Bridging Recovery Initiative Despite Gaps in Entry (BRIDGE): study protocol for a randomized controlled trial of a bridge clinic compared with usual care for patients with opioid use disorder

Abstract Background Patients with substance use disorders are overrepresented among general hospital inpatients, and their admissions are associated with longer lengths of stay and increased readmission rates. Amid the national opioid crisis, increased attention has been given to the integration of addiction with routine medical care in order to better engage such patients and minimize fragmentation of care. General hospital addiction consultation services and transitional, hospital-based “bridge” clinics have emerged as potential solutions. We designed the Bridging Recovery Initiative Despite Gaps in Entry (BRIDGE) trial to determine if these clinics are superior to usual care for these patients. Methods This single-center, pragmatic, randomized controlled clinical trial is enrolling hospitalized patients with opioid use disorder (OUD) who are initiating medication for OUD (MOUD) in consultation with the addiction consult service. Patients are randomized for referral to a co-located, transitional, multidisciplinary bridge clinic or to usual care, with the assignment probability being determined by clinic capacity. The primary endpoint is hospital length of stay. Secondary endpoints include quality of life, linkage to care, self-reported buprenorphine or naltrexone fills, rate of known recurrent opioid use, readmission rates, and costs. Implementation endpoints include willingness to be referred to the bridge clinic, attendance rates among those referred, and reasons why patients were not eligible for referral. The main analysis will use an intent-to-treat approach with full covariate adjustment. Discussion This ongoing pragmatic trial will provide evidence on the effectiveness of proactive linkage to a bridge clinic intervention for hospitalized patients with OUD initiating evidence-based pharmacotherapy in consultation with the addiction consult service. Trial registration ClinicalTrials.govNCT04084392. Registered on 10 September 2019. The study has been approved by the Vanderbilt Institutional Review Board. The current approved protocol is dated version May 12, 2021.

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Design and methods of a multi-site randomized controlled trial of an integrated care model of long-acting injectable buprenorphine with infectious disease treatment among persons hospitalized with infections and opioid use disorder

Contemporary Clinical Trials ◽

10.1016/j.cct.2021.106394 ◽

2021 ◽

Vol 105 ◽

pp. 106394

Author(s):

Nikhil Seval ◽

Cynthia A. Frank ◽

Alain H. Litwin ◽

Prerana Roth ◽

Meredith A. Schade ◽

...

Keyword(s):

Infectious Disease ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Opioid Use Disorder ◽

Opioid Use ◽

Care Model ◽

Disease Treatment ◽

Randomized Controlled ◽

Long Acting ◽

Design And Methods

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Vitamin D supplementation, COVID-19 and disease severity: a meta-analysis

QJM ◽

10.1093/qjmed/hcab009 ◽

2021 ◽

Cited By ~ 1

Author(s):

K Shah ◽

D Saxena ◽

D Mavalankar

Keyword(s):

Vitamin D ◽

Randomized Controlled Trials ◽

Usual Care ◽

Odds Ratio ◽

Meta Analysis ◽

Vitamin D Supplementation ◽

Hospitalized Patients ◽

Controlled Trials ◽

Randomized Controlled

Abstract Objective: Current meta-analysis aims to understand the effect of oral supplementation of vitamin D on intensive care unit (ICU) requirement and mortality in hospitalized COVID-19 patients. Methods: Databases PubMed, preprint servers, and google scholar were searched from December 2019 to December 2020. Authors searched for the articles assessing role of vitamin D supplementation on COVID-19. Cochrane RevMan tool was used for quantitative assessment of the data, where heterogeneity was assessed using I2 and Q statistics and data was expressed using odds ratio with 95% confidence interval. Results: Final meta-analysis involved pooled data of 532 hospitalized patients (189 on vitamin D supplementation and 343 on usual care/placebo) of COVID-19 from three studies (Two randomized controlled trials, one retrospective case-control study). Statistically (p<0.0001) lower ICU requirement was observed in patients with vitamin D supplementation as compared to patients without supplementations (odds ratio: 0.36; 95% CI: 0.210-0.626). However, it suffered from significant heterogeneity, which reduced after sensitivity analysis. In case of mortality, vitamin D supplements has comparable findings with placebo treatment/usual care (odds ratio: 0.93; 95% CI: 0.413-2.113; p=0.87). The studies did not show any publication bias and had fair quality score. Subgroup analysis could not be performed due to limited number of studies and hence dose and duration dependent effect of vitamin D could not be evaluated. Conclusions: Although the current meta-analysis findings indicate potential role of vitamin D in improving COVID-19 severity in hospitalized patients, more robust data from randomized controlled trials are needed to substantiate its effects on mortality.

