Gallo, Rachel M, MPH

Jimenez, Frances, BS

Richards, Mark, BS

Rosingana, Katie, BA

Smith, Mary Lindsey, PhD

English

University of Southern Maine: Digital Commons@USM

University of Southern Maine USM Digital Commons Substance Use Research & Evaluation Cutler Institute 2019 Expanding Access to Medication-Assisted Treatment (MAT) through Primary Care Practices: Findings from the Maine Health Access Foundation's Addiction Care Program (Years One and Two) Mary Lindsey Smith PhD University of Southern Maine, Cutler Institute, m.l.smith@maine.edu Rachel M. Gallo MPH University of Southern Maine, Cutler Institute, rachel.gallo@maine.edu Katie Rosingana BA University of Southern Maine, Cutler Institute, katherine.rosingana@maine.edu Mark Richards BS University of Southern Maine, Muskie School of Public Service, mark.f.richards@maine.edu Frances Jimenez BS University of Southern Maine, Cutler Institute, frances.jimenez@maine.edu Follow this and additional works at: https://digitalcommons.usm.maine.edu/substance-use-research-and-evaluation  Part of the Substance Abuse and Addiction Commons Recommended Citation Smith, M. L., Gallo, R., Rosingana, K., Richards, M., & Jimenez, F. (2019). Expanding Access to Medication-Assisted Treatment (MAT) through Primary Care Practices: Findings from the Maine Health Access Foundation's Addiction Care Program (Years One and Two). University of Southern Maine, Muskie School of Public Service, Cutler Institute. This Report is brought to you for free and open access by the Cutler Institute at USM Digital Commons. It has been accepted for inclusion in Substance Use Research & Evaluation by an authorized administrator of USM Digital Commons. For more information, please contact jessica.c.hovey@maine.edu. Expanding Access to Medication-Assisted Treatment (MAT) through Primary Care PracticesFindings from the Maine Health Access Foundation's Addiction Care Program (Years One and Two)Mary Lindsey Smith, PhD, MSWRachel Gallo, MPHKatie Rosingana, BAMark Richards, BSFrances Jimenez, BSUniversity of Southern MaineJuly 2019Addiction Care Program Overview23System ChangeMaine has an expanded treatment infrastructure for OUDs.Grantee StrategiesGrantee programs increase the availability of medication-assisted treatment (MAT) in primary care settings.OutcomeMore people with opioid use disorder (OUD) are in treatment and recovery.High-Level Overview of ProgramIn April of 2017, the Maine Health Access Foundation (MeHAF) provided funds to ten grantee sites to expand access to patient-centered addiction care for people with opioid use disorder (OUD) through their Addiction Care Program.Addiction Care Program GranteesThere are 10 Addiction Care Program grantees located throughout Maine. Each grantee is engaging in comprehensive planning and implementation activities designed to build capacity to provide medication-assisted treatment (MAT) in primary care settings.Program Components: Technical Assistance Qualidigm: Training, education, and technical assistance to support grantee organizations, both individually and as a cohort. Haram Consulting, Eric Haram, LADC: Technical assistance to sites around integrated treatment models for OUDs.Maine Behavioral Healthcare, Mary Jean Mork, LCSW: Technical assistance related to billing / coding for MAT services.Maine Medical Association: Technical assistance related to public policy.Program Components: EvaluationThe Addiction Care Program evaluation is being led by the Muskie School. Evaluation data is collected from a variety of sources including surveys, administrative data, continuous quality improvement measures, interviews, and focus groups. This mixed methods approach:• informs current and future planning activities; • guides the implementation and refinement of the intervention strategies; • provides ongoing feedback to grantee organizations on improvements to access and delivery of MAT in their region; and • offers a summative assessment of the implementation experience and documents grantee organization milestones and successes.Evaluation Methods7Grantee ProgramsTechnical Assistance Qualidigm& Haram ConsultingEvaluation USM MuskieUnderstand Barriers and Facilitators Collect Data, Make ObservationsAssess OutcomesShare Data and LearnOngoingData Sharing & LearningThe program evaluation utilized traditional evaluation techniques in tandem with quality improvement strategies to provide rapid cycle feedback to help inform grantee planning and implementation activities.Evaluation FrameworkSurveys• Health Systems, Practice, and Provider Survey:• Fall 2017: 150 respondents• Interim Planning Site Survey:• Summer 2018: 27 respondents• Provider Survey:• Spring 2019: 31 respondents9Data Dashboards• Custom data collect ion dashboards created for all 10 grantees• Dashboards were submitted quarterly in both years and included the following:• Continuous quality improvement metrics• Site-specif ic metrics• Community engagement logs• Training/ education logData Sources: Quantitative10Pat ient Focus Groups• Year One: questions around patient perspectives on opioid use in the state, personal experiences with addict ion and treatment, personal experiences with MAT, engagement in the Addict ion Care Program, and patient-centered care• Year Two: questions around personal experiences seeking treatment, experiences with MAT, treatment engagement, recovery coaches, and patient-centered care• 37 patients part icipated in focus groups at grantee organizationsData Sources: QualitativeProvider Interviews• Year One: provider experiences, opinions on MAT, challenges, strategies, and organizational needs• Year Two: change team feedback on barriers and facilitators to collaboration, planning and implementation, lessons learned, and next steps• 102 providers part icipated in interviews at grantee organizationsPatient Perspectives1112What did we hear from patients?