{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:58:29Z","timestamp":1785445109343,"version":"3.56.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Addict Sci Clin Pract"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People who use drugs (PWUD) interact with hospital and emergency departments at higher rates than the general population. PWUD have unique needs when receiving hospital-based care and often face challenges receiving care in hospital-based environments. Programs such as Hospital at Home provide the opportunity to deliver hospital-level care outside of traditional hospital-based environments through the use of in-person outreach and virtual care, however have traditionally faced challenges providing this care to people actively using substances and to those who are unhoused or unsafely housed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      In Vancouver, Canada a novel partnership was formed between Hospital at Home and a community-based, harm reduction site in order to provide hospital-level care for PWUD who are unhoused or precariously housed. Baseline demographic data as well as substance use disorder diagnoses, admitting diagnoses and admission outcome were collected. During the first 3 months of the program, 17 patients were admitted, with 94% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916) of patients admitted for an infectious disease. There was a high preponderance of opioid use disorder (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915, 88%) and stimulant use disorder (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914, 82%). There was 1 patient-initiated discharge and 2 patients required transfer back to hospital to receive a higher level of care. All other patients completed treatment and were discharged to community. Median length of stay was 31 days (standard deviation 26 days).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early program findings suggest that providing hospital-level of care in a community based harm reduction setting may be an acceptable alternative to traditional hospital admission in appropriately selected patients who use drugs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13722-026-00708-9","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T17:36:41Z","timestamp":1785260201000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An application of hospital at home for precariously housed people who use drugs in a community-based harm reduction setting in Vancouver, Canada"],"prefix":"10.1186","volume":"21","author":[{"given":"Pamela","family":"Bai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Fairbairn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Dick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Drake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephane","family":"Partridge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Brooks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"issue":"6","key":"708_CR1","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1111\/add.14892","volume":"115","author":"D Lewer","year":"2020","unstructured":"Lewer D, Freer J, King E, Larney S, Degenhardt L, Tweed EJ, et al. Frequency of health-care utilization by adults who use illicit drugs: a systematic review and meta\u2010analysis. Addiction. 2020;115(6):1011\u201323. https:\/\/doi.org\/10.1111\/add.14892. PubMed PMID: 31705770; PubMed Central PMCID: PMC7210080.","journal-title":"Addiction"},{"issue":"12","key":"708_CR2","doi-asserted-by":"publisher","first-page":"e53","DOI":"10.2105\/AJPH.2015.302885","volume":"105","author":"L Ti","year":"2015","unstructured":"Ti L, Ti L. Leaving the Hospital Against Medical Advice Among People Who Use Illicit Drugs: A Systematic Review. Am J Public Health. 2015;105(12):e53\u20139. https:\/\/doi.org\/10.2105\/AJPH.2015.302885.","journal-title":"Am J Public Health"},{"issue":"31","key":"708_CR3","doi-asserted-by":"publisher","first-page":"E1066","DOI":"10.1503\/cmaj.240364","volume":"196","author":"M Khan","year":"2024","unstructured":"Khan M, Nicole X, Crabtree A, Moe J, Nasmith T, Daly-Grafstein D, et al. Before medically advised departure from hospital and subsequent drug overdose: a population-based cohort study. CMAJ. 2024;196(31):E1066\u201375. https:\/\/doi.org\/10.1503\/cmaj.240364. PubMed PMID: 39313269; PubMed Central PMCID: PMC11426346.","journal-title":"CMAJ"},{"key":"708_CR4","doi-asserted-by":"publisher","unstructured":"Choi M, Kim H, Qian H, Palepu A. Readmission rates of patients discharged against medical advice: a matched cohort study. PLoS One. 2011;6(9):e24459. https:\/\/doi.org\/10.1371\/journal.pone.0024459","DOI":"10.1371\/journal.pone.0024459"},{"issue":"11","key":"708_CR5","doi-asserted-by":"publisher","first-page":"1935","DOI":"10.1093\/cid\/ciy924","volume":"68","author":"LR