Berks County Medical Society Medical Record Fall 2019 - 29

Analysis of Effective
Intervention Strategies for
Patients Presenting with
Substance Use Disorder
by Charles Barbera, MD, Reading Hospital
at Tower Health
Erica E. Gleason, Drexel University College of Medicine
INTRODUCTION: The frequency of substance abuse-related
emergency department visits demands that the most effective
intervention strategies to combat the issue be identified. The "Warm
Handoff" (WHO) Program aims to provide patients with access to
detoxification and rehabilitation services to prevent returns to the
emergency department and promote recovery. The program was
determined to be between 67% and 73% effective at placing patients
in treatment between June of 2017 and June of 2018. Based upon
this success rate, we hypothesized that the program continued to
successfully recruit patients between June of 2018 and June of 2019,
leading to higher rates of recovery than for those who were not
successfully recruited to the program.
METHODS: A list of 312 patients was compiled using the UPMC
Opioid Report on Web Focus for a one-year period, from June of
2018 through June of 2019. Information from patient charts was
entered into an Excel Datasheet. For each patient, it was noted
whether the individual was offered a WHO, accepted a WHO,
or returned to the ED with drug-related complaints. Recovery
was assessed by whether the patient returned to the emergency
department with drug-related complaints. Data analysis was
performed by calculating rates of acceptance and returns to ED
in Excel. In the second part of the study, the Warm Handoff
intervention was compared to the intervention of an addiction
medicine physician. The percentage of patients who accepted
treatment after an addiction medicine consult was compared to the
percentage that accepted treatment through the Warm Handoff
program.

a Warm Handoff; 20.6% of individuals accepted services while
79.3% did not accept. 25.6% of patients who accepted the WHO
returned to the emergency department for drug-related complaints,
while 19% of those who did not accept the WHO returned. The
remaining 54 of the original 312 patients were admitted to the
hospital during their visit; 61.1% of these individuals accepted
treatment from an addiction medicine physician and 38.9% did not
accept treatment.
CONCLUSION: The results indicate that the program is not
recruiting patients as successfully as last year. However, because it is
not known whether individuals were excluded from last year's data
because of confounding mental health treatment, it is not possible
at this time to compare rates of acceptance between years. This can
be corrected for in further analysis of the program's success if future
methods of group assignment remain the same as for this project.
The rate of returns to the ED was lower for patients who did not
accept the Warm Handoff. Further analysis with the same group
assignment method is necessary to substantiate these results. Patients
who were admitted to the hospital during their stay received an
addiction medicine consult with a trained physician. The percentage
of patients who were interested in some form of treatment after
their addiction medicine consult was greater than the percentage
interested in treatment via Warm Handoff. Many patients desired
to start medication assisted treatment to aid in their rehabilitation
process after consult with addiction medicine. These results suggest
the possibility of an enhancement to the WHO program through
the addition of MAT resources in the emergency department.
Erica Gleason is a graduate of the University of Scranton
and is now in the Class of 2022 at Drexel University College
of Medicine. While at the University of Scranton she acted
as a Retreat Leader with the goal of building community
and inspiring self-reflection, and currently at Drexel she is
a member of the a cappella group Doctor's Note and helps
interview and evaluate prospective students.
continued on next page

RESULTS: The full list of patients on the UPMC Opioid Report
during this one-year period was separated into two groups: those
who received mental health assessment or treatment over the course
of their hospital stay and those who did not. The sample of 312
individuals was composed of the patients who did not need mental
health assessment or treatment. Patients necessitating mental health
assessment or treatment were excluded from this sample because
the offer of the Warm Handoff Program is extended to individuals
who have been psychologically cleared by a health professional.
Fifty patients were not offered a Warm Handoff at the time of
their emergency visit. Two hundred and eight patients were offered

FALL 2019

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Berks County Medical Society Medical Record Fall 2019

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