• Patients cite a number of reasons for why initiating and engaging in treatment can be difficult, even when they are ready to seek help. The majority indicated that there is often no clear path for individuals seeking treatment for OUDs.• The majority of patients indicated that lack of insurance and the cost associated with treatment are the greatest barriers to accessing and engaging in MAT.13What did we hear from patients? Key Program ComponentsPatients identified a number of factors that they feel are important components of a successful MAT program. Creating treatment protocols and policies that include interventions specific to the tasks and challenges faced by patients at each stage of the treatment, maintenance and recovery; supportive staff and family; and addressing social determinants were frequently cited as important elements of MAT.14What did we hear from patients? Promoting Long-Term RecoveryConsistent and rapid access to MAT, auxiliary recovery supports (housing, employment, transportation), social supports as well as opportunities for community engagement were the most frequently mentioned factors necessary to support ongoing maintenance and recovery. Capacity Building Milestones1516Capacity Building: Community EngagementOver the course of two years, grantees engaged with their community through diverse mechanisms and focused on various topics. 767657523125181312119644113Advisory Board MeetingRoundtable or Group DiscussionPresentation or Educational EventPublic Meeting or ForumFlyer DistributionGrant Planning Team MeetingArticle - OnlineArticle - NewspaperTV FeatureRadio FeatureIn-Person TrainingPress Release or ConferenceSocial Media CampaignYouth EngagementOtherTypes of Community EngagementNote: The “other” category is comprised of site-specific types and topics of community engagement that were not rolled into a specific category.1026541352215832208Community OrganizingRecovery SupportsGeneral OUD/SUD EducationTreatment OptionsReducing StigmaPreventionPrescription Drug UseChronic Pain ManagementSocial Determinants of HealthOtherTopics of Community Engagement17Capacity Building: Training and EducationOver the course of two years, grantees held a variety of training and education opportunities. They utilized diverse mechanisms and focused on various topics. 585 Training/Education Sessions Recorded 6,322 Attendees Recorded**This is not individual attendees (i.e. attendees may be at more than one session and counted multiple times)573944653911Less than 1 hour1-2 hours3-5 hours6-8 hours2 DaysMore than 2 daysTraining/Education Duration555854525143323029272323191811109876644321OtherAddiction/ OUDs / OpioidsRecovery / Peer RecoveryHub and Spoke ModelGrant RelatedDiagnosing and Treating AddictionPreventionPeer SharingWorkflow ImplementationX Waiver TrainingCommunity OrganizingReducing StigmaChronic Pain ManagementRole Specific TrainingPrescribing Guidelines and LawsMAT PoliciesTechnologyPatient Engagement StrategiesSafe Prescribing & Prescribing LimitsMaternity Care and/or Snuggle ME GuidelinesNaloxone TrainingData Sharing / Universal ReleaseSafe and Compassionate TaperingBilling, Coding, and ReimbursementSocial Determinants of HealthPrescription Drug UsePrimary Training TopicsThe number of waivered providers is increasingSince the inception of the program the number of providers delivering MAT increased five times — from 27 providers to 1361827 2748 52 496173 7360 66 6698 100 101 101 103 102106 107 110124 127 130136Total Number of Providers Delivering MAT Capacity Building: Providers“I feel some of our greatest success has been the continuous addition of providers to our team” (Provider, Year Two)19Capacity Building: ProvidersBy Year Two, providers:• Felt more knowledgeable about their work related to OUD• Had increased satisfaction with the way they work with individuals with OUD• Felt they had increased support from colleagues• Were more motivated to work with individuals with OUD“There’s always more to learn but as I have continued to work with people I have certainly gained confidence that I am providing competent and quality care to meet patients’ needs.”- (Provider, Year Two)By the end of Year Two, providers were also more confident in their organizat ion’s ability to integrate MAT into their clinical work and more convinced that it  is important to do so.Programmatic Milestones2089969020040060080010001200Number of Patients on MAT by MonthMore patients are receiving MATAs of March 2019, grantees served nearly 11 t imes the patients as they did in October of 2018.21Capacity Building: Patient Panels*Note: more grantees reported on this metric in 2019.