Clinical Scorecard: 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

At a Glance

Key Highlights

• Integrated care team includes infectious diseases consultant, drug liaison nurse, assertive outreach worker, and OPAT/COPAT services
• Patients managed by the integrated team had higher rates of severe infections and cocaine injection but improved BBV screening and outpatient referral rates
• Person-centered, multidisciplinary care model improves engagement, supports safe discharge, and bridges hospital and community care

Guideline-Based Recommendations

Diagnosis

• Screen all hospitalized PWID for blood-borne viruses (BBVs) including HIV, hepatitis B, and hepatitis C
• Assess severity and complexity of injection-related infections including bacteremia, abscesses, and infected DVT

Management

• Implement integrated care teams combining infectious diseases expertise, drug liaison, and assertive outreach
• Offer medication-assisted treatment for opioid use disorder alongside infection management
• Provide harm reduction advice and interventions during hospital stay
• Use outpatient antimicrobial therapy (OPAT) or complex oral antibiotic therapy (COPAT) for ongoing infection management post-discharge

Monitoring & Follow-up

• Conduct regular clinical reviews and drug toxicity monitoring during outpatient antibiotic therapy
• Support patient attendance at outpatient appointments through assertive outreach

Risks

• High risk of patient-directed discharge leading to incomplete treatment
• Social and medical multimorbidities complicate management and increase disease burden
• Stigma and poorly managed addiction symptoms can reduce engagement with care

Patient & Prescribing Data

PWID hospitalized with injection-related infections, including those with severe infections and high prevalence of cocaine injection

Integrated team patients had higher BBV screening rates (90.7% vs 64.4%) and outpatient care offers (81% vs 6%) compared to historic controls, indicating improved treatment engagement and follow-up

Clinical Best Practices

• Establish multidisciplinary integrated care teams to address complex medical and social needs of PWID
• Use automated alerts to identify admitted PWID for early team intervention
• Coordinate infection management with addiction treatment and harm reduction services
• Facilitate supported outpatient follow-up to reduce readmissions and incomplete treatment
• Adopt person-centered care models to improve patient engagement and health outcomes

References

• Scottish drug use and hospitalization trends
• Integrated care models for PWID with infections
• OPAT and COPAT services in infection management