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MEDICATION ASSISTED TREATMENT COMMUNITY OF PRACTICE MAT in Primary Care: Expanding Access April 11, 2019
Transcript of MAT in Primary Care: Expanding Access1viuw040k2mx3a7mwz1lwva5-wpengine.netdna-ssl.com/wp...MAT in...
MEDICATION ASSISTED TREATMENT
COMMUNITY OF PRACTICE
MAT in Primary Care: Expanding Access
April 11, 2019
Disclosures
No individuals in a position to control content for this
activity has any relevant financial relationships to
declare.
WELCOME &
INTRODUCTIONS
Purpose of MAT CoP
To promote and support the successful implementation of
an integrated MAT approach in healthcare settings.
MAT CoP Resources
• MAT Google Group
To join discussions about MAT program development, email Adelaide
Murray at [email protected].
• Resources & Tools
Resources to support implementation of MAT programs can be accessed
on the Center for Excellence website:
http://nhcenterforexcellence.org/resources/community-of-practice-
resources/
• MAT Technical AssistanceSubmit requests to the Center for Excellence:
http://nhcenterforexcellence.org/center-services/request-ta/
Objectives
1. Describe strategies for overcoming potential challenges
to implementing MAT.
2. Identify available resources to support MAT
implementation.
3. Use workflow templates and protocols to support MAT
implementation.
4. Discuss systems level challenges related to MAT
implementation.
MAT in Primary Care:
Expanding AccessLinda Barton, RN, Care Manager, MAT
Shelley Friedman, RN, MSN, MBA, Clinic Manager
Dr. Brian Lombardo, Family Practice/Medical Director for Primary Care
Dr. Erin McNeely, Internal Medicine/Assistant Medical Director for Primary Care
Lauren Senn, Practice Director
Alice Peck Day Memorial Hospital, Lebanon, NH
Disclosures: We have nothing to disclose except that we love primary care.
Overview and Objectives:
Understand the potential of doing MAT in primary care.
Explore resources and pitfalls for implementation.
Introduce workflow templates and protocols.
A National Epidemic: How did we get here?
2016: 63,632 US drug overdose deaths
66% of those involved opioids
Rate of overdose deaths increased by 21.5% from 2015-2016
States with the highest rates of death due to drug overdose in 2016
- West Virginia (52.0 per 100,000)
- Ohio (39.1 per 100,000)
- New Hampshire (39.0 per 100,000)
- District of Columbia (38.8 per 100,000)
- Pennsylvania (37.9 per 100,000)
https://www.cdc.gov/drugoverdose/data/statedeaths.html
How Can we Help?
2015: Only 30% of SUD-specific programs (nationally) offer medications for opioid use disorder
The Primary Care Potential:
medication + brief intervention counseling = similar outcome as formal treatment program
Goals of Medication Assisted Treatment:
• Decreasing mortality
• Increasing retention in treatment
• Reducing medical and SUD treatment costs
• Reducing opioid overdose among patients in treatment
• Increasing abstinence from opioids
• Lowering a person’s risk of contracting HIV or hepatitis C
+ Meeting patients’ primary care needs
Barriers to starting our own MAT practice
1. Stigma
https://www.npr.org/2018/10/31/662009650/social-stigma-is-one-reason-the-opioid-crisis-is-hard-to-confront
2. Previous Behavioral Issues Surrounding Patients on Chronic Opioid Medications
3. Workload and Resources
1. Lack of Behavioral Health Support
2. Lack of Social Work Support
4. Training
1. Waivers- Cost and Time
2. Support Staff Education and Training
3. Behavioral Health Awareness
APD
• Intensive MAT & SUD Tx
Implementation process
• All staff education
• Ongoing mentorship
State stigma largely resolved
CHESHIRE
• Moms in Recovery
• PC: BH consult expansion
& MAT grant from FHC
• Established as Keene HUB
• Defined principles for BH
care improvement
• MFS reverse integration
project
• Stigma identified as key
barrier > active trainings
2019
MT ASCUTNEY
• Education & awareness
training
CONCORD
• Talks from expert groups
to help staff
• MAT implementation
Community Group
Practices
• Two embedded BH
specialists
• Two supervisors with
week long OUD training.
