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Medicated Assisted Treatment and Health Centers

Thursday, August 8, 2019   (0 Comments)
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By Barbara DiPietro, PhD, Senior Director of Policy, National Health Care for the Homeless Council

 

 

 

 

 

Pam H., Baltimore, MD

 

“My life changed completely in just 3 months!”

 

After three years addicted to opioids, Pam was ready to make a change. In May, she started on buprenorphine at Health Care for the Homeless in Baltimore and by the time I met her in July, she was exuberant about her new life. I asked her how the MAT program helped her and she was emphatic: “I look better, I feel better, and I don’t have the urge to do drugs anymore.” She went on to describe that she’s more stable, she’s able to focus on her goals to work and be with her family, and especially how she’s now spending time with her granddaughter. She firmly believes that MAT saved her life.

 

 

Pam represents one of the many thousands of patients who received medication for her opioid addiction at a health center. In 2017, health centers nationwide provided MAT to nearly 65,000 patients—a 65% increase over 2016. The 2018 UDS data will likely show similar growth. The tangible change in quality of life that Pam has experienced is not unique, but it does represent her health center’s commitment to providing her treatment, supporting her through difficult moments, and facilitating her recovery.

 

The story of health centers and MAT is a nuanced one. More health center providers are getting their waiver, and more patients are being treated each year. But at the same time, 73% of health centers nationally reported zero MAT patients in 2017 (four states do not have a single health center patient reported). While Region X reports greater engagement with MAT in comparison, still over half of health centers in these four states reported zero MAT patients (58%). Clearly more needs to be done to implement prescribing for a drug that has revolutionized opioid treatment and should be a standard of care delivered at all health centers.

 

Starting a MAT program and expanding it to meet patient need can seem daunting, but it doesn’t need to be. Below are strategies to consider in order to maximize the care your health center can deliver to patients with opioid use disorder.1

 

11 Proven Implementation Strategies 

 

  • Organizational Support and Buy In

1. Identify internal champions: Bringing up a new program and getting “buy-in” from a wide range of decision-makers takes a focused and determined effort, especially when there’s reservations about the program itself. Foster a champion in your leadership who can help persuade others and organize the actions needed to establish MAT services.

 

2. Consult with more experienced health centers: If you are just starting, talk with others who have already successfully implemented a program. Start small with just a handful of patients, and then build from there as comfort level grows.

 

3. Consider “diversion” from a broader perspective: Diversion of any prescribed drug is a concern that needs to be addressed directly with a patient and appropriate steps taken to achieve greater engagement in treatment. At the same time, many patients report having first tried buprenorphine on the street and confirm that it has reduced their opioid use, prevented overdoses, and provided a pathway to formal treatment. Don’t let fear of diversion prevent your program from offering MAT. Instead, build communication strategies with patients and work to achieve a better understanding of how to engage in treatment.

 

  • Staff Training and Support 

4. Provide staff training and support: Recognizing and treating substance use disorder requires skills that not all primary care providers have received, creating a discomfort with the subject that then yields low interest in MAT. Make sure all your primary care staff are getting the training and skills they need to provide high-quality, comprehensive care to their patients.

 

5. Engage many staff roles in MAT: Community health workers, outreach workers, peer specialists, and case managers all have roles to ensure a successful MAT program. There’s always a need to reach out and engage patients who have disconnected from care or need additional support. There’s also always ways to achieve improved integration of primary care and behavioral health services within a health center—MAT provides an opportunity to evaluate and improve overall operations across disciplines.

 

6. Consider dedicating administrative staff to coordinate: If possible, a dedicated program coordinator for MAT (depending on your patient volume) can help keep track of required documentation, prior authorizations (if applicable), and help evaluate program effectiveness. This person can also serve as an intermediary across disciplines and take over responsibilities that otherwise may fall to providers, thereby reducing capacity.

 

7. Build MAT into the culture and hiring practices: Set expectations with new staff about participation in MAT, and assign a mentor to those providers who are reluctant to engage in MAT so that it becomes an integral part of the health center’s standard of care. Reduce the stigma of addiction by normalizing its treatment.

 

  • Program Flexibility

8. Modify workflows to maximize provider capacity: Evaluate how to efficiently do a quick “check in” for patients and which staff are available to respond in a timely manner to patients needing additional support. Not only will this approach make your MAT program stronger, any changes can make your broader service model more responsive to patients and ultimately, demonstrate better health outcomes in numerous areas.

 

9. Ensure MAT program is flexible enough to meet patient needs: Patient-centered care means tailoring care plans to the individual—and MAT is no exception. A rigid requirement for group therapy attendance and other program components may work for some patients but not others. Design a program that allows for the flexibility to meet clients “where they are” and then actively work with them on their goals for recovery.

 

  • Community Partnerships and Resources

10. Partner with others in the community: Hospitals and emergency departments, behavioral health providers, detention centers, emergency responders, drug courts, etc. are all potential partners in the community who have a vested interest in helping community members access treatment and be successful in recovery. Identify where you need help and create a partnership that works for everyone involved.

 

11. Maximize available funding and resources: Over the last two years, the federal government has distributed over $10 billion in grants to states to increase treatment capacity, facilitate recovery, assist with law enforcement, and develop new research. This includes numerous funding opportunities for HRSA-funded health centers to expand services, hire new staff, and develop their programs. There are also a wealth of peer-learning modules (such as Project ECHO) that have been helpful in developing programs using professional guidance.

 

 

So rarely are we able to see such dramatic changes in our patients’ health, but MAT affords us that opportunity. Not only are we able to prevent overdose deaths, but we can rapidly change the quality of life that our patients experience and directly facilitate better health outcomes across numerous measures. Pam H. from Baltimore is not an exception—all our patients with OUD can be Pam. But we have to take the first step and make treatment available.

 

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1 More information available at: Kaiser Family Foundation (April 2019). Addressing the Opioid Crisis: Medication-Assisted Treatment at Health Care for the Homeless Programs.

 

 

 

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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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