Hospitalized patients with opioid use disorder who were referred to an on-site clinic that provides wraparound services during the transition to outpatient care (a bridge clinic) reported fewer overdoses and more refills of medications like buprenorphine in the weeks following discharge, a study in JAMA Network Open found. However, the use of the bridge clinic was not associated with a faster discharge compared with usual opioid use disorder (OUD) care, nor did it reduce hospital readmissions or health care costs.
“Bridge clinics offer presumed care advantages, including timely provision of [medications] while a long-term clinician is identified, and notwithstanding other barriers, including stigma, they may offer the ability to discharge patients early,” wrote David Marcovitz, M.D., of the Vanderbilt University School of Medicine and colleagues.
Marcovitz and colleagues recruited 335 hospitalized adults with OUD (median age of 38) who were being seen in an addiction consultation service. Patients were randomized to receive usual care or care in the bridge clinic, which was co-located with the addiction consultation service. Patients assigned to the bridge clinic received enhanced case management during and after their hospitalizations, as well as a buprenorphine-naloxone prescription at discharge. They were asked to present weekly to the bridge clinic for the first eight weeks, then twice monthly based on their clinical presentations. Patients in the usual care group were referred to a community clinic and received a buprenorphine-naloxone prescription at discharge.
At 16 weeks, patients reported their recurrent opioid use, overdoses, and the number of buprenorphine-naloxone prescriptions they filled; they also reported whether they had been successfully linked to health care professionals who provided medications for OUD. Information on health care utilization was collected from the patients’ electronic medical records.
The median lengths of stay in the hospital did not differ between patients in the bridge clinic or in usual care (5.7 days compared with 5.9 days, respectively). After discharge, patients in the bridge clinic group had fewer hospital-free days, experienced more hospital readmissions, and had higher care costs. The total median cost of care was $9,482 in the bridge clinic group compared with $1,705 in the usual care group.
Eighty-eight patients completed the 16-week follow-up calls. Compared with the usual care group, those in the bridge clinic group were less likely to report having experienced an overdose and more likely to report linkage to health care professionals who provided medications for OUD. They also reported refilling more buprenorphine prescriptions.
The finding that the bridge clinic group incurred greater costs and more may be a result of patients utilizing care that they previously had not, wrote Marlene Martin, M.D., of the University of California, San Francisco, and Noa Krawczyk, Ph.D., of the NYU Grossman School of Medicine, in an accompanying commentary. “This finding may also reflect increased trust in the health care system associated with the bridge clinic group, as stigma often prevents patients with OUD from seeking and accessing care.”
For related information, see the Psychiatric News article “Bridge Clinic Cuts Emergency Department Use in Patients With OUD.”
(Image: Getty Images/iStock/sturti)
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