Development of an addiction medicine clinic integrated into an internal medicine ambulatory practice

Substance use disorders (SUDs) are widespread, yet few individuals receive treatment. Internal medicine (IM) residents need clinical training on how to provide SUD treatment.

In 2023, the authors used a structured approach to develop an addiction clinic integrated into the University of Cincinnati IM resident primary care practice to provide SUD treatment. A formative logic model with output measures to evaluate the short-term outcome of the first 15 weeks of clinic was used. Output measures included no-show rates, number of patient visits, and primary SUD diagnosis. Short-term outcomes of residents' experiences were evaluated using a retrospective pre-post survey and the McNemar paired test to assess their confidence in performing addiction-related clinical tasks before vs after their rotation.

Eighteen learners were sent a survey from December 2023 to March 2024, with 11 responding (61%). Short-term outcomes included resident-reported confidence as moderate, quite, or extremely confident in the listed tasks before vs after their clinic experiences: making an SUD diagnosis (4 [36%] vs. 10 [91%], P = .03), interpreting urine drug screen results (4 [36%] vs. 10 [91%], P = .03), starting buprenorphine for opioid use disorder (OUD) (1 [9%] vs. 8 [73%], P = .02), titrating buprenorphine for OUD (0 [0%] vs. 8 [73%], P = .01), starting medications for alcohol use disorder (4 [36%] vs. 7 [64%], P = .36), and harm reduction counseling (4 [36%] vs. 9 [82%], P = .06). In the first 15 weeks of this clinic, there were 73 patient visits. Primary SUD diagnoses were OUD (37 [51%]), alcohol use disorder (18 [25%]), other (7 [9%]), stimulant use disorder (6 [8%]), and nicotine (5 [7%]).

Next steps include further evaluation of the clinic rotation's impact on resident clinical behaviors, attitudes on SUD, and patient SUD outcomes.