Alcohol Addict. 2017;26:667.CrossRef
52.
Chutuape MA, Katz EC, Stitzer ML. Methods for enhancing transition of substance dependent patients from inpatient to outpatient treatment. Drug Alcohol Depend. 2001;61(2):137–43.CrossRef
53.
D’Onofrio G, Degutis LC. Integrating project ASSERT: a screening, intervention, and referral to treatment program for unhealthy alcohol and drug use into an urban emergency department. Acad Emerg Med. 2010;17(8):903–11.CrossRef
54.
Metsch LR, Feaster DJ, Gooden L, Matheson T, Stitzer M, Das M, et al. Effect of patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use: a randomized clinical trial. JAMA J Am Med Assoc. 2016;316(2):156–70.CrossRef
55.
Kosten TR, O’Connor PG. Management of drug and alcohol withdrawal. N Engl J Med. 2003;348(18):1786–95.CrossRef
56.
Stancliff S, Joseph H, Fong C, Furst T, Comer SD, Roux P. Opioid maintenance treatment as a harm reduction tool for opioid-dependent individuals in New York City: the need to expand access to buprenorphine/naloxone in marginalized populations. J Addict Dis. 2012;31(3):278–87.CrossRef
57.
Ball JC, Ross A. The effectiveness of methadone maintenance treatment. New York: Springer; 1991.CrossRef
58.
Fiellin DA, Moore BA, Sullivan LE, Becker WC, Pantalon MV, Chawarski MC, et al. Long-term treatment with buprenorphine/naloxone in primary care: results at 2-5 years. Am J Addict/Am Acad Psychiatr Alcohol Addict. 2008;17(2):116–20.CrossRef
59.
Bhatraju EP, Grossman E, Tofighi B, McNeely J, DiRocco D, Flannery M, et al. Public sector low threshold office-based buprenorphine treatment: outcomes at year 7. Addict Sci Clin Pract. 2017;12(1):7.CrossRef
60.
Cornish R, Macleod J, Strang J, Vickerman P, Hickman M. Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK general practice research database. BMJ. 2010;341:c5475.CrossRef
61.
Cousins G, Boland F, Courtney B, Barry J, Lyons S, Fahey T. Risk of mortality on and off methadone substitution treatment in primary care: a national cohort study. Addiction. 2016;111(1):73–82.CrossRef
62.
Evans E, Li L, Min J, Huang D, Urada D, Liu L, et al. Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006–10. Addiction. 2015;110(6):996–1005.CrossRef
63.
Ronan MV, Herzig SJ. Hospitalizations related to opioid abuse/dependence and associated serious infections increased sharply, 2002–12. Health Aff (Millwood). 2016;35(5):832–7.CrossRef
64.
Walley AY, Paasche-Orlow M, Lee EC, Forsythe S, Chetty VK, Mitchell S, et al. Acute care hospital utilization among medical inpatients discharged with a substance use disorder diagnosis. J Addict Med. 2012;6(1):50–6.CrossRef
65.
Lynch FL, McCarty D, Mertens J, Perrin NA, Green CA, Parthasarathy S, et al. Costs of care for persons with opioid dependence in commercial integrated health systems. Addict Sci Clin Pract. 2014;9:16.CrossRef
66.
Lo-Ciganic WH, Gellad WF, Gordon AJ, Cochran G, Zemaitis MA, Cathers T, et al. Association between trajectories of buprenorphine treatment and emergency department and in-patient utilization. Addiction. 2016;111(5):892–902.CrossRef
67.
Stetler CB, Legro MW, Wallace CM, Bowman C, Guihan M, Hagedorn H, et al. The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006;21(Suppl 2):S1–8.CrossRef
68.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci IS. 2009;4:50.CrossRef
69.
Powell BJ, Proctor EK, Glass JE. A systematic review of strategies for implementing empirically supported mental health interventions. Res Soc Work Pract. 2014;24(2):192–212.CrossRef
70.
Kleinbaum DG, Kupper LL, Nizam A, Miller KE. Applied regression analysis and other multivariable methods. 4th ed. Pacific Grove: Duxbury Press; 2008.
71.
Mickey RM, Greenland S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol. 1989;129(1):125–37.CrossRef
72.
73.
Neumann PJ, Sanders GD, Russell LB, Siegel JE, Ganiats TG. Cost-effectiveness in health and medicine. 2nd ed. New York: Oxford University Press; 2016.CrossRef
74.
Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness-the curious resilience of the $50,000-per-QALY threshold. N Engl J Med. 2014;371(9):796–7.CrossRef
75.
Muhr T. ATLAS. ti (Version 6.0. 15). Berlin: Scientific Software Development; 2012.
76.
Kim HM, Smith EG, Stano CM, Ganoczy D, Zivin K, Walters H, et al. Validation of key behaviourally based mental health diagnoses in administrative data: suicide attempt, alcohol abuse, illicit drug abuse and tobacco use. BMC Health Serv Res. 2012;12:18.CrossRef
77.
Steele LS, Glazier RH, Lin E, Evans M. Using administrative data to measure ambulatory mental health service provision in primary care. Med Care. 2004;42(10):960–5.CrossRef
78.
Valenstein M, Ritsema T, Green L, Blow FC, Mitchinson A, McCarthy JF, et al. Targeting quality improvement activities for depression. Implications of using administrative data. J Family Pract. 2000;49(8):721–8.
79.
Walley AY, Farrar D, Cheng DM, Alford DP, Samet JH. Are opioid dependence and methadone maintenance treatment (MMT) documented in the medical record? A patient safety issue. J Gen Intern Med. 2009;24(9):1007–11.CrossRef
Metadata
Title
Study protocol for a pragmatic trial of the Consult for Addiction Treatment and Care in Hospitals (CATCH) model for engaging patients in opioid use disorder treatment
Authors
Jennifer McNeely
Andrea B. Troxel
Hillary V. Kunins
Donna Shelley
Joshua D. Lee
Alexander Walley
Zoe M. Weinstein
John Billings
Nichola J. Davis
Roopa Kalyanaraman Marcello
Bruce R. Schackman
Charles Barron
Luke Bergmann
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2019
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-019-0135-7

Other articles of this Issue 1/2019

Addiction Science & Clinical Practice 1/2019 Go to the issue

Research

Electronic self-administered screening for substance use in adult primary care patients: feasibility and acceptability of the tobacco, alcohol, prescription medication, and other substance use (myTAPS) screening tool

Research

Utilization of addiction treatment among U.S. adults with history of incarceration and substance use disorders

Review

Strategies to increase implementation of pharmacotherapy for alcohol use disorders: a structured review of care delivery and implementation interventions

Research

Development of a social media-based intervention targeting tobacco use and heavy episodic drinking in young adults

Research

Does an adapted Dialectical Behaviour Therapy skills training programme result in positive outcomes for participants with a dual diagnosis? A mixed methods study

Research

Short screening tools for risky drinking in Aboriginal and Torres Strait Islander Australians: modified AUDIT-C and a new approach