Overview

Masters and doctoral level mental health clinicians are integrated onto primary health care teams to address the biopsychosocial needs of patients in medication assisted treatment (MAT) programs.

Organization Name

OHSU Scappoose Family Medicine Clinic
OHSU Family Medicine at Richmond

Organization Type

• FQHC
• Rural health system

National/Policy Context

• There are growing numbers of medication assisted treatment programs in response to the opioid epidemic.

Local/Organizational Context

• The organization had been experiencing suboptimal outcomes especially for complex patients in medication assisted treatment programs. In addition, there was inadequate access to addiction treatment in resource sparse communities .

Patient Population Served and Payor Information

• Rural residents of the Pacific Northwest

Leadership

• Rebecca E. Cantone, MD
• Joan Fleishman, PsyD
• Brian Garvey, MD, MPH
• Nicholas Gideonse, MD

Funding

• This intervention received grant funding:
  • FQHC – DHHS HRSA16074 Substance Use Disorder Treatment Expansion (Click here for information on HRSA grants)
  • Grant: 6 H80CS241610404 (Click here for grant application)
  • Grant from The Substance Abuse and Mental Health Services Administration (1H79TI026752-01– Expanding MAT Capacity Across Oregon)
• Columbia County Coordinated Care Organization provided additional funding for hiring.

Research + Planning

• The organization sent notification to all patients of additional behavioral health visits.
• The organization hired additional staff such as behavioral health professionals and other staff needed to support increased frequency of visits,

Tools or Products Developed

• Risk-stratified registry of MAT patients
• Patient agreement: Included education about the medication and requirements of the program, compliance with call-ins, and behavior.

Team Members Involved

• Behavioral Health Specialist
• NPs
• Physicians

Workflow Steps

• Patient selection:
  • A risk-stratified patient registry is used to determine level of support and visit frequency needed per patient.
  • The patient completes an assessment with behavioral health clinicians during the initial referral visit to the program to assess readiness for treatment.
  • Patients sign an agreement which includes education about the medication and requirements of the program, compliance with call-ins, and expected behavior.
• Participating patients initially have semi-weekly contact with behavioral health clinicians and alternate between weekly visits with the nurse and clinician.
  • Behavioral health clinicians address underlying mental health conditions, coping skills, and relapse prevention using person-centered and cognitive-behavioral techniques
  • The nurse performs care management visits with prescription management and drug screening measures.
  • The primary care provider monitors medication side effects, doses, and mental and physical health to prevent segregation of care.
• As patients stabilize, the frequency of visits decreases, alternating among the 3 care team members, at least monthly.
• Team monitors stability and intensifies support when needed, which is distinct from punitive approaches.

Budget Details

• Cost to hire behavioral health clinicians
• Cost for any change in frequency of appointments with nurses and PCPs from existing MAT program
• Cost of time to generate patient assessment and agreement
• Cost to make a risk-stratified patient registry
• Note: Increased cost may be offset by decreased use-related ED visits, hospitalizations, and overdose related morbidity and mortality

Where We Are

• The project is currently ongoing.

Outcomes

• Access to addiction treatment: This increased following the implementation of this intervention.
• PCP confidence in prescribing: PCPs were more confident in prescribing primary care based MAT following the implementation of this intervention.
• Patient support: Patients perceived increased levels of support following the implementation of this intervention.

Benefits

• This project led to increased access to addiction treatment in communities where services are sparse and increased clinician confidence to provide primary care based MAT.
• It streamlined the process for patient engagement in MAT, allowing for increased levels of engagement.
• The project addresses patients’ psychosocial needs.
• The project reduces pressure PCPs to manage addiction treatment on their own.

Glossary

• Medication Assisted Treatment (MAT) programs: Use of medications such as buprenorphine, methadone, and naltrexone to help treat opioid addiction

Sources

Cantone, R. E., Fleishman, J., Garvey, B., & Gideonse, N. (2018). Interdisciplinary Management of Opioid Use Disorder in Primary Care. The Annals of Family Medicine, 16(1), 83-83. doi:10.1370/afm.2184