Integrated Inpatient Care Team Improves Outcomes for People Who Inject Drugs in Scotland

Overview

An integrated inpatient care team in a Scottish hospital significantly improved health outcomes for people who inject drugs (PWID) hospitalized with injection-related infections. Compared to historic controls, patients managed by the team had more severe infections but higher rates of blood-borne virus screening and outpatient follow-up with supported attendance.

Background

Hospitalizations for injection drug use complications have increased in Scotland over the past decade, with evolving injection behaviors including increased cocaine use and poly-substance use. PWID experience complex infections such as bacteremia and blood-borne viruses, compounded by social and medical multimorbidities that contribute to prolonged hospital stays and high rates of unplanned discharge. Traditional care models often fail to address these challenges, prompting a shift toward person-centered, integrated care approaches. Integrated care teams combining infectious disease expertise, drug liaison, and assertive outreach have shown promise in the US but have not been widely implemented in the UK until recently.

Data Highlights

Key Findings

• Patients managed by the integrated team had more severe and complex infections, including a significantly higher rate of bacteremia (37.2% vs 11%).
• The integrated team cohort had a high prevalence of cocaine injection (81%), reflecting changing drug use patterns in Scotland.
• Blood-borne virus screening rates were substantially higher in the integrated team group (90.7%) compared to historic controls (64.4%).
• A markedly greater proportion of patients seen by the integrated team were offered outpatient follow-up with supported attendance (81% vs 6%).
• The integrated care model facilitated safer treatment pathways and improved engagement with outpatient services despite the complexity of patient needs.

Clinical Implications

Implementing a multidisciplinary integrated care team for PWID hospitalized with injection-related infections can enhance adherence to recommended care standards such as blood-borne virus screening and improve linkage to outpatient services. This patient-centered approach addresses both medical and social complexities, potentially reducing unplanned discharges and readmissions. Clinicians should consider adopting similar integrated models to optimize outcomes in this vulnerable population.

Conclusion

The integrated inpatient care team model effectively meets the complex healthcare needs of PWID in Scotland, improving infection management and continuity of care. This approach offers a promising framework for enhancing outcomes in similar healthcare settings.

References

1. Meeting the Healthcare Requirements of Individuals Who Inject Drugs: An Analytical Overview of an Integrated Inpatient Care Team in an Acute Hospital Setting in Scotland, 2023