Linkage to Care Outcomes Following Treatment in A Low-Threshold Substance Use Disorder Bridge Clinic.

BACKGROUND: Treatment for substance use disorders (SUD) remains low in the United States. To better meet needs of people who use alcohol and other drugs, low threshold bridge clinics which offer treatment without barrier and harm reduction services have gained prevalence. Bridge clinics work to surmount barriers to care by providing same day medication and treatment for SUD and eventually transitioning patients to community-based treatment providers. In this study, we examine SUD treatment outcomes among patients who transitioned out of a bridge clinic. METHODS: This is a retrospective cohort study of posttreatment outcomes of patients seen at an urban medical center's bridge clinic between 2017 and 2022. The primary outcome was being in care anywhere at time of follow-up. We also examined the proportion of patients who completed each step of the cascade of care following transfer: connection to transfer clinic, completion of a clinic visit, retention in care, and medication use among those remaining in care at the transfer clinic. We examined the association of different bridge clinic services with still being in care anywhere and the association between successful transfer with being in care and taking medication at follow-up. RESULTS: Of 209 eligible participants, 63 were surveyed. Sixty-five percent of participants identified as male, 74% as white, 12% as Hispanic, 6% as Black, and 16% were unhoused. Most participants (78%) reported being connected to SUD treatment from the Bridge Clinic, and 37% remained in care at the same facility at the time of survey. Eighty-four percent reported being in treatment anywhere and 68% reported taking medication for SUD at follow-up, with most participants reporting taking buprenorphine (46%). CONCLUSION: Of those participants who transitioned out of a bridge clinic into community-based SUD care, 78% were successfully connected to ongoing care and 84% were still in care at follow-up.

Predictors of engagement and retention in care at a low-threshold substance use disorder bridge clinic.

INTRODUCTION: People with substance user disorder (SUD) have frequent intersections with the health care system; however, engagement and retention in SUD care remain low, particularly for marginalized populations. Low-threshold treatment models that aim to eliminate barriers to care are one proposed intervention to increase access and equity in SUD treatment. METHODS: This is a retrospective, cohort study of patients treated at a low-threshold bridge clinic from 2016 to 2021. The study's primary aim was to describe patient characteristics associated with engagement, defined as two or more completed visits, and treatment retention at 60 days, defined as a completed visit 45-to-75 days after first visit. A secondary outcome was transfer to ongoing treatment after bridge clinic. The study analyzed multivariable models assessing demographic and clinical predictors for each outcome using generalized estimating equations. RESULTS: The study found that 1857 patients completed 2730 care episodes. The mean age was 38.7 years old, 70 % were male, 30 % female, 79 % White, 7 % Black, 9 % Latinx, and 97 % spoke English. Opioid use disorder (OUD) was the most common type of SUD, seen among 84 % of episodes, followed by alcohol (30 %), and stimulant use disorder (28 %). Seventy percent of bridge clinic episodes of care resulted in engagement, 38 % were retained at 60 days, and 28 % had transfer to care documented. In adjusted analyses, engagement was lower for Black patients compared to White patients and higher for patients who received buprenorphine or naltrexone. Retention for Black patients was also lower compared to White patients and higher for patients who were unhoused and patients who received buprenorphine or naltrexone. Transfer of care was more likely among patients who received buprenorphine. CONCLUSIONS: At a low-threshold bridge clinic 70 % of patients successfully engaged in care and 38 % were retained at two months. While OUD and AUD were most prevalent, stimulant use was common in this population. Patients who received buprenorphine or naltrexone had higher engagement, and retention, and those receiving buprenorphine also had higher care transfer. Black patients had lower rates of engagement and retention. Treatment providers need to adopt low-threshold SUD care models to eliminate racial disparities and address the needs of people using stimulants.

Temporal association of the development of oropharyngeal microbiota with early life wheeze in a population-based birth cohort.

BACKGROUND: A critical window in infancy has been proposed, during which the microbiota may affect subsequent health. The longitudinal development of the oropharyngeal microbiota is under-studied and may be associated with early-life wheeze. We aimed to investigate the temporal association of the development of the oropharyngeal microbiota with early-life wheeze. METHODS: A population-based birth cohort based in London, UK was followed for 24 months. We collected oropharyngeal swabs at six time-points. Microbiota was determined using sequencing of the V3-V5 region of the 16S rRNA-encoding gene. Medical records were reviewed for the outcome of doctor diagnosed wheeze. We used a time-varying model to investigate the temporal association between the development of microbiota and doctor-diagnosed wheeze. FINDINGS: 159 participants completed the study to 24 months and for 98 there was complete sequencing data at all timepoints and outcome data. Of these, 26 had doctor-diagnosed wheeze. We observed significant increase in the abundance of Neisseria between 9 and 24 months in children who developed wheeze (p = 0∙003), while in those without wheezing there was a significant increment in the abundance of Granulicatella (p = 0∙012) between 9 and 12 months, and of Prevotella (p = 0∙018) after 18 months. INTERPRETATION: A temporal association between the respiratory commensal Granulicatella and also Prevotella with wheeze (negative), and between Neisseria and wheeze (positive) was identified in infants prior to one year of age. This adds to evidence for the proposed role of the microbiota in the development of wheeze. FUND: Research funding from the Winnicott Foundation, Meningitis Now and Micropathology Ltd.