Implementation of addiction consult services and bridge clinics in the HEALing communities study in Massachusetts.

Abstract

Addiction Consult Services (ACS) and bridge clinics are hospital-based intervention strategies to expand access to medication for opioid use disorder (MOUD) which many Massachusetts communities adopted during the HEALing Communities Study (HCS). This study describes the implementation of HCS hospital-based MOUD intervention strategies using the RE-AIM framework. Post-hoc analysis of community ACS and bridge clinic implementation as part of a waitlist cluster randomized controlled trial of sixteen Massachusetts HCS communities across Wave 1 (randomized to receive intervention first) and Wave 2 (wait-list controls received the intervention second). The intervention was ACS and/or bridge clinics. Main measures include Adoption (planned to implement); Implementation (served at least one patient); Reach (median number of patients served per month); Effectiveness (receipt of MOUD within 14 days of opioid-related emergency or hospital encounter using Massachusetts Public Health Data Warehouse) and Maintenance (serving patients in the year post-study intervention). Eleven communities adopted 17 ACS and bridge clinics. Among the 17 adopted, 14 (7 ACS and 7 bridge clinics) were implemented. ACS reached a median of 16 patients/month and bridge clinics a median of 51 patients/month. Hospitals that implemented ACS and bridge clinics first did not have significantly higher 14-day post hospital MOUD rates compared to waitlisted hospitals. All 14 implemented ACS and bridge clinics were maintained post-intervention. ACS and bridge clinics were widely adopted intervention strategies, and the majority of programs were implemented and sustained, demonstrating the perceived value of these services to their communities.