Year of Publication

2020

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Teresa Waters

Committee Member

Dr. Joseph Benitez

Committee Member

Dr. Martha Riddell

Abstract

Background. The opioid epidemic is a public health emergency that requires collaboration between both private and public sectors to increase access to and capacity for efforts directed at treatment, prevention, and recovery. The Commonwealth of Kentucky via funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) created their State Targeted Response to the Opioid Crisis (Opioid STR) in order to help address these needs. The University of Kentucky, as an awardee of these funds, decided on an approach to highlight the Emergency Department (ED) bridge model, which links patients discharged from EDs and the hospital (inpatient addiction consult and education service) to treatment and recovery support services. One aspect of this model was the creation of the First Bridge Clinic, an outpatient clinic, which aims to minimize barriers to medications for opioid use disorder (MOUD) as well as to provide immediate evaluation, initiation, or continuation of MOUD treatment prior to “bridging” the patients to ongoing comprehensive treatment in the community.

Purpose. This capstone created a descriptive profile of patients referred to and engaging in this unique clinic. It also examined whether in-hospital initiation of MOUD or other demographic and clinical characteristics increase the likelihood of not only patients being scheduled for an intake appointment with the First Bridge Clinic, but also the likelihood of them actually keeping their first appointments.

Methods. A retrospective chart review of clinical data was performed. Demographic characteristics including age, sex, race, pregnancy status, veteran status, history of incarceration, homelessness, initiation of medications for OUD, type of MOUD, and the number of referrals received per yearly quarter were analyzed by descriptive statistics on all those who received a referral, those who received an appointment, and those who kept their appointments. Two-sample t-tests and chi-square tests were used to compare characteristics of those who received and kept appointments. Logistic regression modeling was performed to examine predictor variables for scheduling a First Bridge Clinic appointment as well as for actually keeping the first appointment.

Results. The clinic serves a largely Caucasian population with an average age of 36 years old. People who had recently been released from a correctional facility or homeless individuals were found to be less likely to receive an appointment to the First Bridge Clinic. While people who were on MOUD at the time of referral were more likely to receive an appointment at the First Bridge Clinic, they were not more likely to keep their first appointment. Overall, there was an upward trend demonstrated over the time period of the analysis in the utilization of the clinic demonstrating a need for the services provided.

Conclusions and Implications for Public Health Practice. Results indicate that 1) state-level regulations for MOUD initiation may make implementation of this model more challenging in the fast-paced environment of the ED, and 2) the rural population largely served by UKhealthcare establishments may face significant barriers to follow up care. Providing same or next day outpatient appointments could potentially increase the likelihood these patients are able to initiate outpatient care.

Available for download on Saturday, April 23, 2022

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