Feasibility of an interdisciplinary primary care-based intervention to improve care transitions for hospitalized patients with substance use disorders: The IntACT pilot randomized controlled trial protocol

Background Hospitalizations are common among individuals with substance use disorders (SUD) and represent crucial opportunities to engage patients in treatment. Quality efforts to increase SUD treatment access in hospital settings must be paired with interventions that support linkage to follow-up SUD and medical care. However, the best way to support patients with SUD during transitions of care after hospitalization is unknown. Methods The IntACT pilot study is a single-site randomized controlled trial that aims to assess the feasibility and preliminary effectiveness of a primary care-based Interdisciplinary Addiction Care Transition (IntACT) team. IntACT deploys from a partnering primary care clinic to the hospital to meet patients with SUD while they are admitted, then follows them after discharge for four months to facilitate linkage to and retention in follow-up care. The pilot study will randomize 75 hospitalized patients with SUD to receive IntACT or Usual Care, assessing both implementation and effectiveness outcomes over a six month study period. Primary outcomes include implementation measures (e.g., reach, acceptability, feasibility, and cost) assessed using a mixed methods approach, as well as preliminary measures of effectiveness including successful linkage to follow-up medical and/or SUD care after hospitalization and retention in treatment. Secondary effectiveness measures include time to first post-discharge follow-up visit, substance use patterns, and acute care utilization (e.g., hospital readmissions). The IntACT study will also enroll 20 clinicians from hospital and outpatient settings who interact with IntACT while providing patient care to provide input on intervention feasibility, appropriateness, and acceptability. Study design and procedural elements will also be assessed for feasibility and acceptability. Discussion Identifying promising interventions to support transitions to follow-up SUD and medical care following hospitalization is imperative to increase SUD treatment access and improve care quality. The IntACT pilot study evaluates the feasibility of a novel, potentially scalable team-based care transition intervention, gathering implementation data from both patients and clinicians who are exposed to the intervention. The results of this pilot study will inform intervention refinement for a future fully-powered clinical trial, as well as other implementation and research efforts supporting care transitions for people with SUD. Trial registration Clinicaltrials.gov NCT07575373