Bridging Recovery Initiative Despite Gaps in Entry (BRIDGE): study protocol for a randomized controlled trial of a bridge clinic compared with usual care for patients with opioid use disorder

Marcovitz, David; White, Katie D.; Sullivan, William J.; Limper, Heather M.; Dear, Mary Lynn; Buie, Reagan; Edwards, David A.; Chastain, Cody A.; Kast, Kristopher A.; Lindsell, Christopher J.

doi:10.1186/s13063-021-05698-4

Cited by 5 publications

(7 citation statements)

References 40 publications

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“…While the high OTP linkage (87%) and 1-month retention (58%) rates among bridge clinic patients treated with methadone under the 72-h rule provides proof of concept and a randomized controlled trial of bridge clinic care is ongoing, additional peer reviewed data are needed on the rates of successful linkage to long term care among bridge clinic patients on buprenorphine [24,31]. This finding should serve as a call to action for bridge clinic teams to publish programmatic data on linkage outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Interdisciplinary teams, which may include registered nurse care managers, social workers, psychologists, case managers, patient navigators, peer recovery coaches, pharmacists, addiction medicine physicians, psychiatrists, and nurse practitioners, deliver clinical care and harm reduction services on a scheduled or walk-in basis, with the specific services offered tailored to program size and staffing (Table 1) [22,23,28]. Providers may be trained in internal medicine, family medicine, emergency medicine, and/or psychiatry depending on the model [22,23,28,30,31]. Although some bridge clinics offer integrated behavioral health services or referral, engagement in psychosocial treatment is not required to access MOUD.…”

Section: Hospital-based Outpatient Bridge Clinicsmentioning

confidence: 99%

“…The impact of bridge clinic care compared to usual care on other SUD treatment outcomes, including non-prescribed opioid use, opioid overdose, and injection-related infections, and acute care utilization remains under study. A randomized controlled trial comparing bridge clinic referral to treatment as usual among hospitalized patients with OUD initiating buprenorphine/naloxone or naltrexone began recruitment in 2019 [31].…”

Section: Impact On Other Sud Treatment Outcomesmentioning

confidence: 99%

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Substance use disorder bridge clinics: models, evidence, and future directions

Taylor

Wakeman

Walley

et al. 2023

Addict Sci Clin Pract

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Background The opioid overdose and polysubstance use crises have led to the development of low-barrier, transitional substance use disorder (SUD) treatment models, including bridge clinics. Bridge clinics offer immediate access to medications for opioid use disorder (MOUD) and other SUD treatment and are increasingly numerous. However, given relatively recent implementation, the clinical impact of bridge clinics is not well described. Methods In this narrative review, we describe existing bridge clinic models, services provided, and unique characteristics, highlighting how bridge clinics fill critical gaps in the SUD care continuum. We discuss available evidence for bridge clinic effectiveness in care delivery, including retention in SUD care. We also highlight gaps in available data. Results The first era of bridge clinic implementation has yielded diverse models united in the mission to lower barriers to SUD treatment entry, and preliminary data indicate success in patient-centered program design, MOUD initiation, MOUD retention, and SUD care innovation. However, data on effectiveness in linking to long-term care are limited. Conclusions Bridge clinics represent a critical innovation, offering on-demand access to MOUD and other services. Evaluating the effectiveness of bridge clinics in linking patients to long-term care settings remains an important research priority; however, available data show promising rates of treatment initiation and retention, potentially the most important metric amidst an increasingly dangerous drug supply.

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Section: Discussionmentioning

confidence: 99%

Section: Hospital-based Outpatient Bridge Clinicsmentioning

confidence: 99%

Section: Impact On Other Sud Treatment Outcomesmentioning

confidence: 99%

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Substance use disorder bridge clinics: models, evidence, and future directions

Taylor

Wakeman

Walley

et al. 2023

Addict Sci Clin Pract

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“…We leveraged a protocol to assess candidacy for OPAT among patients randomized to the bridge clinic. However, due to hospital bed demand related to the COVID-19 pandemic, this protocol was modified such that all patients deemed eligible for OPAT were referred to a bridge clinic and were not included in the trial after April 2021 …”

Section: Methodsmentioning

confidence: 99%

Effect of a Co-Located Bridging Recovery Initiative on Hospital Length of Stay Among Patients With Opioid Use Disorder

Marcovitz,

Dear,

Donald

et al. 2024

JAMA Netw Open

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ImportanceCo-located bridge clinics aim to facilitate a timely transition to outpatient care for inpatients with opioid use disorder (OUD); however, their effect on hospital length of stay (LOS) and postdischarge outcomes remains unclear.ObjectiveTo evaluate the effect of a co-located bridge clinic on hospital LOS among inpatients with OUD.Design, Setting, and ParticipantsThis parallel-group randomized clinical trial recruited 335 adult inpatients with OUD seen by an addiction consultation service and without an existing outpatient clinician to provide medication for OUD (MOUD) between November 25, 2019, and September 28, 2021, at a tertiary care hospital affiliated with a large academic medical center and its bridge clinic.InterventionThe bridge clinic included enhanced case management before and after hospital discharge, MOUD prescription, and referral to a co-located bridge clinic. Usual care included MOUD prescription and referrals to community health care professionals who provided MOUD.Main Outcomes and MeasuresThe primary outcome was the index admission LOS. Secondary outcomes, assessed at 16 weeks, were linkage to health care professionals who provided MOUD, MOUD refills, same-center emergency department (ED) and hospital use, recurrent opioid use, quality of life (measured by the Schwartz Outcome Scale–10), overdose, mortality, and cost. Analysis was performed on an intent-to-treat basis.ResultsOf 335 participants recruited (167 randomized to the bridge clinic and 168 to usual care), the median age was 38.0 years (IQR, 31.9-45.7 years), and 194 (57.9%) were male. The median LOS did not differ between arms (adjusted odds ratio [AOR], 0.94 [95% CI, 0.65-1.37]; P = .74). At the 16-week follow-up, participants referred to the bridge clinic had fewer hospital-free days (AOR, 0.54 [95% CI, 0.32-0.92]), more readmissions (AOR, 2.17 [95% CI, 1.25-3.76]), and higher care costs (AOR, 2.25 [95% CI, 1.51-3.35]), with no differences in ED visits (AOR, 1.15 [95% CI, 0.68-1.94]) or deaths (AOR, 0.48 [95% CI, 0.08-2.72]) compared with those receiving usual care. Follow-up calls were completed for 88 participants (26.3%). Participants referred to the bridge clinic were more likely to receive linkage to health care professionals who provided MOUD (AOR, 2.37 [95% CI, 1.32-4.26]) and have more MOUD refills (AOR, 6.17 [95% CI, 3.69-10.30]) and less likely to experience an overdose (AOR, 0.11 [95% CI, 0.03-0.41]).Conclusions and RelevanceThis randomized clinical trial found that among inpatients with OUD, bridge clinic referrals did not improve hospital LOS. Referrals may improve outpatient metrics but with higher resource use and expenditure. Bending the cost curve may require broader community and regional partnerships.Trial RegistrationClinicalTrials.gov Identifier: NCT04084392

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“…The Bridge Clinic at Vanderbilt University Medical Center (VUMC) is a transitional, hospital-based clinic that provides multispecialty, multidisciplinary outpatient addiction treatment including medication for opioid use disorder for individuals recently hospitalized for complications of substance use [ 5 ]. The Bridge Clinic is available to patients referred from the general adult hospital at Vanderbilt with any primary substance use disorder (SUD) (including primary opioid use disorder or primary alcohol use disorder).…”

mentioning

confidence: 99%