Evaluating the Impact of the Bridge Clinic in Patients With Opioid Use Disorder

Overview

This study aims to determine whether referral to the Bridge Clinic reduces overall index hospital length of stay when compared to direct referral to a long-term outpatient addiction provider for patients with active opioid use disorder (OUD) being considered for medications-for-addiction treatment (MAT).

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Health Services Research
    • Masking: Single (Outcomes Assessor)
  • Study Primary Completion Date: February 2021

Interventions

  • Other: Bridge Clinic
    • Referral to the Bridge Clinic for temporary outpatient addiction treatment while the bridge clinic identifies an outpatient addiction treatment provider to accept the patient for long term treatment.
  • Other: Usual Care
    • Referral to an outpatient provider for addiction treatment.

Arms, Groups and Cohorts

  • Active Comparator: Usual Care
    • Participants randomized to this arm will receive care as usual.
  • Active Comparator: Bridge Clinic
    • Participants randomized to this arm will be referred to the Bridge Clinic to facilitate identification and referral to an outpatient provider for addiction treatment.

Clinical Trial Outcome Measures

Primary Measures

  • Hospital length of stay
    • Time Frame: approximately 3 to 42 days
    • Overall index hospital length of stay measured in days

Secondary Measures

  • Cost
    • Time Frame: 16 weeks post-randomization
    • Total costs, and costs for each admission and care resource used measured in dollars
  • Successful care linkage
    • Time Frame: 16 weeks post-randomization
    • Self-reported outcome of linkage to a MAT provider as defined by attending at least one visit with a MAT provider
  • MAT prescriptions filled
    • Time Frame: 16 weeks post-randomization
    • Reported buprenorphine-naloxone (or naltrexone) prescriptions filled
  • Readmissions and Emergency Department (ED) visits
    • Time Frame: 16 weeks post-randomization
    • Composite number of ED visits and readmissions
  • Hospital and ED free days
    • Time Frame: 16 weeks post-randomization
    • Days alive out of the hospital and/or ED
  • Mortality
    • Time Frame: 16 weeks post-randomization
    • Death in hospital – dichotomous measurement
  • Recurrent opioid use
    • Time Frame: 16 weeks post-randomization
    • Reported recurrent opioid use and the approximate number of times of opioid use

Participating in This Clinical Trial

Inclusion Criteria

  • Inpatients at VUH with active OUD being considered for MAT.
  • Patient accepting a transitional prescription for buprenorphine-naloxone or IM naltrexone whose outpatient plans are not fixed

Exclusion Criteria

  • Deemed ineligible for referral to outpatient Bridge Clinic by the Addiction Consult Team (examples include but are not limited to patients with severe, active co-occurring psychiatric disorders requiring a higher level of psychiatric care or patients for whom methadone maintenance is deemed the best choice of MAT).
  • Patients previously randomized in this study.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Vanderbilt University Medical Center
  • Provider of Information About this Clinical Study
    • Principal Investigator: David Marcovitz, Assistant Professor of Psychiatry, MD – Vanderbilt University Medical Center
  • Overall Official(s)
    • David Marcovitz, MD, Principal Investigator, Vanderbilt University Medical Center
  • Overall Contact(s)
    • David Marcovitz, MD, 615-936-3555, david.marcovitz@vumc.org

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