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Randomized Controlled Trial of Electronic Care Plan Alerts and Resource Utilization by High Frequency Emergency Department Users with Opioid Use Disorder

Western Journal of Emergency Medicine ◽

10.5811/westjem.2015.11.28319 ◽

2016 ◽

Vol 17 (1) ◽

pp. 28-34 ◽

Cited By ~ 12

Author(s):

Niels Rathlev ◽

Reda Almomen ◽

Ashley Deutsch ◽

Howard Smithline ◽

Haiping Li ◽

...

Keyword(s):

Emergency Department ◽

Randomized Controlled Trial ◽

Resource Utilization ◽

High Frequency ◽

Controlled Trial ◽

Opioid Use Disorder ◽

Care Plan ◽

Opioid Use ◽

Randomized Controlled

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Impact of remdesivir on 28 day mortality in hospitalized patients with COVID-19: February 2021 Meta-analysis

10.1101/2021.03.04.21252903 ◽

2021 ◽

Author(s):

Robert Robinson ◽

Vidhya Prakash ◽

Raad Al Tamimi ◽

Nour Albast ◽

Basma Al-Bast ◽

...

Keyword(s):

Usual Care ◽

English Language ◽

Meta Analysis ◽

Severity Of Illness ◽

Hospitalized Patients ◽

Randomized Controlled ◽

Analysis Process ◽

All Cause Mortality ◽

The Impact

AbstractBackgroundThe COVID-19 pandemic has stimulated worldwide investigation into a myriad of potential therapeutic agents, including antivirals such as remdesivir. The first RCT reporting results on the impact of remdesivir on COVID-19 in a peer reviewed journal was the ACTT-1 trial published in November, 2020. The ACTT-1 trial showed more rapid clinical improvement and a reduced risk of 28-day mortality in patients who received remdesivir.This study is a meta-analysis of peer reviewed RCTs aims to estimate the association of remdesivir therapy compared to the usual care or placebo on all-cause mortality in hospitalized patients with COVID-19. Software based tools to accelerate the analysis process.MethodsMeta-analysis of peer reviewed RCTs comparing remdesivir to usual care or placebo. The protocol for this meta-analysis was registered and published in the PROSPERO database (CRD42021229985) on February 5, 2021.ResultsFour English language RCTs were identified, including data from 7,333 hospitalized patients worldwide using remdesivir in COVID-19 positive patients.Meta-analysis of all identified RCTs showed no difference in survival in patients who received remdesivir therapy compared to usual care or placebo. The random effects meta-analysis has a summary odd ratio is 0.89 (95% CI 0.65-1.21, p = 0.30). Considerable variability in the severity of illness is noted with the rates of IMV at the time of randomization ranging from 0% to 27%.ConclusionsThis meta-analysis of randomized controlled trials published in peer-reviewed literature by February 1, 2021 did not show reduced mortality in hospitalized patients with COVID-19 who received remdesivir. Further research is needed to clarify the role of remdesivir therapy in the management of COVID-19.

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Patient engagement with PEAR-008, a game-based digital therapeutic for the treatment of opioid use disorder: protocol for a randomized controlled open-label, decentralized trial (Preprint)

JMIR Research Protocols ◽

10.2196/32759 ◽

2021 ◽

Author(s):

Hilary Luderer ◽

Lisa Chiodo ◽

Amanda Wilson ◽

Christina Brezing ◽

Suky Martinez ◽

...

Keyword(s):

Patient Engagement ◽

Opioid Use Disorder ◽

Opioid Use ◽

Open Label ◽

Randomized Controlled

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Health care utilization and overall costs based on opioid dependence in patients undergoing surgery for degenerative spondylolisthesis

Neurosurgical FOCUS ◽

10.3171/2018.2.focus17764 ◽

2018 ◽

Vol 44 (5) ◽

pp. E14 ◽

Cited By ~ 5

Author(s):