• Targeting staff
trainings
NASHUA
• BH integration pilot • Routine screening MH & SUD
• Embedded MH services
• Engaging PCPs in MAT
State stigma improving
DHMC
• Academic grand rounds
• IM, Hospitalist, FP, ED
Pedi section/in service
trainings
• Opioid Addiction
Treatment Collaborative
Efforts to Combat Behavioral Health Stigma at your D-HH
D-HH
SYSTEM(Responding Sites)
MANCHESTER
• Classes on Stigma at the nurse
and MA level.
• Needs to get to providers
Resource Allocation:
Education:
• Waiver Training
• Additional CME Days
• Staff Workshops
• Clinic Shadowing
• Certified Recovery Coach
• Mentoring Calls
Staffing:
• Per Diem Nursing Support
• Staff hours for MAT work
• Medical Records
• Scheduling Support
• Dedicated MA and RN
• Planning and Development
Resources!
DHHS:
Substance Abuse and
Mental Health Services
Administration
American Academy
of Addiction
Psychiatrists:
BU and UVM
Alice Peck Day
Primary Care
NH Foundation for
Healthy Families
5-state
mentoring
pilot
project
GRANT $
Mentoring
Resources
PCSS (Providers’ Clinical Support System)
Headrest
Templates and Protocols
Treatment
Needs
Questionnaire
Copyrighted under Creative Commons
Attribution-Non Commercial-No
Derivates 4.0 International License
Current State
For Patients:
Convenience
Reduced stigma
Cost
Comprehensive care
For Providers:
Satisfaction
Collaboration
Continuity
DK 50 years old -
• Started using at age 9 - sister shared drugs with her.
• Had been in treatment with Dr. Mason but disappeared.
• Returned when PCP started doing MAT.
• Complications of sepsis and spinal abscess, hospitalized.
• Has engaged in plan of care but continues to use, albeit less.
• Declines residential treatment because of 13 year old son.
• Son has behavior problems.
• No financial assistance - no clothes, no car, no money.
JK 25 years old -
• Long history of drug use since early teen years.
• Methamphetamine is drug of choice but also opiates.
• Inconsistently engaging.
• Last drug screen poly-pharmacy.
• Anticipating a visit RN spent hours trying to prepare an inpatient stay.
• Broad array of barriers
JM 46 years old -
• Long history chronic back pain after spinal abscess and surgery.
• Comes from dysfunctional family with history of addiction.
• On chronic methadone for pain and compliant for some time.
• Also on “benzos-attempted” wean.
• Decompensated—admitted several times to BB retreat.
• Started using IV again after someone stole his methadone
prescription.
• Admitted to program.
• Added Klonopin, increased dose of buprenorphine and changed it
to three times a day.
• Relatively stable and compliant with all aspects of care plan.
Initial MAT Visit
MAT Follow Up Visit
References
• The American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of
Medications in the Treatment of Addiction Involving Opioid Use, May 27, 2015.
• The American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of
Medications in the Treatment of Addiction Involving Opioid Use, May 27, 2015.
• Lee JD, Grossman E, DiRocco D, Gourevitch MN. Home buprenorphine/naloxone induction in primary
care. Journal of General Internal Medicine, 24(2):226-32. doi:10.1007/s11606-008-0866-8. Epub 2008 Dec
17. PubMed Central PMCID: PMC2628995.
• https://www.dhhs.nh.gov/dcbcs/bdas/documents/matguidancedoc.pdf
ADDITIONAL CASE STUDY DISCUSSION
QUESTIONS?
DISCUSSION OF FUTURE TOPICS
Harm Reduction & Diversion
CoP Meeting Schedule
Location: NH Hospital Association
From: 2:30pm – 4:30pm
June 13
August 8
October 10
December 12
Final Thoughts
• Utilize Google Group for questions, event/resource sharing,
and discussion!
• 2 CEUs and CNEs available
• Please hand in your evaluation!
Thank you for coming!
REKHA SREEDHARA, MPH ADELAIDE MURRAY
[email protected] [email protected]
REBECCA SKY, MPH MELISSA SCHOEMMELL, MPH
[email protected] [email protected]
MOLLY ROSSIGNOL, DO FAAFP FASAM REGINA FLYNN, BS
[email protected] [email protected]
PETER MASON, MD
LINDY KELLER, MLADC
