Suppor ting the he alth of pe ople who use dr ugs in the pr imar y c ar e se tting K a re n L a mp, MD, Ma rtha Me za , T o b in She lto n, L CSW a nd L e tic ia Ce rva nte s So lis
Our o b je c tive s T o sha re a suc c e ssful mo de l fo r I nte g ra ting SUD tre a tme nt into prima ry c a re • • E ng a g ing pe rso ns using drug s in the ir re c o ve ry T o sha re le sso ns le a rne d thro ug h the pro c e ss Ba rrie rs to la unc hing SU tre a tme nt in a prima ry c a re se tting • • So lutio ns T o disc uss susta ina b ility o f se rvic e s
Ve nic e F a mily Clinic
Ve nic e F a mily Clinic VF C is a n F QHC e sta b lishe d in 1970 27,000 pts, 84,000 prima ry a nd spe c ia lty c a re visits 12 site s, 9 stre e t o utre a c h te a ms
Ho w did we sta rt?
Suc c e ssful I nte g ra tio n o f SU se rvic e s into prima ry c a re Ste p 1 : Asse ss Org a niza tio na l re a dine ss Buy-in fro m ke y le a de rship • Se nio r ma na g e me nt Clinic a l le a de rship Bo a rd o f Dire c to rs Asse ss a ttitude s a b o ut sub sta nc e use • • Adding SUD se rvic e s te ste d the Clinic ’ s c ulture a nd a ttitude s L iste n to sta ff to a ddre ss b a rrie rs •
Pe rc e ive d Ba rrie rs: he a ring fro m o ur pro vide rs • SUD tre a tme nt sho uld ha ve a de dic a te d pro vide r a nd b e se t a side in a spe c ia lty c linic T he re is no t e no ug h sta ff to pro vide SUD • tre a tme nt T he re is to o muc h sta ff turno ve r – it’ s ha rd to • ke e p e ve ryo ne tra ine d • T he re a re b a rrie rs to tre a ting pe rso ns e xpe rie nc ing ho me le ssne ss
Pe rc e ive d Ba rrie rs Pa tie nts with me nta l he a lth c o mo rb iditie s ma y • no t b e a ppro pria te • T he c linic ma y a ttra c t to o ma ny SUD pa tie nts T he c linic ha s a no -na rc o tic po lic y • • Pro vide rs fe a r SUD tre a tme nt will no t re ma in a prio rity a mo ng le a de rship F E AR se e me d to b e a c o mmo n de no mina to r • la c k o f e xpe rtise , kno wle dg e , to o ls
I mple me nta tio n stra te g ie s Ste p 2 : Ga ve o ur pro g ra m a na me : “SUMMI T ” S ub sta nc e use , m o tiva tio n, m e dic a tio n, i nte g ra te d t re a tme nt Use o f ne utra l la ng ua g e to ide ntify the pro g ra m a nd its pa rtic ipa nts Ste p 3: De ve lo pe d a nd a do pte d e vide nc e b a se d tre a tme nt pro to c o ls: • use d fo r tra ining MOUD (me dic a tio ns fo r OUD) pro vide rs a nd SUMMI T BH sta ff se ts c o nsiste nt sta nda rd o f c a re •
Me dic a l a nd BH pro to c o ls Ava ila b le fre e a t www.ra nd.o rg
I nte g ra tio n… Pro vide d to o ls fo r SUD tre a tme nt a t a ll le ve ls 1. Pro vide rs: MOUD fo c use d 2. BH sta ff: e vide nc e b a se d mo de ls o f c a re 3. I de ntifie d re spe c te d MOUD a nd BH c ha mpio ns a s “g o to ” sta ff fo r he lp 4. Co ntinue d c o mmunic a tio n with sta ke ho lde rs Ste p 5: Ha rm re duc tio n a nd tra uma info rme d c a re mo de ls thro ug ho ut the a g e nc y
Who a re we ? – Be ha vio ra l He a lth • L CSW – SUMMI T Clinic a l ma na g e r a nd the ra pist • L CSW (the ra pist) • 2 Ca re c o o rdina to rs/ Ca se ma na g e rs • 3 Ce rtifie d Alc o ho l a nd Drug Co unse lo rs • SUMMI T Pro g ra m Ma na g e r
Who a re we ? - Me dic a l Pro vide rs 39 pro vide rs, 13 X-wa ive re d pro vide rs: 21 MD/ DO’ s: 8 a c tive MOUD pre sc rib e rs 13 NPs: 3 a c tive MOUD pre sc rib e rs 5 PA’ s: 2 a c tive MOUD pre sc rib e rs
DAT A: F isc a l ye a r 2018/ 19 651patie nts re c e ive d SUMMI T BH se rvic e s in 5,000 e nc o unte rs 464 patie nts re c e ive d b upre no rphine pre sc riptio ns in 1520 e nc o unte rs
Ho w do pa tie nts ma ke it in? • Sc re e ning a t prima ry c a re visits (NI DA q uic k sc re e n b i-a nnua lly) • Wa lk-in • Wo rd o f mo uth (pa rtne rs, fa milie s, ne ig hb o rs, fe llo w use r, de a le rs) • Ho me le ss o utre a c h
Ho w do pa tie nts ma ke it in? • Ne e dle e xc ha ng e (no ne e d to b e VF C pa tie nt to a tte nd) • SUMMI T Suppo rt g ro ups (no ne e d to b e VF C pa tie nt to a tte nd) • Ca re c o o rdina to r / fro nt de sk se nds a ta sk o r c a lls to se e who is a va ila b le . Pre fe ra b ly sa me da y!!!
