{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T23:04:35Z","timestamp":1783465475474,"version":"3.55.0"},"update-to":[{"DOI":"10.3310\/nihropenres.13534.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T00:00:00Z","timestamp":1730851200000}}],"reference-count":44,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T00:00:00Z","timestamp":1730851200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR133022"],"award-info":[{"award-number":["NIHR133022"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["openresearch.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["NIHR Open Res"],"abstract":"<ns3:p>Background Opioid substitution therapy (also known as \u2018opioid agonist therapy\u2019 or \u2018medication treatment of opioid use disorder\u2019) is associated with improved health and social outcomes for people who use heroin and other illicit opioids. It is typically managed in the community and is not always continued when people are admitted to hospital. This causes opioid withdrawal, patient-directed discharge, and increased costs. We are establishing a project called iHOST (improving hospital opioid substitution therapy) to address these problems. This is an applied health research project in which we will develop and evaluate an intervention that aims to improve opioid substitution therapy in three acute hospitals in England. The intervention was developed in collaboration with stakeholders including people who use opioids, hospital staff, and other professionals who work with this group. It includes five components: (1) a card that patients can use to help hospital clinicians confirm their opioid substitution therapy, (2) a helpline for patients and staff, (3) an online training module for staff, (4) a clinical guideline for managing opioid withdrawal in hospital, and (5) \u2018champion\u2019 roles at each hospital. Methods We will do a mixed-methods study including a quasi-experimental quantitative study and a qualitative process evaluation. The primary outcomes for the quantitative study are patient-directed discharge and emergency readmission within 28 days. We will do a difference-in-difference analysis comparing changes in these outcomes for patients at iHOST sites with changes for patients at control hospitals. The process evaluation will use in-depth interviews, focus groups, and site observations with people who use opioids and staff. We will assess acceptability of the intervention, barriers and facilitators to implementation, and contextual factors impacting outcomes. Impact We anticipate that iHOST will improve care for hospital patients who use illicit opioids and\/or are receiving community-based opioid substitution therapy. Depending on the results, we will promote the intervention at hospitals across the UK. Dissemination, including through publication, will inform hospital-based services for people who use drugs both in the UK and other countries.<\/ns3:p>","DOI":"10.3310\/nihropenres.13534.2","type":"journal-article","created":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T11:25:07Z","timestamp":1730892307000},"page":"10","update-policy":"https:\/\/doi.org\/10.3310\/nihropenres.crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Improving hospital-based opioid substitution therapy (iHOST): protocol for a mixed-methods evaluation"],"prefix":"10.3310","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3698-7196","authenticated-orcid":false,"given":"Dan","family":"Lewer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Burns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niamh","family":"Eastwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalind","family":"Gittins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3617-1966","authenticated-orcid":false,"given":"Adam","family":"Holland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5712-5734","authenticated-orcid":false,"given":"Vivian","family":"Hope","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aubrey","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3442-3995","authenticated-orcid":false,"given":"Penny","family":"Lewthwaite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4575-2104","authenticated-orcid":false,"given":"Ann-Marie","family":"Morris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Noctor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Preston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4920-0914","authenticated-orcid":false,"given":"Jenny","family":"Scott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0822-3279","authenticated-orcid":false,"given":"Erica","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sedona","family":"Sweeney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nerissa","family":"Tilouche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisha","family":"Wickremsinhe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2024,11,6]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"1011-1023","DOI":"10.1111\/add.14892","article-title":"Frequency 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status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.3310\/nihropenres.14984.r33375, Sandra A Springer, Yale School of Medicine, Connecticut, 19 Nov 2024, version 2, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/4-10\/v2#referee-response-33375","order":0,"name":"referee-response-33375","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.3310\/nihropenres.14692.r33051, Chris Tremonti, Alcohol and Drug Services St Vincent\u2019s Hospital, University of Sydney, Sydney, 08 Oct 2024, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/4-10\/v1#referee-response-33051","order":1,"name":"referee-response-33051","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Dan Lewer<\/b>; \n<i>Posted: 04 Nov 2024<\/i>; 11. 'Patients who may benefit from OST' \u2013 a limitation of using the ICD-11 diagnostic criteria of opioid use disorder is that that those not forthcoming in their opioid use may not be captured. In hospitals without ihost \u2013 where stigma may be higher against those who use opioids \u2013 there may therefore be less people captured by this criteria, and a \u2018falsely high\u2019 proportion of people receiving appropriate treatment. I\u2019m unsure if I have a solution to that problem, it may just be worth discussing.  \n<i>Response: We agree, this is a potential source of bias. We have added the following text to the list of limitations in our supplementary file: \u201c<\/i>\n<b><i>Use of ICD-10 codes may differ between iHOST and control sites<\/i><\/b>\n<i>. We will use ICD-10 diagnoses (F11, Mental and behavioural disorders due to use of opioids) to identify eligible patients. The use of these codes may differ between hospitals. Bias may occur if iHOST sites become more likely to identify opioid dependence after implementation of the intervention. For example, this scenario may lead to a lower average severity of opioid dependence because the hospital may have a lower threshold for identifying opioid dependence, and therefore an inflated effect estimate. This is just an example of a potential bias resulting from changing use of ICD-10 codes.\u201d<\/i>  12.&nbsp;I am unclear why the authors are only capturing those administer methadone. I do appreciate that buprenorphine is now commonly being used for pain management, but not typically at the doses seen in OST. Furthermore in my jurisdiction it is commonly used in the form of suboxone or subutex, while temgesic is used for pain. I do wonder if patients on buprenorphine could be captured, perhaps with a criteria of it needing to be in a specific form, or on a daily dose &gt;8mg (which would be unusual in pain management).  \n<i>Response: Please also see comments #7 and #8. In our context, buprenorphine is rarely used for OST, and in addition detailed prescribing data is typically difficult to capture in a structured format. In our partner hospitals it would likely require reading free-text notes for each patient prescribed buprenorphine. ie. The information specialists at the hospitals can query a database to identify patients prescribed buprenorphine, but they cannot determine what product and dose was used. The majority who are prescribed buprenorphine probably would not be receiving OST.<\/i>  13. The limitation of treatment bias warrants a small discussion too - those hospitals with iHOST may be geared towards the success of its implementation.  \n<i>Response: We agree and have added the following text under Limitations\/process evaluation: \u201c(d) The three hospitals participating in iHOST may be more motivated or otherwise optimised for successful implementation. Recommendations for roll-out will need to account for potential additional barriers such as the absence of a motivated senior \u2018champion\u2019.\u201d<\/i>","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/4-10\/v2#referee-comment-3375","order":2,"name":"referee-comment-3375","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This project is funded by the National Institute for Health and Care Research (NIHR), a \u2018Health and Social Care Delivery Research\u2019 award to Professor Magdalena Harris (Improving Hospital Opiate Substitution Therapy (iHOST), Grant Reference Number NIHR133022). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}