Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, Fort Worth, TX.
Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, Fort Worth, TX.
Ann Emerg Med. 2023 Dec;82(6):694-704. doi: 10.1016/j.annemergmed.2023.06.014. Epub 2023 Aug 5.
Little is known about the effectiveness of bridge clinics as transitional care programs for people with opioid use disorder in emergency departments (EDs). We assessed the effect of bridge clinic referral on health services use among patients with opioid use disorder identified in the ED.
We used data for individuals aged 18 years and over with active opioid use disorder and no history of medication for opioid use disorder who were administered medication for opioid use disorder while in the ED between January 2013 and August 2022. Bridge clinic referrals started in January 2021. Eligible patients after this date comprised the intervention group. The usual care group included eligible patients before bridge clinic implementation, who were a 1:1 propensity score matched to intervention patients. We estimated risk differences and 95% confidence limits for linkage to long-term care, ED use, and inpatient admission within 120 days of the index ED visit.
Our study population comprised 928 observations after matching. Patients referred to the bridge clinic had a higher risk of linkage to long-term care (risk differences=25%; 95% confidence limits: 20%, 30%), higher risk of ED use (risk differences=7.5%, 95% confidence limits: 1.6%, 13%), and lower risk of inpatient admission (risk differences= -1.9%, 95% confidence limits: -5.9%, 2.1%). Inpatient admission increased among patients with serious mental illness but decreased among patients without serious mental illness.
Our overall results suggest that bridge clinic referral increases linkage to long-term care. Nevertheless, qualitatively different effects on inpatient admission between patients with and without serious mental illness warrant consideration of unmet needs among patients with serious mental illness.
对于将桥接诊所作为急诊科（ED）中阿片类药物使用障碍患者的过渡性护理计划，目前知之甚少。我们评估了 ED 中识别出的阿片类药物使用障碍患者接受桥接诊所转介对卫生服务利用的影响。
我们使用了 2013 年 1 月至 2022 年 8 月期间在 ED 中接受阿片类药物使用障碍治疗且无阿片类药物使用障碍治疗史的 18 岁及以上有活性阿片类药物使用障碍的个体数据。桥接诊所转介于 2021 年 1 月开始。此后符合条件的患者构成干预组。常规护理组包括桥接诊所实施前符合条件的患者，这些患者与干预患者进行了 1:1 的倾向评分匹配。我们估计了在索引 ED 就诊后 120 天内与长期护理、ED 使用和住院入院相关的风险差异和 95%置信区间。
匹配后我们的研究人群包括 928 个观察结果。转介至桥接诊所的患者与长期护理相关的风险更高（风险差异=25%；95%置信区间：20%，30%），与 ED 使用相关的风险更高（风险差异=7.5%；95%置信区间：1.6%，13%），与住院入院相关的风险更低（风险差异=-1.9%；95%置信区间：-5.9%，2.1%）。严重精神疾病患者的住院入院率增加，但无严重精神疾病患者的住院入院率下降。
我们的总体结果表明，桥接诊所转介增加了与长期护理的联系。然而，严重精神疾病患者和无严重精神疾病患者之间住院入院率的不同影响需要考虑严重精神疾病患者的未满足需求。
