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New clinic bridges inpatient, outpatient addiction care

May. 2, 2019, 8:44 AM

The Addiction Bridge Clinic will be staffed by a multispecialty team, including, from left, David Edwards, MD, PhD, David Marcovitz, MD, William Sullivan, MD, MEd, Cody Chastain, MD, Katie White, PhD, MD, and Jason Ferrell, LCSW.
The Addiction Bridge Clinic will be staffed by a multispecialty team, including, from left, David Edwards, MD, PhD, David Marcovitz, MD, William Sullivan, MD, MEd, Cody Chastain, MD, Katie White, PhD, MD, and Jason Ferrell, LCSW. (photo by Frederick Breedon)

by Kelsey Herbers

Vanderbilt University Medical Center is launching a Bridge Clinic for patients with substance use disorder who are leaving Vanderbilt University Adult Hospital (VUAH) and require follow-up care for their addiction.

The clinic, which opens May 17 in the Village at Vanderbilt, will manage patients for a three-month transitional period to ensure they continue receiving care for their addiction in hopes of preventing future hospitalizations, morbidity and mortality.

The clinic services will prioritize patients who are caught in the hospital system without a safe or timely discharge option. Because they’re often not linked to follow-up care, these vulnerable patients have longer lengths of stay and high rates of readmission locally and nationally.

“The Bridge Clinic is intended to expand access to a state-of-the-art addiction treatment model using an integrated care team that is designed around the individual’s needs and will facilitate successful hospital transitions into long-term wellness in recovery and engagement in a personalized care plan,” said Jameson Norton, MBA, Chief Executive Officer of Vanderbilt Psychiatric Hospital and Executive Director of Vanderbilt Behavioral Health.

“VUMC is uniquely capable of building these innovative, person-centered solutions by bringing together a multidisciplinary team of specialists to achieve better outcomes on behalf of those we serve.”

According to David Marcovitz, MD, assistant professor of Psychiatry and Behavioral Sciences and medical director of the Bridge Clinic and the VUAH Addiction Consultation Service, the integrated approach will leverage collaboration by psychiatry, internal medicine and pain medicine.

The approach will be especially helpful for patients who require intravenous (IV) antibiotic therapy to treat injection-related infections, most often from opioid use disorder. These patients are typically held in the hospital or referred to a skilled nursing facility throughout the therapy’s six-week duration to avoid the potential risk of the patient injecting into the central line.

“Through the Addiction Consultation Service, we’ve been observing that patients with infectious complications from IV drug use are getting stuck in the hospital when there’s no empirical evidence to suggest they can’t be managed as outpatients with a PICC (peripherally inserted central catheter) line. These prolonged lengths of stay generate frustration for patients and providers alike at times,” said Marcovitz.

“Based on preliminary data from other national leaders in this field, we believe these patients can be safely discharged once their acute medical issues are resolved to an outpatient clinic where they can receive medications for addiction treatment and regular follow-up. If we can make sure these patients don’t fall through the cracks, maybe we can make it safer for them to leave the hospital.”

Marcovitz believes the approach will decrease patients’ length of stay and rate of readmission while freeing inpatient beds for more acute care needs.

The Bridge Clinic will operate one day per week with an eventual capacity of up to 200 patients once all new providers have been onboarded. Patients will be followed in clinic for up to three months, starting with weekly visits for six to eight weeks after discharge, followed by biweekly visits.

Patients will then be referred to VUMC’s longitudinal programs or to community providers to continue addiction treatment with appropriate medications and psychological support.

The clinic’s staff will include an addiction psychiatrist, primary care physician, infectious disease doctor, pain anesthesiologist, nurse practitioner, social worker and recovery coach to cover all aspects of the patient’s care.

“With so much stigma and limited availability of reliable treatment for some of the most economically and socially vulnerable of our patients, we haven’t been able to treat the underlying disease that is ultimately responsible for their admission to our medical center: their substance use disorder,” said William Sullivan, MD, MEd, Hugh J. Morgan Chief Resident in the Department of Internal Medicine, who will be providing primary care services in the clinic.

“With regular follow-up with the same treatment team, we will be able to make a real impact not only on the medical complications of opioid use disorder, but also on the psychological, interpersonal and familial consequences of opioid use as we develop trust between patients and providers.”

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