Evaluating bed-based care for substance use disorder in Canada

Is expanding hospital inpatient, or bed-based, care a way to help address the overdose crisis? An analysis article in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.240955 describes the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), which can help provinces determine whether bed-cased care is effective.

British Columbia and Alberta, the two provinces with the highest rate of overdose deaths, are focusing more on bed-based care. British Columbia is considering expanding capacity, and Alberta is planning to build 11 new inpatient facilities to help people with substance use disorder (SUD).

Inpatient care offers a range of supports, from reducing drug use to abstinence, with a range of medications and psychological treatments. However, access to care is challenging, with long wait-lists because of a lack of beds and specialized health workers.

"The RE-AIM framework is flexible enough to incorporate evaluation of the effectiveness of component services, as well as the extent to which they meet the needs of the eligible client base and how facilities expand, adapt, and are sustained over the long term," writes Dr. Bohdan Nosyk, a professor at Simon Fraser University, Burnaby, BC, and a scientist at the Centre for Advancing Health Outcomes, Vancouver, BC, with coauthors.

"Bed-based models of care for people with SUD offer multifaceted, complex interventions that are resource intensive. Effectiveness is therefore difficult to evaluate. Using the RE-AIM framework helps to highlight suboptimal evidence of effectiveness of bed-based care and likely limited capacity relative to the size of the populations with SUD."

The authors suggest that the RE-AIM framework can help provinces evaluate whether bed-based care for SUD can meet the needs of their populations and whether it is effective for improving outcomes for people with SUD.