Patient experiences with a transitional, low-threshold clinic for the treatment of substance use disorder: A qualitative study of a bridge clinic

Snow, Rachel; Simon, Rachel E.; Jack, Helen; Oller, Devin; Kehoe, Laura; Wakeman, Sarah E.

doi:10.1016/j.jsat.2019.09.003

Cited by 65 publications

(58 citation statements)

References 29 publications

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“…Stepped care procedures, such as the hub and spoke or collaborative care models (stage 3), are used to modify a person's OUD medications, medical care and psychosocial needs over 6 or more months, using the same approach that primary care practices (PCPs) apply to chronic diseases. Innovations in primary care, such as value-based payments for improved outcomes, expansion of telemedicine technology (137), embedding recovery coaches in PCPs (138), and measurement-based care (139) have all been found to improve long-term outcomes for people with an OUD (stage 4). Expand research, using longitudinal timeframes, on cognitive skills training, such as improving executive functioning or strengthening emotional regulation in adolescents and young adults to assist them in effectively navigating through the exposure of alcohol and other substances…”

Section: Substance Abuse and Addiction Overview And Prioritized Researchmentioning

confidence: 99%

Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit

Vodovotz

Barnard

et al. 2020

Front. Med.

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Declining life expectancy and increasing all-cause mortality in the United States have been associated with unhealthy behaviors, socioecological factors, and preventable disease. A growing body of basic science, clinical research, and population health evidence points to the benefits of healthy behaviors, environments and policies to maintain health and prevent, treat, and reverse the root causes of common chronic diseases. Similarly, innovations in research methodologies, standards of evidence, emergence of unique study cohorts, and breakthroughs in data analytics and modeling create new possibilities for producing biomedical knowledge and clinical translation. To understand these advances and inform future directions research, The Lifestyle Medicine Research Summit was convened at the University of Pittsburgh on December 4–5, 2019. The Summit's goal was to review current status and define research priorities in the six core areas of lifestyle medicine: plant-predominant nutrition, physical activity, sleep, stress, addictive behaviors, and positive psychology/social connection. Forty invited subject matter experts (1) reviewed existing knowledge and gaps relating lifestyle behaviors to common chronic diseases, such as cardiovascular disease, diabetes, many cancers, inflammatory- and immune-related disorders and other conditions; and (2) discussed the potential for applying cutting-edge molecular, cellular, epigenetic and emerging science knowledge and computational methodologies, research designs, and study cohorts to accelerate clinical applications across all six domains of lifestyle medicine. Notably, federal health agencies, such as the Department of Defense and Veterans Administration have begun to adopt “whole-person health and performance” models that address these lifestyle and environmental root causes of chronic disease and associated morbidity, mortality, and cost. Recommendations strongly support leveraging emerging research methodologies, systems biology, and computational modeling in order to accelerate effective clinical and population solutions to improve health and reduce societal costs. New and alternative hierarchies of evidence are also be needed in order to assess the quality of evidence and develop evidence-based guidelines on lifestyle medicine. Children and underserved populations were identified as prioritized groups to study. The COVID-19 pandemic, which disproportionately impacts people with chronic diseases that are amenable to effective lifestyle medicine interventions, makes the Summit's findings and recommendations for future research particularly timely and relevant.

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Section: Substance Abuse and Addiction Overview And Prioritized Researchmentioning

confidence: 99%

Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit

Vodovotz

Barnard

et al. 2020

Front. Med.

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“…Recently several innovative bridge clinic models have been developed offering low threshold daily drop-in prescribing groups [65, 66] for the purposes of harm reduction and/or linking inpatient units to outpatient treatment with the composition of the group varying from day to day. These models are helpful for initial accessibility but may not be designed to facilitate development of group cohesion to support stability and medication maintenance over time, and attendance may vary widely from day to day and week to week.…”

Section: Resultsmentioning

confidence: 99%

Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation

Sokol

Albanese

Chew

et al. 2019

Addict Sci Clin Pract

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BackgroundGroup-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting. However, the more practical “how to” components of successfully delivering GBOT has received little attention in the medical literature, potentially limiting its widespread implementation and utilization. Building on a previous case series, this paper delineates the key components to implementing GBOT by asking: (a) What are the core components to GBOT implementation, and how are they defined? (b) What are the malleable components to GBOT implementation, and what conceptual framework should providers use in determining how to apply these components for effective delivery in their unique clinical environment?MethodsTo create a blueprint delineating GBOT implementation, we integrated findings from a previously conducted and separately published systematic review of existing GBOT studies, conducted additional literature review, reviewed best practice recommendations and policies related to GBOT and organizational frameworks for implementing health systems change. We triangulated this data with a qualitative thematic analysis from 5 individual interviews and 2 focus groups representing leaders from 5 different GBOT programs across our institution to identify the key components to GBOT implementation, distinguish “core” and “malleable” components, and provide a conceptual framework for considering various options for implementing the malleable components.ResultsWe identified 6 core components to GBOT implementation that optimize clinical outcomes, comply with mandatory policies and regulations, ensure patient and staff safety, and promote sustainability in delivery. These included consistent group expectations, team-based approach to care, safe and confidential space, billing compliance, regular monitoring, and regular patient participation. We identified 14 malleable components and developed a novel conceptual framework that providers can apply when deciding how to employ each malleable component that considers empirical, theoretical and practical dimensions.ConclusionWhile further research on the effectiveness of GBOT and its individual implementation components is needed, the blueprint outlined here provides an initial framework to help office-based opioid treatment sites implement a successful GBOT approach and hence potentially serve as future study sites to establish efficacy of the model. This blueprint can also be used to continuously monitor how components of GBOT influence treatment outcomes, providing an empirical framework for the ongoing process of refining implementation strategies.

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“… 29 , 30 Outpatient clinics that offer transitional, low threshold access are becoming more common, and patients report positive experiences with care received from them compared with alternatives. 31 Policy and health system efforts should recognize that more treatment “beds” may not be the answer but rather increased capacity for outpatient management of OUD and consider transforming detox units into treatment initiation centers. 32 …”

Section: Discussionmentioning

confidence: 99%

Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder

et al. 2020

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Patient experiences with a transitional, low-threshold clinic for the treatment of substance use disorder: A qualitative study of a bridge clinic

Cited by 65 publications

References 29 publications

Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit

Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit

Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation

Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder

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