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Implementing Peer Support in Emergency Departments and Inpatient Settings
Anthony Lucas, MPH; Mark Lanyon, PhD, ICADC, ICCDPD, LCDP, LPC
INTRODUCTION
Actively substance-abusing patients are common in hospital emergency departments (ED) and inpatient settings. Frequent users of both the ED and inpatient estimates vary from 58 to 77 percent.1,2 Untreated, substance use disorders (SUD) are associated resultant poor health outcomes and costly recurring overutilization of the hospital’s health care resources.3 It is estimated that substance- abusing frequent users result in 8.9 ED visits annually with average annual charges of $13,000 per patient.1 It is further estimated that substance-abusing frequent users result in 1.3 inpatient hospital admissions annually — 5.8 inpatient days each, with average annual charges of $45,000 per patient.1
Research has shown that 20 percent of behavioral health patients consume 80 percent of hospital resources by cycling through the most acute and expensive levels of care. Continued use of these acute and expensive levels of care without adding a strong recovery support system is like treating a sinus infection with only half of the prescribed antibiotics. The symptoms of the sinus infection temporarily subside, but the infection returns worse than in the beginning.4
Substance abuse has a severe impact on the individual, the family, and society including hospitals, the criminal justice system, and social services. Substance abuse is ubiquitous, destructive, and hard to address because users are often hard to engage. Hospitals tend to aggregate the highly-disordered patients. Engaging these patients can be a challenge often resulting in poor adherence to care and poor clinical outcomes. Traditionally, hospitals do not have the resources or infrastructure to address the patient’s SUD while in the hospital or at discharge. Patients are often discharged with little or no education on their addiction, no connection to treatment, and may not even realize they have an SUD.5
To address these needs, Allegheny County, Penn. engaged in a Quality Improvement Project partnership with the Commonwealth of Pennsylvania’s Department of Human Services in 2012 to increase the initiation and engagement of people with SUD treatment. This partnership was supported by a grant from the managed care organizations, two regional health systems, four hospitals, and the local county Department of Human Services. monitoring agency for behavioral health managed care services, was engaged by the Commonwealth to provide project management promising interventions to implement in the greater Pittsburgh area. By 2014, one of the approaches considered, and eventually adopted, was the Project Engage model, which utilizes people with lived SUD experience (peer supports) in non-psychiatric hospital ED and inpatient settings.
of peer support in medical settings, the learning collaborative approach for model replication, and lessons learned for successful implementation.
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Del Med J | December 2017 | Vol. 89 | No. 12
