Patient Engagement and Opinions of a Medication Assisted Treatment Program for Opioid Use Disorder: A Qualitative Assessment

Introduction: Opioid use disorder is widely regarded as a national health epidemic. Stephen Klein Wellness Center 6as started a Medication-Assisted Treatment (MAT) program to help combat this epidemic- a program that is unique in that it does not require sustained abstinence for continued participation in the program. Objective: The objective of this study is to better understand the beliefs and attitudes of patients towards a substance use treatment program that does not require sustained abstinence. Methods: Five focus groups, totaling 31 participants, were assembled from patients who are current participants in Stephen Klein’s MAT program. The content of the interviews included interviewees\u27 general opinions of the program, opinions of its’ strengths and limitations, opinions on how it differs from other drug and alcohol programs, suggestions for improvements to the program, and opinions on the fact that the program does not require abstinence for participation. Data were analyzed using a qualitative thematic approach. Results: Forthcoming Conclusion: Forthcomin

Health Outcomes in Pathways to Housing Clients

Introduction: Homelessness is widespread throughout the United States, with homeless individuals accounting for over half a million of the country’s population. In addition, chronic mental, behavioral, and medical issues are overly expressed in this population. Therefore, the purpose of this project was to determine if the Housing First Model, represented by Pathways to Housing PA, would alleviate these chronic conditions over the course of stay. Methods: The target population of the study was the homeless population, specifically within the city of Philadelphia. Data was collected via the SAMHSA (Substance Abuse and Mental Health Services Administration) NOMs (National Outcome Measures) survey. To determine the difference of clinical measures over time, a repeated measures ANOVA was conducted. The main outcomes measured were systolic blood pressure, perception of life quality, and overall perception of health, as they were the three measures with the most robust data. Results: Data collected from all four sites (n=256) of Pathways to Housing was analyzed together to see if there was a noticeable difference from baseline to time of departure, in 6-month increments. However, the analysis for all three measures of systolic blood pressure (p=.136), perception of life quality (p=.223), and overall perception of health (p=.484) had p-values above the cutoff of 0.05. Therefore, there was no statistical difference in the three of the outcome measures over time. Conclusion: The results fail to support the hypothesis that Pathways to Housing PA made a statistically significant difference in systolic blood pressure, perception of life quality, and overall perception of health. It has been hypothesized that this may be due to the attrition rate as well as missing data points. In the future we are looking to see if there are more data points to analyze as the data is continually being collected. In addition, we are looking at analyzing more site-specific information

Investigating Chronic Illness in Pathways to Housing Clients

Approximately 553,000 individuals were homeless in the US each night in 2017, each at significant risk for substance use disorder, severe mental illness, and untreated chronic disease. Housing First (HF) is an evidence-based model for reaching high risk homeless individuals by providing a personal home to clients without the requirement for abstinence. HF has been shown as effective as other frameworks in remission of substance use, connectedness in the community, and client perceived quality of life, but there is a gap in the literature regarding the impact of HF services on clinical measures of chronic health, which could help further bolster HF’s evidence-based practice. Using SAMHSA data available from 5 participating Philadelphia HF centers, this study evaluated survey responses via the CMHS NOMs, as well as blood pressure, BMI, and breath CO at baseline, 6 months, and 12 months enrolled into the program. Survey responses were evaluated using Cochrane Q test and clinical endpoints were assessed through paired t test. Clients perception of their own health improved, as well as their own perceived social connectedness. However, there were no differences noted in any of the clinical endpoints measured. HF clients are at high risk for substance use disorder and serious mental illness, which makes short-term progress on health concerns difficult. While responses to surveys matched the literature, no improvement in measured clinical endpoints suggests revaluation of a more mature data set and emphasis on collecting clinical endpoints such as HbA1c and Lipid studies to further evaluate HF services in Philadelphia

Housing First for People with Opioid Use disorder (OUD) and engagement with Medication-assisted Treatment (MAT) and Harm Reduction Services

