best practices in medication assisted treatment · best practices in medication assisted treatment...
TRANSCRIPT
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Best Practices in Medication Assisted Treatment
Kiame Mahaniah, MD
CMO, North Shore Community Health
Assistant Professor, Tufts University School of Medicine
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MAT: comparisons
• What is the evidence regarding the options?
-> Behavioral intervention alone versus MAT
-> HAT
-> Methadone vs. Naltrexone IM vs. Buprenorphine
-> Buprenorphine vs. Methadone
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MAT: best practices
• Baseline:
-> integration: why?
• First step:
-> SBIRT
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MAT: best practices
• Baseline
-> policies and processes: but trumping that philosophy
• How is a philosophy determined?
-> patient selection/exclusion
-> team member roles
-> what counts as a strike?
-> management of exceptions
-> patient dismissal/re-entry
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MAT: best practices
• Baseline
-> Diversion control processes
-> Documentation
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MAT: in practice
• Refining your processes:
-> team meetings
-> outreach to special constituencies
-> outreach to different communities
-> growing your practice
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MAT: what does the future look like?
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Launch of Screening, Brief Intervention, and Referral to
Treatment (SBIRT) using LEAN
• Implementation of SBIRT in Primary Care – Tower Foundation Grant
• LEAN Process - Project Charter
• Work Flow – Process Map
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Screening Work Flow
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Implementation
• Staff Training on SBIRT
• Development of Protocol; Quick guides
• Pre-screening on Health Risk Assessment Form (Annual/New)
• Further Assessment when Pre-screen positive• AUDIT/DAST• CRAFFT for 12-17 age patients
• Documentation in EMR• Use of Quick Texts; care plans in assessment• Special Quick texts to differentiate adult from pediatric;
ensures confidentiality
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Data Collection
Salem: Newly up and running; no data to share at this time.
0
50
100
150
200
250
Pat
ien
ts
PFHC Running SBIRT Data
# patients screened
# Positive screens
# BNI's performed
# Referrals
0
100
200
300
400
500
600
700
800
900
Jan
-14
Feb
ruar
y
Mar
ch
Ap
ril
May
Jun
e
July
Au
gust
Sep
tem
be
r
Oct
ob
er
No
vem
be
r
De
cem
ber
Jan
-15
Feb
ruar
y
Pat
ien
ts
GFHC Running SBIRT Data
# Screened to date
# positive screens
# BNI's performed
# referrals
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Sustainability
• Strengths• Grant Finances
• Relationship with BNI-ART Institute
• Dedicated staff - CHW
• Challenges• Switching from 5 A’s MI
• Increasing responsibilities of MA’s
• EMR issues (rights, etc.)
• Documentation
• Lessons Learned
Continuum of Care: Community-Based Partnerships include:
• Physicians Roundtable
• High-Risk Task Force
• Opiate Prevention Partnership
• Shelter Liaison
• AGH ED SBIRT
• Suboxone Treatment Program