Timing of initial post-discharge walk-in bridge clinic visit and outpatient linkage to care in opioid use disorder

Nico Carswell; Michaela Mitchell; Samuel Newman; Peter Park; Kari Teigen; William McInturf; Dustin DeMoss

doi:10.12746/swjm.v14i61.1692

Nico Carswell Department of Psychiatry, John Peter Smith Hospital, JPS Health Network, Fort Worth, TX
Michaela Mitchell Burnett School of Medicine at Texas Christian University
Samuel Newman Office of Clinical Research, JPS Health Network, Fort Worth, TX
Peter Park University of Colorado Anschutz School of Medicine
Kari Teigen Office of Clinical Research, JPS Health Network, Fort Worth, TX
William McInturf Department of Psychiatry, John Peter Smith Hospital, JPS Health Network, Fort Worth, TX
Dustin DeMoss Department of Psychiatry, John Peter Smith Hospital, JPS Health Network, Fort Worth, TX

DOI: https://doi.org/10.12746/swjm.v14i61.1692

Abstract

Introduction: Opioid use disorder (OUD) bridge clinics are used as temporary post-discharge “bridges” for OUD treatment after a hospital or emergency department (ED) discharge while patients wait to obtain a regular outpatient provider. The objective of this study was to assess whether earlier initial follow up after discharge in a walk-in based OUD bridge clinic is associated with increased outpatient OUD treatment linkage. Methods: This was a retrospective cohort study of patients (N=165, 66% male) referred to a single walk-in, urgent care center-based OUD bridge clinic within a county safety-net hospital system after hospital or ED discharge. A modified Poisson regression model with a log link and robust standard errors was used to estimate adjusted risk ratios and 95% confidence intervals. Results: There was no significant association between the amount of time until a patient’s first OUD bridge clinic visit after being referred at discharge from the hospital or ED and eventual outpatient treatment linkage (unadjusted RR 1.00; 95% CI: 0.99, 1.01; p=0.84). Discussion: Our study contrasts with previous studies showing that earlier appointments after discharge improve linkage to care in patients with OUD. This may suggest that the walk-in structure of our bridge clinic may attenuate the negative impact of delays to follow-up care by allowing patients to present according to readiness and availability.

Downloads

Download data is not yet available.

References

1. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2022 national survey on drug use and health [Internet]. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2023. Available from: https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report
2. Taylor JL, Samet JH. Opioid Use Disorder. Ann Intern Med 2022;175(1):ITC1–16.
3. Owens P, Weiss A, Barrett M. Hospital burden of opioid-related inpatient stays: Metropolitan and rural Hospitals, 2016 [Internet]. Agency for Healthcare Research and Quality; 2020 [cited 2025 Mar 25]. Available from: https://hcup-us.ahrq.gov/reports/statbriefs/sb258-Opioid-Hospitalizations-Rural-Metro-Hospitals-2016.jsp
4. Dowell D, Brown S, Gyawali S, et al. Treatment for Opioid Use Disorder: Population Estimates — United States, 2022. MMWR Morb Mortal Wkly Rep 2024;73(25):567–74.
5. Florence C, Luo F, Rice K. The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017. Drug Alcohol Depend 2021;218:108350.
6. Santo T, Clark B, Hickman M, et al. Association of Opioid Agonist Treatment With All-Cause Mortality and Specific Causes of Death Among People With Opioid Dependence: A Systematic Review and Meta-analysis. JAMA Psychiatry 2021;78(9):979–93.
7. Marcovitz D, Dear ML, Donald R, et al. Effect of a Co-Located Bridging Recovery Initiative on Hospital Length of Stay Among Patients With Opioid Use Disorder: The BRIDGE Randomized Clinical Trial. JAMA Netw Open 2024;7(2):e2356430.
8. Snow RL, Simon RE, Jack HE, Oller D, Kehoe L, Wakeman SE. Patient experiences with a transitional, low-threshold clinic for the treatment of substance use disorder: A qualitative study of a bridge clinic. J Subst Abuse Treat 2019;107:1–7.
9. Tofighi B, McNeely J, Yang J, et al. Outcomes of a NYC Public Hospital System Low-Threshold Tele-Buprenorphine Bridge Clinic at 1 Year. Subst Use Misuse 2022;57(8):1337–40.
10. Taylor JL, Wakeman SE, Walley AY, Kehoe LG. Substance use disorder bridge clinics: models, evidence, and future directions. Addict Sci Clin Pract 2023;18(1):23.
11. Peterson C, Liu Y, Xu L, Nataraj N, Zhang K, Mikosz CA. U.S. National 90-Day Readmissions After Opioid Overdose Discharge. Am J Prev Med 2019;56(6):875–81.
12. Moreno JL, Wakeman SE, Duprey MS, Roberts RJ, Jacobson JS, Devlin JW. Predictors for 30-Day and 90-Day Hospital Readmission Among Patients With Opioid Use Disorder. J Addict Med 2019;13(4):306–13.
13. Christian N, Bottner R, Baysinger A, et al. Hospital Buprenorphine Program for Opioid Use Disorder Is Associated With Increased Inpatient and Outpatient Addiction Treatment. J Hosp Med 2021;16(6):345–8.
14. Waite MR, Heslin K, Cook J, Kim A, Simpson M. Predicting substance use disorder treatment follow-ups and relapse across the continuum of care at a single behavioral health center. J Subst Use Addict Treat 2023;147:208933.
15. Reif S, Acevedo A, Garnick DW, Fullerton CA. Reducing Behavioral Health Inpatient Readmissions for People With Substance Use Disorders: Do Follow-Up Services Matter? Psychiatr Serv 2017;68(8):810–8.
16. Roy PJ, Price R, Choi S, et al. Shorter outpatient wait-times for buprenorphine are associated with linkage to care post-hospital discharge. Drug Alcohol Depend 2021;224:108703.
17. Hall NY, Le L, Majmudar I, Mihalopoulos C. Barriers to accessing opioid substitution treatment for opioid use disorder: A systematic review from the client perspective. Drug Alcohol Depend 2021;221:108651.
18. Laks J, Kehoe J, Farrell NM, et al. Methadone initiation in a bridge clinic for opioid withdrawal and opioid treatment program linkage: a case report applying the 72-hour rule. Addict Sci Clin Pract 2021;16(1):73.
19. Lynch MJ, Vargas D, Winger ME, et al. A telemedicine bridge clinic improves access and reduces cost for opioid use disorder care. Drug Alcohol Depend Rep 2024;11:100227.
20. Solomon KT, O’Connor J, Gibbons JB, et al. Association Between Hospital Adoption of an Emergency Department Treatment Pathway for Opioid Use Disorder and Patient Initiation of Buprenorphine After Discharge. JAMA Health Forum 2023;4(3):e230245.