Intro: Opioid Use Disorder (OUD)is one of the most prevalent and deadly SUD’s in the country and many barriers exist for individuals living with homelessness and concurrent psychiatric illnesses when hoping to engage in Medication-Assisted-Recovery/Treatment (MAR/MAT). The current study evaluates the Pathways to Housing PA’s (PTHPA) Housing First(HF) model which provides scatter-site housing with social and maintenance services to individuals with a history of chronic homelessness and a diagnosis of OUD. Methods: A retrospective chart analysis was completed for to assess factors relating to MAT engagement using PTHPA’s Credible BH recording system. MAT engagement prior to HF, psychiatric, homelessness, and medical history were all collected from a Psychiatric Assessment performed upon admission into the HF program. MAT retention and engagement during HF was obtained from self-reported information provided in case notes from PTHPA team members. Results: 76.7% of people engaged in MAT with methadone or buprenorphine treatment after being housed for at least 2 months (n=133). Re-engagement in MAT was higher in individuals who had prior MAT participation prior to the housing first intervention. Years homeless, age and race did not have a significant association with MAT participation following the HF intervention, although gender was associated with different levels of MAT participation between males and females. 23.33% of individuals were able to retain/stay on MAT prior to engaging in HF. 81.375% of individuals who engaged in MAT during the HF intervention were able to retain/stay on MAR by the end of the recording period. Conclusion: There was a significant association of increased MAT engagement in individuals with prior MAR participation. The study at hand suggests that a scatter-site HF model with adequate social service and MAR support can be associated with greater rates of retention in MAR while supporting higher rates of MAR participation in individuals experiencing chronic homelessness and primary OUD than the general population

Beyond The Waiver Training: Practical Tips You May Not Have Learned

Objectives Understand the critical importance of philosophy, structure, and access in MAT Share practical tips for starting MAT in your practice Discuss lessons learned with developing a MAT progra

Medical Respite Care Services for Homeless Patients Discharged from Thomas Jefferson University Hospital: A Needs Based Assessment

Introduction: Medical respite programs have been proposed as a temporary solution to address the increased hospital readmission rates and lack of appropriate discharge options that exist for homeless patients. Objective: This study examines the 90-day readmission rate and discharge locations of patients experiencing homelessness. Methods: We conducted a retrospective chart review of homeless patients discharged from Thomas Jefferson University Hospital (TJUH) between April 30th 2017 to April 30th 2018. Homelessness was identified as any patient with 1 of the following locations listed for residency: 833 Chestnut Street, Broad Street Ministry, St. John’s Hospice, shelter as address, no address listed. The primary outcome was 90-day hospital readmission rate to TJUH. The secondary outcome was discharge location. Data regarding patient age and insurance status were also collected. Descriptive statistics were performed using SPSS, version 23. Results: Out of a sample of n=14233, data was separated by hospitalization type documented as emergency department (n=2283), observation (n=98) and inpatient (n=202). Inpatient data was examined. The mean age was 46 years and 58.4% of patients had Medicaid. 70.8% of patients were discharged to home/residence and 15.8% left against medical advice (AMA). 20.8% of patients experienced ≥1 hospital readmission in 90-days. Conclusion: Gaps exist in the discharge disposition options in EPIC (an electronic medical record system). Homeless patients have higher AMAs compared to the general population. Future efforts should focus on integrating medical respite care into the comprehensive discharge planning programs by TJUH, and educating healthcare providers on discharge options available for homeless patients

Medication Assisted Treatment in the Primary Care Setting: A Prospective Review

Introduction: Project HOME Health Services (PHHS) initiated a Medication Assisted Treatment program for Opioid Use Disorder in a primary care setting that is the first of its kind in the city of Philadelphia. This study assesses the MAT program by evaluating the Quality of Life (QoL) of the participants as well as their perception of the program. Objective: The purpose of this study is to assess the QoL of the participants in the MAT program at PHHS and to evaluate the participants’ satisfaction with the program. Methods: The population includes patients enrolled in the MAT program at PHHS who consented to complete a survey. Participants completed the WHOQOL-BREF and the Mental Health Statistics Improvement Program (MHSIP) surveys. Scores for the four QoL domains were calculated. Results: Participants in the MAT program have lower QoL scores in all four domains than the general population. Most participants were satisfied with the program. The large group sizes and the identification of participants in public waiting areas are two examples of what participants liked the least. Conclusion: The QoL of individuals in this MAT program is lower than that of the generation population. While there was overall satisfied with the program, specific areas of improvement should be and have been addressed. The survey responses have allowed the staff to make necessary changes that directly impact the participants. This study will be continued to assess for other potential improvements to the MAT program, which could directly benefit its participants

Medication Assisted Treatment for Opioid Use Disorder in the Primary Care Setting in Philadelphia: A Retrospective Review

