Care of injection drug users with soft tissue infections in San Francisco, California

Abstract

Context: Illicit injection drug use results in serious soft tissue infections that are the number one nonpsychiatric reason for admission to San Francisco General Hospital (SFGH), San Francisco, Calif.

Objective: To establish a specialized clinic to provide accessible, high-quality, and cost-effective medical care to patients with soft tissue infections. DESIGN, SETTING, INTERVENTION, AND OUTCOME MEASURES: The Integrated Soft Tissue Infection Services (ISIS) Clinic was established to provide coordinated surgical intervention, substance abuse counseling, and social services for patients with soft tissue infections treated in a public hospital. Demographic information, treatment outcome, and hospital utilization data were analyzed.

Results: In the clinic's first year of operation, there were 3365 patient visits and 2255 surgical procedures. A large number of patients reported recent injection of illicit drugs (61%), were homeless (30%), and either had hepatitis C, hepatitis B, or human immunodeficiency virus infection (62%). Patients using heroin were enrolled in either a detoxification or maintenance program (42%). Few patients were designated as treatment failures (2%) or were lost to follow-up (14%). The ISIS Clinic dramatically reduced emergency department visits (-33.9%), surgical service admissions (-47.3%), inpatient acute care bed days (-33.7%), and operating room procedures (-71%), saving approximately $8 765 200 in the first year of operation.

Conclusions: This clinical intervention was notably cost-effective while preserving a high quality of medical services. Owing to limited data, we can only assume that other communities are similarly confronted with this public health problem. The ISIS Clinic could serve as a model intervention and thus have significant impact on the treatment of this prevalent but often overlooked challenge.