Mind the gap: a quality improvement study to determine health care value of rapid-access telemedicine addiction treatment in recently incarcerated individuals.

backgroundPreviously incarcerated individuals experience a significant and vulnerable time post-release, highlighted by a greater than 129 times higher risk of overdose death. Many factors contribute to this high mortality including lack of health insurance and medications for opioid use disorder (MOUD) prescriptions upon release. Telemedicine provisions for MOUD greatly expanded access to MOUD for persons who previously could not engage in healthcare settings during critical times. Few rapid access, multidisciplinary transitional services exist to capture people in the immediate post-release period and address barriers to treatment engagement and retention. This quality improvement project describes the RIvER Clinic in Pittsburgh, PA which is a transitional post-incarceration clinic that provides multidisciplinary care services including a novel telebridge MOUD program immediately accessible for individuals post-release.

methodsThis quality improvement project was conducted using retrospective chart review during 3/1/2021 to 2/1/2025. Data from a year prior to engagement was additionally obtained. Patients who received a telemedicine bridge prescription of MOUD with the RIvER Clinic were included in this study. All patients had a previous history of incarceration.

results250 patients met the inclusion criteria. 91.6% of telebridge visits resulted in an MOUD prescription on the same day as the initial patient call. 73.6% of telebridge patients presented for a subsequent in-person clinic appointment. The average number of telebridge prescriptions prior to a completed in-person appointment was 1.18. There was a 40% reduction in emergency department (ED) utilization comparing the one year before vs the one year after a telebridge appointment. One patient had a fatal overdose.

conclusionsThe time period post release after incarceration represents a vulnerable time with exceedingly high risk of opioid overdose, death, and poor access to healthcare. The provision of MOUD via telemedicine offers a potentially lifesaving access point to limit overdoses post-release and provide an avenue for meaningful engagement. The RIvER Clinic model shows that offering telemedicine bridge prescriptions for MOUD prior to in person engagement can bridge an important gap and improve healthcare access. This innovative care model shows high in-person treatment engagement, a reduction in ED utilization, and a reduction in rates of overdose mortality.