Introduction: The opioid crisis continues to be a growing public health concern across the United States. Americans struggling with Opioid Use Disorder (OUD) can seek different resources to help curtail their addiction. These include abstinence -based programs such as Narcotics Anonymous and Specialty treatment facilities including methadone and suboxone clinics. It has been shown that increased availability of drugs to treat opioid use addiction, such as methadone and buprenorphine, is linked to a lower likelihood of relapse and fatal overdoses. Therefore, medication assisted treatment (MAT) is a valuable asset because it combines behavioral therapy and medications to treat opioid use disorder. Despite the potential benefit of primary care MATs, there are factors leading to low access and utilization of these programs. They include limited number of trained prescribers, policy barriers such as insurance coverage, and both and provider stigma associated with MAT. Demographics from the MAT program of Project HOME Health Services of Philadelphia were reviewed for this project. Objective: To conduct a retrospective review of MAT program participant demographics at Project HOME Health Services in North Philadelphia. The goal is to identify the key demographics of patients enrolled in the program from July 2017- July 2018. Methods: A review of an Electronic Medical Record database from a population of 108 patients enrolled in the MAT program at Project HOME Health Services from July 2017-2018. The planned analysis is demographic descriptive statistics. Results: The age range of patients was 27-71. Of the 108 patients, 39 were considered active participants in the program (21 male, 18 female). Twenty-five percent of the patient population reported their homeless status as shelter, street, transitional, supportive housing, or formerly homeless. Sixty-nine patients received a hepatitis C virus antibody test, with 26 reporting results suggesting of a possible Hepatitis C, 8 positive, and 20 with negative testing. In the total population, there were 39% reported hypertension, 54% reported depression, and 94% reported current tobacco use. Conclusion: The reported findings describe the demographics of the MAT participants of Project Home of Philadelphia. This data will be utilized in conjunction with other research that assesses adherence to MAT programs and quality of life. Future areas for research involve statistical comparisons to determine factors leading to patient retention in the program. Another project would be to review the patients’ urine toxicology screens for additional information, including the number of months in the program until only the prescribed drugs are in the urine and how many drug screens were positive for fentanyl. Finally, further research may determine specific additional primary care needs of the participants

Training the Next Generation of Family Medicine Providers through Group Buprenorphine-Naloxone Visits

Introduction: The rise in opioid use disorders (OUD) and fatal overdoses highlight the need to expand access to and capacity for treating OUD. Medication Assisted Treatment (MAT), a medication/group visit model, done in the office setting, is an effective remedy for treating OUD. Understanding residents’ perspectives on their clinical training in MAT can inform the design of a more effective and responsive curriculum. Methods: A qualitative study using group semi-structured interviews with residents in an urban family medicine residency rotating through a federally qualified health center. Interviews centered on strengths and weaknesses of the MAT program, resident likeliness to prescribe MAT, and potential training that would boost confidence were conducted. Grounded theory was utilized to identify themes among transcripts. Results: Four interrelated themes emerged: modeling and mentorship, harm reduction, skills, and intent. Residents’ desire to treat and views on harm reduction, combined with their skills and mentorship, give them the confidence and intent to utilize MAT post-residency. Discussion: Residents have the desire to prescribe MAT post-residency but lack confidence to do so. This can be attributed to a lack of modeling, mentorship, and skills developed within residency. Addition of this into programs, combined with exposure to harm-reduction as a principle and practice, must be incorporated into programs and could play an important role in closing the “treatment gap” by training the next generation of providers in providing MAT

High Retention in an FQHC MOUD Program Despite Substantial Vulnerabilities in Population

Background: Seventy-thousand people in Philadelphia use heroin, and another 50,000 misuse prescription opioids. Philadelphia has increased its capacity for medication for opioid use disorder (MOUD) with buprenorphine from 100 slots in 2017 to 2,906 as of December 2018, but clearly there is still a need for thousands of more treatment slots. Additionally, recent evaluations reveal people from vulnerable populations, including homeless, non-white, and those with chronic medical diseases, have compounded difficulty accessing MOUD, even if there is sufficient capacity. Our objective was to describe and report initial outcomes of a low-threshold MOUD program at our Federally Qualified Health Center (FQHC) in Philadelphia. Methods: We followed 79 patients at our FQHC from their time of initiation until their unplanned treatment termination. Additionally, the relationship of time retained in treatment was compared against homelessness status or cocaine use at baseline through Kaplan-Meier Survival estimates. Results: 3 month retention: 82%. 6 month retention: 63%. No significant differences in treatment retention were found between individuals experiencing homelessness vs. not homeless (p=0.25) and cocaine use vs. no cocaine use (p=0.12). Conclusions: Our FQHC MOUD Program engaged a high level of marginalized groups facing multiple vulnerabilities, and retained them in treatment at rates comparable or higher than reported figures from other FQHCs. This shows that the low-threshold, group based model integrated into a primary care setting shows promise in increasing access to and retention in MOUD services