Keypoint: A co-located bridging recovery initiative improved access to care for patients with OUD, but at a high care cost.
Inpatients with opioid use disorder (OUD) referred to a co-located outpatient bridge clinic had more buprenorphine refills, reduced overdose rates, and greater linkage to health care professionals who provide medication for OUD (MOUD), according to study results published in JAMA Network Open. However, these patients experienced more readmissions, higher care costs, fewer hospital-free days, and similar hospital length of stay (LOS) compared with patients with OUD receiving usual care.
Opioid use and overdose deaths are a major public health crisis in the United States. Because MOUD has proven to be the most effective component of substance use treatment in the outpatient setting, general hospitals have increasingly looked toward incorporating integrated addiction consultation services to improve outcomes for patients presenting with OUD. Therefore, researchers assessed the efficacy and utility of a co-located bridging recovery initiative on treatment and care outcomes among inpatients with OUD.
The researchers conducted a parallel-group, randomized, single-center clinical trial (The Bridging Recovery Initiative Despite Gaps in Entry [BRIDGE]; ClinicalTrials.gov Identifier: NCT04084392) from the end of November 2019 through September 2021 at the Vanderbilt University Medical Center, Vanderbilt Psychiatric Hospital in Nashville, Tennessee. The primary outcome was hospital LOS among patients with OUD. Secondary outcomes included linkage to health care professionals who provided MOUD, number of buprenorphine-naloxone (or naltrexone) prescriptions filled, same-center emergency department visit and hospital readmission rates, hospital-free days, recurrent opioid use, mortality, quality of life (assessed via the Schwartz Outcome Scale-10), overdose, and care costs. Eligible participants were patients with active OUD who were 18 years and older, accepted a transitional prescription for naltrexone or buprenorphine-naloxone, and did not have a fixed outpatient MOUD plan before admission.
The intervention was a co-located, multispecialty clinic that provided patients with a buprenorphine-naloxone bridge prescription and coordinated treatment with a clinician within 1 week of discharge. Patients then and presented at the clinic weekly for 8 weeks then twice monthly for treatment. The patient care team was composed of specialists in addiction psychiatry, infectious diseases, internal medicine, and pain anesthesia, as well as social workers, recovery coaches, and a nurse case manager. Usual care consisted of referral to a community healthcare professional for MOUD linkage by a non-specialty, hospital-based social worker team.
The researchers included 355 participants who were randomly assigned 1:1 to the bridge clinic (n=167) or to usual care (n=168). Patients (median age=38.0 years) were mostly White (85.7%), non-Hispanic/Latino (95.5%), and men (57.9%). Demographic variables were balanced across study arms.
The researchers found that hospital LOS was not significantly different between the intervention and usual care cohorts (adjusted odds ratio [aOR], 0.94; 95% CI, 0.65-1.37; P =.74). Furthermore, noted participants referred to the bridge clinic experienced more readmissions (aOR, 2.17; 95% CI, 1.25-3.76), higher care costs (aOR, 2.25; 95% CI, 1.51-3.35), and fewer hospital-free days (aOR, 0.54; 95% CI, 0.32-0.92) than participants in the usual care arm at the 16-week follow-up.
However, the bridge clinic recovery initiative did increase the odds of receiving more MOUD refills (aOR, 6.17; 95% CI, 3.69-10.30), linkage to healthcare professionals who provided MOUD (aOR, 2.37; 95% CI, 1.32-4.26), and decreased the likelihood of an overdose (aOR, 0.11; 95% CI, 0.03-0.41).
Study authors concluded, “These findings suggest that among a complex cohort of hospitalized patients with OUD, outpatient metrics may be positively affected through the connection to a bridge clinic, but higher resource use and higher expenditure may be required to achieve these goals.”
These study findings may be limited, given the low response rate in follow-up, potential treatment bias due to the lack of blinding, and the researchers did not account for differences in OUD severity during randomization.
Note: This article originally appeared on Psychiatry Advisor
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