Not only has the Brigham Health Bridge Clinic been providing timely care for patients with opioid addiction and other substance use disorders since opening last year, but it’s also inspiring innovation to combat the region’s opioid crisis.
During a Quality and Safety Grand Rounds, “Opioid Epidemic Solutions Panel,” on Sept. 12, speakers discussed what they and their colleagues are doing to help patients, particularly those with concerns related to injection drug use. This event, which was led by Scott Weiner, MD, MPH, of the Department of Emergency Medicine and director of the Brigham Comprehensive Opioid Response and Education (B-CORE) Program, was one of several events hosted this month at the Brigham and BWFH to celebrate National Recovery Month and educate our community about the Brigham Health services available to those in need.
Daniel A. Solomon, MD, a physician in the Infectious Disease Clinic who also cares for patients in the Bridge Clinic, spoke about a pilot at the Brigham that is examining whether it’s safe and effective for patients who inject drugs to receive IV antibiotic treatment at home for infections caused by injection drug use.
Even though patients who inject drugs are prone to recurring infections and often need prolonged antibiotic therapy, they historically have not been considered good candidates for a peripherally inserted central catheter (PICC) line — a tube that is inserted into a vein and remains accessible for patients who need ongoing IV treatments. Providers are often reluctant to discharge patients who inject drugs with PICC line out of concern for them using the catheter to inject illicit drugs.
As a result, these patients often undergo long-term inpatient stays to receive IV antibiotics. Patients who inject drugs are referred to the Bridge Clinic — where they receive individualized care plans that may include addiction treatment medications and psychosocial services — and those who meet certain criteria can now successfully complete their course of antibiotics at home.
Since April 2018, 20 patients with a history of injection drug use have been discharged from the Brigham to home with a PICC line to complete a course of IV antibiotics with close follow-up care in the Bridge Clinic. During the Quality and Safety Grand Rounds, Solomon reported that all the patients have completed their antibiotic course and experienced no PICC line complications. Three patients relapsed while on IV antibiotics, but none used the PICC line for illicit drug use. Collectively, 570 inpatient/rehab days were spared for these patients.
“Here is an example of one program that was made possible because of the existence of the Bridge Clinic,” Solomon said.
In addition to the discussion about the home pilot, panelist Christin Price, MD, administrative director of the Bridge Clinic and clinical director of the Brigham and Women’s Medicaid ACO, provided an update on the Bridge Clinic.
More than 400 patients have been referred to the Bridge Clinic since April 2018, and 75 percent of them came to at least one appointment. The average duration of care in the clinic is two and a half months. There is a cohort of patients that has remained with the Bridge Clinic for a longer period of up to 10 months, given their ongoing high acuity. Price said she’s thrilled with the progress that has been made in the clinic to help patients in need. In particular, the Bridge Clinic’s 83 percent retention rate — representing patients who continue to receive treatment at the clinic or in longitudinal care after six months — outshines national averages for similar programs, which rarely reach 50 percent.
“We’re here not only to treat our patients’ addiction, but to also care for them as people,” Price said. “Our goals are to get our patients into treatment, aid them on a path to recovery and help them with other things going on in their lives, such as homelessness or food insecurity, which can often impede recovery. We’re here to support each of them in many ways.”
For more information about recovery month, and to view a calendar of events, visit BWHPikeNotes.org.