Marks","year":"2019","unstructured":"Marks LR, Munigala S, Warren DK, Liang SY, Schwarz ES, Durkin MJ. Addiction Medicine Consultations Reduce Readmission Rates for Patients With Serious Infections From Opioid Use Disorder. Clin Infect Dis. 2019;68(11):1935\u20137. https:\/\/doi.org\/10.1093\/cid\/ciy924. PubMed PMID: 30357363; PubMed Central PMCID: PMC6522678.","journal-title":"Clin Infect Dis"},{"issue":"6","key":"708_CR6","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1001\/jamainternmed.2024.8586","volume":"185","author":"AJ Ober","year":"2025","unstructured":"Ober AJ, Murray-Krezan C, Page K, Friedmann PD, Anderson J, Osilla KC, et al. Hospital Addiction Consultation Service and Opioid Use Disorder Treatment: The START Randomized Clinical Trial. JAMA Intern Med. 2025;185(6):624. https:\/\/doi.org\/10.1001\/jamainternmed.2024.8586.","journal-title":"JAMA Intern Med"},{"key":"708_CR7","unstructured":"Decriminalization. in B.C. [Internet]. [cited 2025 Nov 20]. Available from: https:\/\/www.bccdc.ca:443\/health-info\/prevention-public-health\/decriminalization-in-bc"},{"issue":"5","key":"708_CR8","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1111\/dar.12270","volume":"34","author":"HK Grewal","year":"2015","unstructured":"Grewal HK, Ti L, Hayashi K, Dobrer S, Wood E, Kerr T. Illicit Drug Use In Acute Care Settings. Drug Alcohol Rev. 2015;34(5):499\u2013502. https:\/\/doi.org\/10.1111\/dar.12270. PubMed PMID: 25944526; PubMed Central PMCID: PMC4636467.","journal-title":"Drug Alcohol Rev"},{"key":"708_CR9","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.socscimed.2014.01.010","volume":"105","author":"R McNeil","year":"2014","unstructured":"McNeil R, Small W, Wood E, Kerr T. Hospitals as a \u2018risk environment\u2019: An ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs. Soc Sci Med. 2014;105:59\u201366. https:\/\/doi.org\/10.1016\/j.socscimed.2014.01.010.","journal-title":"Soc Sci Med"},{"issue":"2","key":"708_CR10","doi-asserted-by":"publisher","first-page":"e0229174","DOI":"10.1371\/journal.pone.0229174","volume":"15","author":"JA Singh","year":"2020","unstructured":"Singh JA, Cleveland JD, National. U.S. time-trends in opioid use disorder hospitalizations and associated healthcare utilization and mortality. PLoS ONE. 2020;15(2):e0229174. https:\/\/doi.org\/10.1371\/journal.pone.0229174.","journal-title":"PLoS ONE"},{"issue":"1","key":"708_CR11","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.annemergmed.2019.04.020","volume":"75","author":"SG Weiner","year":"2020","unstructured":"Weiner SG, Baker O, Bernson D, Schuur JD. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Ann Emerg Med. 2020;75(1):13\u20137. https:\/\/doi.org\/10.1016\/j.annemergmed.2019.04.020. PubMed PMID: 31229387; PubMed Central PMCID: PMC6920606.","journal-title":"Ann Emerg Med"},{"issue":"4","key":"708_CR12","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1097\/ADM.0000000000000312","volume":"11","author":"YI Hser","year":"2017","unstructured":"Hser YI, Mooney LJ, Saxon AJ, Miotto K, Bell DS, Zhu Y, et al. High Mortality Among Patients With Opioid Use Disorder in a Large Healthcare System. J Addict Med. 2017;11(4):315\u20139. https:\/\/doi.org\/10.1097\/ADM.0000000000000312. PubMed PMID: 28426439; PubMed Central PMCID: PMC5930020.","journal-title":"J Addict Med"},{"key":"708_CR13","doi-asserted-by":"publisher","unstructured":"Lewer D, Eastwood B, White M, Brothers TD, McCusker M, Copeland C, et al. Fatal opioid overdoses during and shortly after hospital admissions in England: a case-crossover study. PLoS Med. 2021;18(10):e1003759. https:\/\/doi.org\/10.1371\/journal.pmed.1003759","DOI":"10.1371\/journal.pmed.1003759"},{"key":"708_CR14","doi-asserted-by":"publisher","unstructured":"Lewer D, Brothers TD, Harris M, Rock KL, Copeland CS. C <>Lennox editor 2023 Opioid-related deaths during hospital admissions or shortly after discharge in the United Kingdom: A thematic framework analysis of coroner reports. PLoS ONE 18 4 e0283549 https:\/\/doi.org\/10.1371\/journal.pone.0283549.","DOI":"10.1371\/journal.pone.0283549"},{"key":"708_CR15","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s13722-023-00433-7","volume":"19","author":"W Rioux","year":"2024","unstructured":"Rioux W, Kilby K, Jones S, Joshi P, Vandenberg S, Ghosh SM. Perspectives of healthcare workers on the integration of overdose detection technologies in acute care settings. Addict Sci Clin Pract. 2024;19:4. https:\/\/doi.org\/10.1186\/s13722-023-00433-7. PubMed PMID: 38217056; PubMed Central PMCID: PMC10785401.","journal-title":"Addict Sci Clin Pract"},{"key":"708_CR16","unstructured":"Canadian Agency for Drugs and Technologies in Health. Virtual medicine wards and hospital-at-home programs. Health Technology Update [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2024 [cited 2025 Nov 20]. (CADTH Horizon Scans). Available from: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK604826\/ PubMed PMID: 38985908."