Examining patient and provider experiences in collaborative, low threshold care for substance use disorder: A qualitative study of a bridge clinic.

INTRODUCTION Individuals with substance use disorders (SUD) face significant barriers to treatment including health comorbidities, structural obstacles, and stigma. Bridge Clinics offer a novel low-threshold, multidisciplinary approach to SUD treatment designed to transition patients to longer-term care. This study explores patient and provider experiences within a hospital-based Bridge Clinic to optimize treatment approaches.

Methods

We conducted 11 semi-structured interviews with patients (n = 5) and multidisciplinary providers (n = 6) at a hospital-based bridge clinic in Boston, MA. Interviews were recorded, transcribed verbatim, and analyzed using an inductive-deductive thematic approach (framework method with reflexive thematic analysis). Reporting followed the Consolidated criteria for reporting qualitative research (COREQ) checklist.

Results

Five crosscutting themes emerged. (1) Low threshold, nonjudgmental access fostered trust, transparency, and rapid engagement, including same-day medications. (2) Whole person, integrated care addressed substance use, psychiatric comorbidity, infectious disease, and social needs through a biopsychosocial lens. (3) Team based collaboration among addiction psychiatry, internal medicine, primary care, social work, and recovery coaching was the engine of comprehensive care and a source of provider support. (4) Resource allocation and navigation, especially recovery coaching, social services linkage, and harm reduction education were pivotal to progress. (5) Bridging to longer-term care remained the most challenging step, with providers citing out-of-network bottlenecks, limited time for follow-up, and relationship-based hesitancy to hand off care; participants proposed a dedicated referral/bridging specialist.

Conclusion

The Bridge Clinic model successfully engages patients through flexible, stigma-free, comprehensive care delivered by collaborative teams. However, challenges remain in optimizing transitions to longer-term treatment and ensuring culturally competent care. Recommendations include developing dedicated bridging specialists and enhanced cultural competence training to improve model implementation and patient outcomes.