Department of Health Policy, Vanderbilt University, Nashville, TN 37203, USA.
Department of Health Policy, Vanderbilt University, Nashville, TN 37203, USA.
J Subst Use Addict Treat. 2023 Mar;146:208961. doi: 10.1016/j.josat.2023.208961. Epub 2023 Jan 24.
Individuals struggling with opioid use disorder (OUD) utilize the adult emergency department (ED) and psychiatric emergency department at high rates. In 2019, Vanderbilt University Medical Center created a system for individuals identified in the emergency department with OUD to transition care to a Bridge Clinic for up to three months of comprehensive behavioral health treatment, alongside primary care, infectious diseases, and pain management, regardless of their insurance status.
We conducted 20 interviews with patients enrolled in treatment in our Bridge Clinic and 13 providers in the psychiatric emergency department and emergency department. Our provider interviews focused on understanding experiences identifying people with OUD and referring them to care at the Bridge Clinic. Our patient interviews focused on understanding their experiences of care-seeking, the referral process, and their satisfaction with treatment at the Bridge Clinic.
Our analysis generated 3 major themes around patient identification, referral, and quality of care from providers and patients. The study found general agreement between both groups around the high quality of care delivered in the Bridge Clinic compared with OUD treatment at nearby treatment facilities, specifically because it offered a stigma-free environment for the delivery of medication for addiction therapy and psychosocial support. Providers highlighted the lack of a systematic strategy for identifying people with OUD in an ED setting. They also found the referral process cumbersome because it could not be done through EPIC and there were limited patient slots available. In contrast, patients reported a smooth and simple referral from the ED to the Bridge Clinic.
Creating a Bridge Clinic for comprehensive OUD treatment at a large university medical center has been challenging but has resulted in the creation of a comprehensive care system that prioritizes quality care. Funding to increase the number of patient slots available, coupled with an electronic system of patient referral, will increase the reach of the program to some of Nashville's most vulnerable constituents.
患有阿片类药物使用障碍（OUD）的个体大量前往成人急诊部（ED）和精神科急诊部寻求治疗。2019 年，范德比尔特大学医学中心为在急诊部确定为 OUD 的个体创建了一个系统，使他们能够在 Bridge 诊所接受长达三个月的全面行为健康治疗，同时还提供初级保健、传染病和疼痛管理，无论其保险状况如何。
我们对在我们的 Bridge 诊所接受治疗的 20 名患者和精神科急诊部和急诊部的 13 名提供者进行了 20 次访谈。我们的提供者访谈重点是了解识别患有 OUD 的个体并将他们转介到 Bridge 诊所接受治疗的经验。我们的患者访谈重点是了解他们寻求治疗的经历、转诊过程以及对 Bridge 诊所治疗的满意度。
我们的分析产生了 3 个主要主题，涉及提供者和患者对患者识别、转诊和护理质量的看法。研究发现，两组人员普遍认为 Bridge 诊所提供的护理质量很高，与附近治疗设施的 OUD 治疗相比，Bridge 诊所提供了一个无污名化的环境，用于提供成瘾治疗药物和心理社会支持。提供者强调在 ED 环境中缺乏系统的识别 OUD 患者的策略。他们还发现转诊过程繁琐，因为无法通过 EPIC 进行转诊，而且可用的患者名额有限。相比之下，患者报告说从 ED 到 Bridge 诊所的转诊过程很顺利、很简单。
在大型大学医学中心创建 Bridge 诊所以提供全面的 OUD 治疗具有挑战性，但已成功创建了一个全面的护理系统，该系统优先考虑护理质量。增加可用患者名额的资金投入，再加上电子患者转诊系统，将增加该项目对纳什维尔一些最脆弱人群的覆盖范围。
