iHOST: Improving Hospital OST
Improving Hospital Opioid Substitution Therapy (iHOST): implementation and assessment of an intervention to reduce late presentations, discharges against medical advice and repeat admissions among people who use opioids.
London School of Hygiene & Tropical Medicine
Duration of Study in the UK
2 years, 11 months, 28 days
Healthcare services can be inaccessible for people who use drugs such as heroin. Hesitancy in accessing care can lead to high use of accident and emergency (A&E) services and hospital admission for preventable conditions. When people who use opioids (PWUO) are admitted to hospital, they usually need prompt medication e.g. opioid substitution therapy (OST) to prevent drug withdrawal. Delayed provision of OST can lead to use of illicit drugs in hospital and discharge against medical advice.
The iHOST intervention aims to improve OST provision in hospital settings. It has been co-developed with people who use opioids and other stakeholders. It consists of:
1. A ‘My Meds’ patient advocacy card
2. An OST advocacy and information helpline for PWUO and staff.
3. Training for hospital staff.
4. A ‘best practice’ hospital OST policy template
5. A local iHOST ‘champion’
Over 3 years this study will test and implement iHOST in 3 hospital settings and linked drug treatment services. We will: 1st yr) work with London patients and providers to finalise, test and adapt iHOST; 2nd yr) implement iHOST and assess its acceptability, quality and impact at Staffordshire and Leeds hospitals; 3rd yr): refine and disseminate iHOST, develop protocols to help services adapt and use iHOST, and to inform future research.
We will measure iHOST success with quantitative and qualitative methods. We will interview patients and providers to understand iHOST acceptability, uptake, and impact on practice. We will compare patient records at the sites before and after the intervention to assess the difference in discharge against medical advice and emergency readmission within 28 days. We will analyse NHS Hospital Episode Statistics (HES) data for these outcomes to provide a national comparison to the intervention sites. We will cost iHOST and assess its benefits to analyse its value for money.
London - Camden & Kings Cross Research Ethics Committee
Date of REC Opinion
31 May 2022