},{"issue":"3","key":"708_CR17","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1097\/JXX.0000000000000814","volume":"35","author":"G Gaillard","year":"2023","unstructured":"Gaillard G, Russinoff I. Hospital at home: A change in the course of care. J Am Assoc Nurse Pract. 2023;35(3):179\u201382. 10. 1097\/JXX.0000000000000814 PubMed PMID: 36729809.","journal-title":"J Am Assoc Nurse Pract"},{"issue":"1","key":"708_CR18","doi-asserted-by":"publisher","first-page":"e043285","DOI":"10.1136\/bmjopen-2020-043285","volume":"11","author":"MQ Leong","year":"2021","unstructured":"Leong MQ, Lim CW, Lai YF. Comparison of Hospital-at-Home models: a systematic review of reviews. BMJ Open. 2021;11(1):e043285. https:\/\/doi.org\/10.1136\/bmjopen-2020-043285. PubMed PMID: 33514582; PubMed Central PMCID: PMC7849878.","journal-title":"BMJ Open"},{"issue":"11","key":"708_CR19","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1001\/jamainternmed.2016.5974","volume":"176","author":"J Conley","year":"2016","unstructured":"Conley J, O\u2019Brien CW, Leff BA, Bolen S, Zulman D. Alternative Strategies to Inpatient Hospitalization for Acute Medical Conditions: A Systematic Review. JAMA Intern Med. 2016;176(11):1693\u2013702. https:\/\/doi.org\/10.1001\/jamainternmed.2016.5974. PubMed PMID: 27695822.","journal-title":"JAMA Intern Med"},{"issue":"3","key":"708_CR20","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.amjmed.2021.10.007","volume":"135","author":"N Wald-Dickler","year":"2022","unstructured":"Wald-Dickler N, Holtom PD, Phillips MC, Centor RM, Lee RA, Baden R, et al. Oral Is the New IV\u2013Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review. Am J Med. 2022;135(3):369\u2013e3791. https:\/\/doi.org\/10.1016\/j.amjmed.2021.10.007. PubMed PMID: 34715060; PubMed Central PMCID: PMC8901545.","journal-title":"Am J Med"},{"issue":"9","key":"708_CR21","doi-asserted-by":"publisher","first-page":"1126","DOI":"10.1016\/j.cmi.2023.04.030","volume":"29","author":"MC Phillips","year":"2023","unstructured":"Phillips MC, Wald-Dickler N, Davar K, Lee R, Baden R, Holtom P, et al. Choosing patients over placebos: oral transitional therapy vs. IV-only therapy for bacteraemia and infective endocarditis. Clin Microbiol Infect. 2023;29(9):1126\u201332. https:\/\/doi.org\/10.1016\/j.cmi.2023.04.030. PubMed PMID: 37179005.","journal-title":"Clin Microbiol Infect"},{"issue":"5","key":"708_CR22","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1016\/S1473-3099(","volume":"24","author":"AJ Kaasch","year":"2024","unstructured":"Kaasch AJ, L\u00f3pez-Cort\u00e9s LE, Rodr\u00edguez-Ba\u00f1o J, Cisneros JM, Dolores Navarro M, F\u00e4tkenheuer G, et al. Efficacy and safety of an early oral switch in low-risk Staphylococcus aureus bloodstream infection (SABATO): an international, open-label, parallel-group, randomised, controlled, non-inferiority trial. Lancet Infect Dis. 2024;24(5):523\u201334. https:\/\/doi.org\/10.1016\/S1473-3099(. 23)00756-9 PubMed PMID: 38244557.","journal-title":"Lancet Infect Dis"},{"issue":"7","key":"708_CR23","doi-asserted-by":"publisher","first-page":"1892","DOI":"10.1111\/add.15383","volume":"116","author":"V Braithwaite","year":"2021","unstructured":"Braithwaite V, Ti L, Fairbairn N, Ahamad K, McLean M, Harrison S, et al. Building a hospital-based addiction medicine consultation service in Vancouver, Canada: the path taken and lessons learned. Addiction. 2021;116(7):1892\u2013900. https:\/\/doi.org\/10.1111\/add.15383.","journal-title":"Addiction"}],"container-title":["Addiction Science &amp; Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13722-026-00708-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13722-026-00708-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13722-026-00708-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:04:28Z","timestamp":1785441868000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13722-026-00708-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["708"],"URL":"https:\/\/doi.org\/10.1186\/s13722-026-00708-9","relation":{},"ISSN":["1940-0640"],"issn-type":[{"value":"1940-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"assertion":[{"value":"15 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Data was collected for the purpose of informing program design and was therefore exempt from research ethics board review. Under Article 2.5 of the Tri Council Policy Statement, quality improvement and program evaluation activities are not subject to institutional ethics review. This quality improvement initiative is in line with the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"58"}}