From the 2021 HVPAA National Conference
Kristin Herbert (University of South Carolina School of Medicine Greenville), Michael Schmidt, Bree Baginski, Kaileigh Byrne, Perana Roth, Samantha Worth, Onyedikachi Uzor, Kyleigh Connolly
Background
Substance use disorder (SUD) is a national health epidemic. Current standard of care (SOC) for SUD is an outpatient referral following hospital discharge. However, research shows that only 32% of SUD patients who receive a referral actually complete a treatment plan at two-month follow-up. There is no protocol in place to assist navigating these patients to outpatient services, creating a significant lapse in treatment. Professional recovery coaching utilizes peer mentorship to tailor to each patient’s specific needs and stage of recovery. Preliminary research suggests that peer-based recovery services are associated with reduced rates of relapse and increased retention in treatment programs. Implementing recovery coaching prior to discharge is a new model of care allowing providers to practice preventative medicine in treating patients with SUD.
Objective
The purpose of this study is to identify barriers to SUD recovery and assess the efficacy of having providers implement an inpatient connection to recovery coaches as a means of reducing specific personal, social, and psychological barriers to SUD patient recovery.
Methods
This study is a 6-month longitudinal, prospective randomized controlled trial comparing outcomes of patients linked with a peer coach in the hospital to patients given the current SOC. Patients are randomized to either an outpatient referral or a recovery coach using a REDCap algorithm. Thus, one of the predictors is Study Arm (Intervention vs. Control). At baseline, patients complete neurocognitive and survey assessments of inhibitory control, personal and social barriers to their recovery, physical and mental health, and quality of life; these assessments serve as additional predictors in this study. The primary outcome is the patient’s engagement in recovery services. Secondary outcomes include substance use frequency (ASI-Lite) and quality of life (SF-12). Outcomes are assessed through phone surveys and chart review at 30, 60, 90 days and an in-person visit at 6 months.
Results
Results show that the inpatient recovery coach intervention leads to fewer days of drug use (t(72)=2.009,p=.048) at 60-day follow-up and greater engagement in recovery services (χ2(1, 88)=4.83, p=.028) during the six-month post-discharge study period than the control; engagement rates were 66% in the intervention and 43% in the control. In terms of study moderators, poorer inhibitory control at baseline was associated with poorer rates of engagement regardless of condition (β = -2.65, p=.056). In the control condition, lack of financial resources, lack of transport, and lack of drug-free living environment were all associated with higher levels of drug use (ps<.05) across the 6-month study-period. No association was observed in the intervention condition, suggesting that inpatient recovery coaching minimizes these barriers to SUD recovery.
Conclusions
Initiating peer recovery coaching in the hospital is an effective way for providers to link patients to preventative post-discharge care and decrease substance use frequency. Specifically, the recovery coaching model reduces the correlation between 3 common risk factors for SUD relapse: lack of financial resources, lack of transport, and lack of drug-free living environment.
Clinical Implications
This project improves patient quality of care by facilitating greater engagement in recovery services and decreased substance use frequency. It identifies risk factors to SUD recovery failure that the recovery-coach model helps to mitigate and helps providers initiate a longitudinal partnership between the healthcare system and the patient at discharge.
