Patients with opioid use disorder (OUD) leaving treatment early against medical advice (AMA) are associated with negative treatment outcomes as well as re-admissions. For facilities, AMA discharges negatively impact the bottom line.
Why Patients Leave
The number one reason patients abandon treatment prematurely is the fear of withdrawal symptoms.1 Patients with OUD are up to three times more likely to be discharged AMA compared to those without OUD. In a recent study, some core issues were identified as patients’ reasons for leaving the hospital prematurely: undertreated withdrawal and ongoing craving to use drugs, uncontrolled acute and chronic pain, and hospital restrictions such as not being allowed to intermittently leave the hospital floor. For patients with histories of criminal involvement, being hospitalized reminded them of being incarcerated.2
Costs for Facility
When patients leave treatment AMA, in addition to negatively affecting patient outcomes and success, the facility’s financial bottom line is directly impacted. According to several addiction treatment facilities, the largest cost for the facility is patient intake which is estimated at approximately $2500. These costs represent multiple factors — staff time and paperwork associated with intake and diagnosis, withdrawal protocols and medication if needed, counseling, facility costs, and personnel needed for case management and administration.
In addition to these “hard” costs, when a patient wants to leave AMA, it generates a negative impact on facility efficiency because it creates a crisis of disruption that pulls much of the treatment team staff away to convince the one patient to stay. The facility also loses the additional monetary funding from insurance reimbursement, direct patient pay, or grant funding to complete treatment. Secondarily, studies have shown that a significant number of patients who leave AMA are re-admitted, often within 30 days.3 This patient churning process produces further demands on treatment facility resources which prevents staff from helping existing patients.
Addressing Withdrawal Symptoms
Recently, in partnership with leading inpatient facilities, Speranza Therapeutics has witnessed significant reductions in patients leaving AMA by using Speranza Therapeutics S.T. Genesis, a noninvasive, drug-free device that reduces the physical and emotional effects of opioid withdrawal. The device is applied to the patient’s ear and manages withdrawal symptoms for 5 days.
Dramatic Reduction in AMA rates
Providers in this partnership using the S.T. Genesis device averaged a 50% reduction in AMA rates compared to opioid replacement induction protocols. Additionally, 90% of those patients went on to longer term treatment programs in Residential Treatment Centers or through Intensive Outpatient Programs. This demonstrated success provided by S.T. Genesis helps achieve both enhanced patient outcomes and improved facility bottom lines.
Sources:
1. Weiss RD, Potter JS, Griffin ML, et al. Reasons for opioid use among patients with dependence on prescription opioids: the role of chronic pain. J Subst Abuse Treat. 2014;47(2):140-145. doi:10.1016/j.jsat.2014.03.004
2. Rachel Simon, Rachel Snow & Sarah Wakeman (2020) Understanding why patients with substance use disorders leave the hospital against medical advice: A qualitative study, Substance Abuse, 41:4, 519-525, DOI: 10.1080/08897077.2019.1671942
3. Choi M, Kim H, Qian H, Palepu A (2011) Readmission Rates of Patients Discharged against Medical Advice: A Matched Cohort Study. PLoS ONE 6(9): e24459. https://doi.org/10.1371/journal.pone.0024459