The Value of Hospitalization in the Opioid Epidemic: A Scoping Review
Bibliographic record
Abstract
ABSTRACTRésumé Background: Opioid use disorder (OUD) is a potentially chronic, relapsing condition associated with a great degree of morbidity and mortality. In Canada, OUD is at the forefront of the opioid epidemic, which has claimed more than 8000 lives between January 2016 and March 2018. As individuals with OUD are more likely to receive health services from the emergency department and acute hospitalizations, it makes logical sense for there to be a move toward improving the quality of hospital-based services. Hospitalization represents a golden opportunity to connect patients who have OUD with evidence-based treatments. Objectives: To evaluate the effectiveness and offering of hospital-based interventions for individuals with OUD by way of a scoping review. Data sources: Five online databases were searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Study selection: Randomized and nonrandomized intervention studies were considered eligible for inclusion in this scoping review. Results: Twenty two of 354 retrieved papers met inclusion criteria. Detoxification programs (n = 7), relapse prevention programs (n = 11), maternal–perinatal programs (n = 2), and combination programs (n = 2) were identified. Both interventions and outcome measures varied widely between studies, but the overall findings demonstrated the effectiveness of the interventions considered with regard to improved retention in treatment, reduction of illicit opioid use, and reduced hospital length of stay. Conclusions: The findings of our study demonstrate that there is a high degree of congruence between the effectiveness of interventions initiated in the community versus hospital-based treatments for individuals with OUD. Hospitalization represents a golden opportunity to connect patients who have OUD with evidence-based treatments. Contexte: Les troubles liés à l’usage d’opioïdes (TLUO) sont une affection potentiellement chronique et récurrente associée à un degré élevé de morbidité et de mortalité. Au Canada, TLUO figure au premier rang dans l’épidémie d’opioïdes. Elle a coÛté la vie à plus de 8 000 personnes entre janvier 2016 et mars 2018. Comme les personnes ayant cette maladie sont plus susceptibles de recevoir des soins du service des urgences et des hospitalisations en soins de courte durée, il est logique de progresser vers l’amélioration de la qualité des services hospitaliers. L’hospitalisation représente une occasion en or de mettre en relation les patients présentant une TLUO avec des traitements éprouvés. Objectifs: évaluer l’efficacité et l’offre d’interventions en milieu hospitalier pour les personnes atteintes de TLUO par le biais d’une étude de la portée des incidences. Sources de données: cinq bases de données en ligne ont été explorées conformément aux directives de PRISMA. Sélection de l’étude: les études d’intervention aléatoires et non aléatoires ont été considérées comme admissible à l’inscription dans cet examen exploratoire. Résultats: 22 des 354 études récupérés répondaient aux critères d’inclusion. Des programmes de désintoxication (n = 7), des programmes de prévention des rechutes (n = 11), des programmes maternels-périnataux (n = 2) et des programmes combinés (n = 2) ont été identifiés. Les interventions et les mesures de résultats variaient beaucoup d’une étude à l’autre, mais l’ensemble des résultats démontrait l’efficacité des interventions envisagées en ce qui concerne l’amélioration de la rétention du traitement, la réduction de la consommation d’opioïdes illicites et la réduction de la durée de séjour en hôpital. Conclusions: Les résultats de notre étude démontrent qu’il existe un degré élevé de congruence entre l’efficacité des interventions initiées dans la communauté et les traitements en milieu hospitalier pour les personnes atteintes de TLUO. L’hospitalisation représente une occasion en or de mettre en relation les patients présentant un TLUO avec des traitements éprouvés.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.034 | 0.154 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.007 | 0.010 |
| Bibliometrics | 0.024 | 0.019 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.007 | 0.005 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".