Mayur Sharma ◽

Beatrice Ugiliweneza ◽

Zaid Aljuboori ◽

Maxwell Boakye

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Opioid Dependence ◽

Degenerative Spondylolisthesis ◽

Opioid Use Disorder ◽

Hospital Length Of Stay ◽

Care Utilization ◽

Opioid Use ◽

Opioid Dependency ◽

Linear Contrasts

OBJECTIVEOpioid abuse is highly prevalent in patients with back pain. The aim of this study was to identify health care utilization and overall costs associated with opioid dependence in patients undergoing surgery for degenerative spondylolisthesis (DS).METHODSThe authors queried the MarketScan database using ICD-9 and CPT-4 codes from 2000 to 2012. Opioid dependency was defined as having a diagnosis of opioid use disorder, having a prescription for opioid use disorder, or having 10 or more opioid prescriptions. Opioid dependency was evaluated in 12-month period leading to surgery and in the period 3–15 months following the procedure. Patients were segregated into 4 groups based on opioid dependence before and after surgery: group NDND (prior nondependent who remain nondependent), group NDD (prior nondependent who become dependent), group DND (prior dependent who become nondependent), and group DD (prior dependent who remain dependent). The outcomes of interest were discharge disposition, hospital length of stay (LOS), complications, and health care resource costs. The 4 groups were compared using the Kruskal-Wallis test and linear contrasts built from generalized regression models.RESULTSA total of 10,708 patients were identified, with 81.57%, 3.58%, 8.54%, and 6.32% of patients in groups NDND, NDD, DND, and DD, respectively. In group DD, 96.31% of patients had decompression with fusion, compared with 93.59% in group NDND. Patients in group NDD, DND, and DD had longer hospital LOS compared with those in group NDND. Patients in group DD were less likely to be discharged home compared with those in group NDND (odds ratio 0.639, 95% confidence interval 0.52–0.785). At 3–15 months postdischarge, patients in group DD incurred 21% higher hospital readmission costs compared with those in group NDND. However, patients in groups NDD and DD were likely to incur 2.8 times the overall costs compared with patients in group NDND (p < 0.001) at 3–15 months after surgery (median overall payments: group NDD $20,033 and group DD $19,654, vs group NDND $7994).CONCLUSIONSPatients who continued to be opioid dependent or became opioid dependent following surgery for DS incurred significantly higher health care utilization and costs within 3 months and in the period 3–15 months after discharge from surgery.

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Addiction Medicine Consultations Reduce Readmission Rates for Patients With Serious Infections From Opioid Use Disorder

Clinical Infectious Diseases ◽

10.1093/cid/ciy924 ◽

2018 ◽

Vol 68 (11) ◽

pp. 1935-1937 ◽

Cited By ~ 44

Author(s):

Laura R Marks ◽

Satish Munigala ◽

David K Warren ◽

Stephen Y Liang ◽

Evan S Schwarz ◽

...

Keyword(s):

Opioid Use Disorder ◽

Opioid Use ◽

Addiction Medicine ◽

Readmission Rates ◽

Serious Infections

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213. A Comparison of Medication Assisted Therapy Treatment Strategies for Opioid Use Disorder in Persons who Inject Drugs and are Hospitalized with Serious Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.288 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S126-S126

Author(s):

Laura Marks ◽

Evan Schwarz ◽

David Liss ◽

Munigala Satish ◽

David K Warren ◽

...

Keyword(s):

Fungal Infections ◽

Hospital Readmissions ◽

Treatment Strategies ◽

Opioid Use Disorder ◽

Opioid Use ◽

Readmission Rates ◽

Persons Who Inject Drugs ◽

Increased Risk ◽

Hospital Patients ◽

The Impact

Abstract Background Persons who inject drugs (PWID) with opioid use disorder (OUD) are at increased risk of invasive bacterial and fungal infections, which warrant prolonged, inpatient parenteral antimicrobial therapy. Such admissions are complicated by opioid cravings and withdrawal. Comparisons of medications for OUD during prolonged admissions for these patients have not been previously reported. The aim of this study was to evaluate the impact of different OUD treatment strategies in this population, and their impact on ED and hospital readmissions. Methods We retrospectively analyzed consecutive admissions for invasive bacterial or fungal infections in PWID, admitted between January 2016 and January 2019 at Barnes-Jewish Hospital. Patients in our cohort were required to receive an infectious diseases consult, and an anticipated antibiotic treatment duration of >2 weeks. We collected data on demographics, comorbidities, length of stay, microbiologic data, medications prescribed for OUD, mortality, and readmission rates. We compared 90-day readmission rates by OUD treatment strategies using Kaplan–Meier curves. Results In our cohort of 237 patients, treatment of OUD was buprenorphine (17.5%), methadone (25.3%), or none (56.2%). Among patients receiving OUD treatment, 30% had methadone tapers and/or methadone discontinued upon discharge. Patient demographics were similar for each OUD treatment strategy. Infection with HIV (2.8%), and hepatitis B (3%), and hepatitis C (67%) were similar between groups. Continuation of medications for OUD was associated with increased completion of parenteral antibiotics (odds ratio 2.11; 95% confidence interval 1.70–2.63). When comparing medications for OUD strategies, methadone had the lowest readmission rates, followed by buprenorphine, and no treatment (P = 0.0013) (figure). Discontinuation of methadone during the admission or upon discharge was associated with the highest readmission rates. Conclusion Continuation of OUD treatment without tapering, was associated with improved completion of parenteral antimicrobials in PWID with invasive bacterial or fungal infections lower readmission rates. Tapering OUD treatment during admission was associated with higher readmission rates. Disclosures All authors: No reported disclosures.

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