*More patients have OUD documented in their recordsThe number of patients with documented OUD was 1.4 t imes higher in March of 2019 compared to the previous year.22Capacity Building: Screening8221,151 0200400600800100012001400Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19Number of Patients with Documented OUDAverage wait t imes decreased over t imeDespite wait times varying across grantees, the average wait time from MAT referral to induction appointment decreased from nearly a month, to 5 days.23Capacity Building: Wait Times29505101520253035Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19Average Wait Time (days)Lessons Learned2425Lessons Learned: What Factors Facilitated Success? • Flexible Policies• Pat ient-centered• Variety of Tx OptionsTreatment ApproachesNeeded Resources• Staff• Infrastructure• Educat ion• Philosophical Alignment• Importance of MAT• Peer Support• Provider Buy-InCulture Shift  and ChangeCommunity Partnerships• Early Engagement• Cross-sector Collaborat ion• Establish Referral Pathways Time BurdensLearning from OthersPolit icsOther Factors to Consider:26Lessons Learned: What Factors Facilitated Success? 27Lessons Learned: Providing Patient-Centered Care MeHAF Addiction Care Program Year Two: Grantee Responses to Patient FeedbackSummary of Key Findings2829Key Findings from Grantee SitesEngagement• Recruit providers to participate (and be aware of barriers to recruitment)• Engage partners early• Convene a diverse advisory groupInfrastructure• Understand the types of providers and support staff that will be needed for the program• Establish a relationship with a pharmacy/pharmacist• Plan out the program’s infrastructure (e.g. processes for registrations, schedule, finances)• Have a project coordinator or designate someone who will push the work forward (strong leadership)Flexibility• Individualization for patients• Flexibility for the program as it growsOther• Don’t make assumptions (e.g. about who will want to participate and who won’t, who is educated around issues related to substance use disorders)• Find time to educate yourself about relevant topics (e.g. OUDs, substanceuse disorders, needle exchanges, etc.)• Be aware of your environment (e.g. politics)• Prepare for lots of hard work, but it will pay off with rewarding experiences30• Payment / Reimbursement for Services: Our findings indicate that the costs associated with MAT remains the primary barrier for individuals with OUD to accessing treatment and maintaining recovery. Access to insurance coverage and affordable treatment options are critical components to initiating and engaging patients in MAT. • Low Barrier Access to Treatment: Given the chronic nature of OUDs, creating low barrier access to MAT is a critical component to ensuring treatment initiation and ongoing engagement.• Patient-Centered Approach: There is a need for organizations to focus on creating treatment protocols and policies that include interventions specific to the tasks and challenges faced by patients at each stage of the treatment, maintenance and recovery.• Auxiliary Recovery Supports: Access to wrap-around services (i.e. addressing social determinants of health), are crucial elements of patient care that promote long-term maintenance and recovery for individuals with OUDs. • Information for Patients and Families: Finding and accessing treatment for OUDs is difficult for patients and they often did not know what services were available in their community. Clearer communication about available resources is an important element to facilitating treatment engagement.Key Findings31• Capacity Building: Education and training opportunities as well as engaging in a thorough program planning process are critical to building primary care practices’ capacity to deliver MAT.• Stakeholder Engagement: Creating sustainable, effective linkages between clinical and community settings can improve patients' access to treatment and recovery supports by fostering partnerships between clinical providers, community organizations, and public health agencies.• Organizational and Peer Support: Organizational resources and supports forproviders can facilitate the expansion of MAT in primary care settings.Professional mentoring, particularly among new MAT providers is also essentialfor supporting the expansion efforts.• Stigma: The stigma associated with opioid use remains a major barrier forproviders of MAT as well as patients in treatment and recovery. There remains aneed to address stigma surrounding opioids and to educate the communityabout OUDs and MAT.Key FindingsFuture Directions3233Next StepsStigma Auxiliary SupportConnectionsAccessibility for Most-At-Risk PatientsPrimary Care Resistance & CapacityHarm Reduction SupportAvailability of Real-Time Information about Community SupportsFinancial ModelsIn the upcoming year, grantee organizations will continue to work on addressing the needs identified by patients in an effort to promote treatment engagement and long-term recovery.““My dream is someday that the opiate use disorder will be actually the same as COPD, diabetes, hypertension. I think it will come.”Provider, Year One3435Questions?Lindsey Smith, PhD, MSWm.lindsey.smith@maine.eduRachel Gallo, MPHRachel.gallo@maine.edu

Expanding Access to Medication-Assisted Treatment (MAT) through Primary Care Practices: Findings from the Maine Health Access Foundation\u27s Addiction Care Program (Years One and Two)

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Expanding Access to Medication-Assisted Treatment (MAT) through Primary Care Practices: Findings from the Maine Health Access Foundation\u27s Addiction Care Program (Years One and Two)

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