I nte g ra te d Ca re Wa rm ha ndo ffs: fro m me dic a l pro vide rs to c a re ma na g e rs to b e ha vio ra l he a lth, o r in a ny o the r o rde r
Me dic a l Assista nt E xpe rtise
Addre ssing a c c e ss issue s • Ne xt a va ila b le a ppo intme nt is a ppro xima te ly 6 we e ks fro m to da y Pa tie nts o fte n ne e d to b e se e n urg e ntly “strike • while the iro n is ho t” Appo intme nt a va ila b ility is ve ry limite d witho ut • o ve rb o o king o ur me dic a l pro vide rs • Sha re d me dic a l visit
“Refill Group” Name: Current dose of buprenorphine: Number of strips/ pills used per day: Number of strips left: Any symptoms? Any other drug use? If so, what? How many support groups have you been to since your last refill? Triggers encountered this week: What I did for my recovery this week: How is your physical health? Currently Working? Yes No Need to see the provider individually today? Yes No
Increasing Access to Buprenorphine 250 200 Number of Encounters 150 100 50 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2018 2019 Date Individual Encounter Shared Medical Visit On average, our shared medical visit has been able to increase the number of buprenorphine encounters by 30%
T re a tme nt linka g e • Ca re c o o rdina tio n: c ritic a l to a suc c e ssful pro g ra m • E nha nc e s a c c e ss fo r SUMMI T pts to o b ta in a ppts with MOUD pro vide rs • L inka g e to BH se rvic e s • Co nta c t pe rso n fo r Ca ll Ce nte r/ c a re c o o rdina to rs/ c o mmunity tre a tme nt pro g ra m pa rtne rs
Ca re Co o rdina tio n a nd Ca se Ma na g e r E xpe rtise
Ha rm Re duc tio n • Ac c e pts, fo r b e tte r a nd o r wo rse , tha t drug use is pa rt o f o ur wo rld a nd c ho o se s to wo rk to minimize its ha rmful e ffe c ts ra the r tha n simply ig no re o r c o nde mn the m. • Unde rsta nds drug use a s a c o mple x phe no me no n tha t e nc o mpa sse s a c o ntinuum o f b e ha vio rs fro m se ve re a b use to to ta l a b stine nc e , a nd a c kno wle dg e s tha t so me wa ys o f using drug s a re c le a rly sa fe r tha n o the rs. • E sta b lishe s qua lity of life a nd we ll-b e ing –no t ne c e ssa rily c e ssa tio n o f a ll drug use –a s the c rite ria fo r suc c e ssful inte rve ntio ns a nd po lic ie s.
Ha rm Re duc tio n • Ca lls fo r the non- judg me nta l , no n-c o e rc ive pro visio n o f se rvic e s a nd re so urc e s E nsure s tha t drug use rs a nd tho se with a histo ry o f drug • use ha ve a re a l vo ic e in the c re a tio n o f pro g ra ms a nd po lic ie s de sig ne d to se rve the m. • Affirms drug s use rs the mse lve s a s the prima ry a g e nts o f re duc ing the ha rms o f the ir drug use , a nd se e ks to e mpo we r use rs to sha re info rma tio n a nd suppo rt e a c h o the r in stra te g ie s whic h me e t the ir a c tua l c o nditio ns o f use .
Ha rm Re duc tio n • Re c o g nize s tha t the re a litie s o f po ve rty, c la ss, ra c ism, so c ia l iso la tio n, pa st tra uma , se x-b a se d disc rimina tio n a nd o the r so c ia l ine q ua litie s a ffe c t b o th pe o ple ’ s vulne ra b ility to a nd c a pa c ity fo r e ffe c tive ly de a ling with drug -re la te d ha rm. • Do e s no t a tte mpt to minimize o r ig no re the re a l a nd tra g ic ha rm a nd da ng e r a sso c ia te d with lic it a nd illic it drug use .
Be ha vio ra l He a lth • Gro ups a re no t ma nda to ry, b ut stro ng ly e nc o ura g e d • L ike wise , se ssio ns with CADCs a nd the ra pists a re no t ma nda to ry • All pa tie nts intro duc e d to a ll pa rts o f the pro g ra m a t the initia l visit, o r if no t po ssib le , ne xt visit, o r c a re c o o rdina to r c a lls to fo llo w-up.
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