23 Implementation of a Substance Use Disorder Bridge Clinic

Abstract

Despite the availability of substance use disorder (SUD) treatment programs, many patients have difficulty accessing treatment partly due to long wait times. In order to facilitate timely linkage to treatment, our health system implemented a rapid access, low-barrier SUD clinic with the goal of providing prompt initial treatment (including buprenorphine on-demand) and then transitioning to longitudinal care once possible, regardless of insurance status or current substance use. The clinic, which is located close to the ED inside the hospital, opened in April 2018. The goal of this study is to describe the clinic implementation and outcomes for patients treated in the first year of the clinic. This was a retrospective analysis of patients seen at the clinic between April 2018 and March, 2019. Clinic staff includes a medical provider who can prescribe medication for addiction treatment (MAT), a resource specialist who connects patients to housing, phone service, ID cards and other social services, and recovery coaches, who use their own lived experience to coach other patients through their recovery. The data were obtained at the clinic as part of a quality improvement project to monitor the progress of patients treated in the clinic. IRB approval was obtained to use the dataset for this research. In one year, there were 325 patients referred to the clinic and 242 patients (74.8%) who had at least one visit to the clinic. Top sources of referral were: inpatient wards (n=111, 34.2%), emergency department (n=68, 20.9%), primary care (n=50, 15.4%), or other clinic referral (n=55, 16.9%). The patients were 68.3% (n=222) male, with a mean age of 43.4 (SD 11.9) years. 66% of patients had opioid use disorder, 39% had alcohol use disorder, and 31% had polysubstance use. Of the 242 patients who made it to at least one appointment, 131 patients (54.1%) are still active in the clinic, 85 (35.1%) have been bridged to other facilities and 26 (10.7%) were lost to follow-up. Amongst patients treated for opioid use disorder at the clinic, 142 (93%) were taking buprenorphine, 7 (5%) were taking methadone, and 4 (3%) received extended-release naltrexone. For 98 patients who have data 6 months prior and 6 months post clinic referral, ED visits in our health system decreased by 45% (from 276 before to after 151) and hospital admissions in our health system decreased by 37% (from 153 before to 96 after). Creation of a low-barrier, rapid-access, hospital-based substance use disorder bridge clinic is feasible. Outcomes are promising, with high rates of retention and linkage to treatment, and decreased rate of subsequent ED utilization and hospitalization. Keys to success are a multidisciplinary team, harm reduction model, and support from the health system.