The Authors’ Own Words:
We ask authors to describe their impressions regarding the implications of their accepted work, how their findings will change practice, and what is noteworthy about the work.
Honora Englander MD; Talitha Wilson BS; Devin Collins MA; Elena Phoutrides MD, MPH; Melissa Weimer DO, MCR; P. Todd Korthuis MD, MPH; Jessica Calcagni CADC I, MA; & Christina Nicolaidis MD, MPH
Substance Abuse Vol. 39, Iss. 2, 2018
| Our study is a mixed-methods study evaluating a medically enhanced residential treatment (MERT) model integrating intravenous antibiotics and residential substance use disorder (SUD) treatment for hospitalized adults. MERT had low recruitment and retention, and ended after 6 months. We used a mixed-methods approach to describe limited feasibility and acceptability of MERT, and to explore and explain reasons why MERT failed. Our study has several key implications. First, the finding that hospitalized patients declined residential treatment is important and suggests the need for flexible, patient-centered post-acute care models that can engage patients who range from pre-contemplative to action stages of change. Low recruitment also raises questions as to the necessity of stringent residential requirements (e.g. the 30-day blackout period and intensive group attendance), and underscores the need to integrate pain management and other physical healthcare into an SUD treatment setting for this population. Findings that patients with complex medical illness (including PICC lines) and medications for addiction treatment (MAT) “stood out” in residential suggests a need for increased medical support and staff training in residential treatment settings. Finally, though MERT was developed based on a patient needs assessment and broad stakeholder input, our experience raises the question of whether a more iterative design process that included ongoing feedback from adults with SUD and residential staff may have led to a more successful intervention. While a single solution to this widespread national problem is unlikely, we aim to demonstrate lessons that are likely to be applicable across future models. Our study is a mixed-methods study evaluating a medically enhanced residential treatment (MERT) model integrating intravenous antibiotics and residential substance use disorder (SUD) treatment for hospitalized adults. MERT had low recruitment and retention, and ended after 6 months. We used a mixed-methods approach to describe limited feasibility and acceptability of MERT, and to explore and explain reasons why MERT failed. Our study has several key implications. First, the finding that hospitalized patients declined residential treatment is important and suggests the need for flexible, patient-centered post-acute care models that can engage patients who range from pre-contemplative to action stages of change. Low recruitment also raises questions as to the necessity of stringent residential requirements (e.g. the 30-day blackout period and intensive group attendance), and underscores the need to integrate pain management and other physical healthcare into an SUD treatment setting for this population. Findings that patients with complex medical illness (including PICC lines) and medications for addiction treatment (MAT) “stood out” in residential suggests a need for increased medical support and staff training in residential treatment settings. Finally, though MERT was developed based on a patient needs assessment and broad stakeholder input, our experience raises the question of whether a more iterative design process that included ongoing feedback from adults with SUD and residential staff may have led to a more successful intervention. While a single solution to this widespread national problem is unlikely, we aim to demonstrate lessons that are likely to be applicable across future models. Our study is a mixed-methods study evaluating a medically enhanced residential treatment (MERT) model integrating intravenous antibiotics and residential substance use disorder (SUD) treatment for hospitalized adults. MERT had low recruitment and retention, and ended after 6 months. We used a mixed-methods approach to describe limited feasibility and acceptability of MERT, and to explore and explain reasons why MERT failed. Our study has several key implications. First, the finding that hospitalized patients declined residential treatment is important and suggests the need for flexible, patient-centered post-acute care models that can engage patients who range from pre-contemplative to action stages of change. Low recruitment also raises questions as to the necessity of stringent residential requirements (e.g. the 30-day blackout period and intensive group attendance), and underscores the need to integrate pain management and other physical healthcare into an SUD treatment setting for this population. Findings that patients with complex medical illness (including PICC lines) and medications for addiction treatment (MAT) “stood out” in residential suggests a need for increased medical support and staff training in residential treatment settings. Finally, though MERT was developed based on a patient needs assessment and broad stakeholder input, our experience raises the question of whether a more iterative design process that included ongoing feedback from adults with SUD and residential staff may have led to a more successful intervention. While a single solution to this widespread national problem is unlikely, we aim to demonstrate lessons that are likely to be applicable across future models. Our study is a mixed-methods study evaluating a medically enhanced residential treatment (MERT) model integrating intravenous antibiotics and residential substance use disorder (SUD) treatment for hospitalized adults. MERT had low recruitment and retention, and ended after 6 months. We used a mixed-methods approach to describe limited feasibility and acceptability of MERT, and to explore and explain reasons why MERT failed. Our study has several key implications. First, the finding that hospitalized patients declined residential treatment is important and suggests the need for flexible, patient-centered post-acute care models that can engage patients who range from pre-contemplative to action stages of change. Low recruitment also raises questions as to the necessity of stringent residential requirements (e.g. the 30-day blackout period and intensive group attendance), and underscores the need to integrate pain management and other physical healthcare into an SUD treatment setting for this population. Findings that patients with complex medical illness (including PICC lines) and medications for addiction treatment (MAT) “stood out” in residential suggests a need for increased medical support and staff training in residential treatment settings. Finally, though MERT was developed based on a patient needs assessment and broad stakeholder input, our experience raises the question of whether a more iterative design process that included ongoing feedback from adults with SUD and residential staff may have led to a more successful intervention. While a single solution to this widespread national problem is unlikely, we aim to demonstrate lessons that are likely to be applicable across future models.” |
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