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Opioid Crisis: Hub-and-Spoke Approach on the Kitsap Peninsula

Friday, January 12, 2018   (0 Comments)
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Lynn Gerlach, Tamarack Communication

-an interview with Angela Bland, Care Coordinator, Peninsula Community Health Services



As the nation’s attention is riveted on the opioid crisis killing Americans every day – in many cases killing people with the very drugs prescribed for them to manage pain – we continue to showcase Region X health centers’ efforts to address the problem in their service areas. This month we return to Washington and a health center that has successfully joined the state’s targeted Hub-and-Spoke approach to substance use disorder treatment. The CHC became the hub for a three-county area.


In early 2016, Peninsula Community Health Services (PCHS) took a firm stand against opioid abuse and misuse and poor prescribing procedures. Health Resources and Services Administration (HRSA) funding provided PCHS with a federal Substance Abuse Service Expansion grant of $325,000.


The first thing PCHS did was to staff up appropriately. They hired Angie Bland to serve as Integrated Program Care Coordinator; Deborah Olin, a Chemical Dependency Professional (CDP); and a half-time pharmacist, Albert Carbo.  Fully dedicated to the Medication-Assisted Treatment (MAT) program, those three launched the new approach, intending to make a difference in the lives of their patients and the broader community.


Next, PCHS worked to get all its medical doctors buprenorphine waivered. Now, all PCHS providers are routinely trained to earn the buprenorphine waiver. PCHS now has 16 MAT-licensed prescribers, including 7 MDs and 9 Advance Practice Clinicians. Embracing Washington State’s hub-and-spoke model, the health center was able to lower barriers to intervention, believing that “any door is a good door to walk through” when taking the first step to seek treatment. The goal was multiple points of access.


In September of 2016, the health center became part of 3CCORP, a three-county network of providers to create a system of care able to serve a regional population of about 367,000 with Jefferson and Clallam counties. Surveys of hospitals, DOH, insurance claims, overdose reporting, Healthy Youth, Syringe Exchange reports, law enforcement, fire/EMS, medical providers, and workforce leaders revealed the following:


  • In a population with a median age of 39, 25% were Medicaid recipients.
  • Seven of Washington’s 29 tribes are within this area.
  • One county, Clallam, had an overdose rate 42% higher than the state average.
  • Total opioid-related inpatient hospital stays in 2015 had been just shy of 1000.
  • Collectively, the three counties were investing $183,000 each month to transport methadone patients for treatment.
  • 70% of the area’s heroin users had previously been prescription opioid users. 52% of them had witnessed an overdose in the past year, and 52% were very or somewhat interested in getting help.
  • Of the 1,918 known heroin users in the region, 1,477 were not in treatment.
  • Together, the three counties were exchanging 1.7 million syringes each year.
  • 100% of law enforcement respondents indicated that the opioid crisis is a concern in their jurisdiction.


3CCORP sought to understand why buprenorphine-waivered providers were not serving at their authorized capacity. These were the reasons they were given: excessive paperwork; inadequate referral options for complex patients; lack of care coordination for supportive services; increased access to supportive outpatient SUD service; perceived unreasonable time demands; concern about diversion.


In August 2017, poised to expand its treatment capacity in the region and also mentor other agencies, the health center received funding through the Washington State Targeted Response grant made possible by the 21st Century Cures Act. With that additional $789,825, total for the hub and its spokes, Peninsula has worked to enlarge its hub-and-spoke approach to MAT for Opioid Use Disorders (OUD) services. The health center is actively cultivating stronger partnerships for MAT prescribers and coordination with law enforcement, needle exchanges, SUD agencies and all of the major community mental health agencies.


As the formal network of spokes solidifies, the plan is to invite more community partners to the table as “dotted line” spokes for an even larger coordinated network throughout the entire region. An early example for PCHS is having its certified navigator staff actually attend the Kitsap Therapeutic Court sessions to enroll individuals in Medicaid and in the integrated primary care the health center offers. The goal is to collectively start 200 unique individuals into OUD services by next spring.


To date more than 250 current PCHS patients have been referred for some level of substance abuse treatment service. The health center will be hiring another coordinator as the “Hub coordinator” to further bridge the gap between PCHS and its spokes out in the community. Along with Debbie Olin, that individual will identify patients appropriate for MAT. The final new team member, Dr. Ann Bruce, an addiction specialist, has been hired to work directly with patients seen as beyond the scope of primary care MAT providers.  Once Dr. Bruce’s patients are stabilized within the MAT program, they will be referred back to their primary care providers for long-term treatment. 


Health Center CEO Jennifer Kreidler-Moss, a licensed clinical pharmacist herself who retains Board certification in Psychiatric Pharmacy, says she cannot believe how quickly substance abuse treatment is becoming part of the standard in primary care treatment. “Ten years ago, it was not on anyone’s radar. Five years ago, it was something we referred out. Today, it is something we not only treat ourselves, but we are leading our region in helping others meet the needs of their patients.”


NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.


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