Using Structured Frameworks to Implement Opioid Use Disorder (OUD) Prevention Approaches. Melissa Struzzo, MPH

Transcription

1 Using Structured Frameworks to Implement Opioid Use Disorder (OUD) Prevention Approaches Melissa Struzzo, MPH

2 Learning Objectives To identify ways to engage the community coalition in collaboration with a public health department in actively developing, implementing and promoting opioid prescribing guidelines and additional opioid misuse prevention strategies. To explain a structured framework to work successfully with healthcare providers to develop, implement and evaluate the opioid prescribing guidelines and supplemental prevention strategies. To review the findings from the implementation evaluation and stakeholder interviews conducted on the implementation of the guidelines in primary care settings.

3 Background - Nationally Drug overdose deaths kill more people than guns or car accidents. Of the 20.5 million Americans 12 or older that had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers.* From American Society of Addiction Medicine (ASAM) s Opioid Addiction 2016 Facts & Figures -

4 Background - Nationally

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6 Background - Locally 476 Treat and release emergency department (ED) visits for which unintentional (UI) drug poisoning was the principal cause of admission among Sonoma County residents. Of UI drug poisonings, 20% (n=88) were for opiates; of these, 72% were for pharmaceutical opioids, and 28% for heroin. 191 Hospitalizations for which UI drug poisoning was the principal cause of admission among Sonoma County residents. Of UI drug poisonings, 30% (n=57) were for opiates; of these, 93% were for pharmaceutical opioids. 44* Deaths (annual average) from UI drug poisoning. (* annual average). Every 8 days someone in Sonoma County dies from an accidental drug overdose.

7 How to Address Epidemic Locally Increased Access to MAT More X Licenses Drug Medi-Cal Waiver Parity Mental Health Services Co-prescribing Narcan (PHP Pilot) Buprenorphine Guidelines Social Host Ordinance Specific Language on Rx Opioid Prescribing Guidelines

8 Partners with Sonoma County Department of Health Services

9 How to Address Epidemic Locally PRESCRIBING GUIDELINES County-wide launch specific date Endorsements/participation from clinics/hospitals even if already using their set of guidelines Implementation plan created More than just development of guidelines Implementation Support Monitoring & Eval

10 ED Guidelines

11 Primary Care Guidelines Summary

12 Outreach (Including Media) Pre-Launch Patients: Developed letters for hospitals/clinics to send to all hospital patients Developed letter templates for the FQHCs and private practice to notify patients Clinicians/Prescribers: Medical Executive Committee Presentations Letter templates for hospitals/clinics to notify all prescribers of upcoming launch/policy change Articles in Sonoma Medicine Magazine County Health Department: Convening meetings with Opioid Prescribing Workgroup members Announcements by Health Officer to Sonoma County Medical Association Epidemiological report showing the gravity of issue at local level Weekly implementation updates to OPWG At the time of Official Launch Patients: PSAs & Radio Ads about Opioid Risks Facebook Ads/Posts Clinicians/Prescribers: Reminders to all prescribers of upcoming launch/policy changes Online Toolkit to accompany guidelines Messaging/talking points for prescribers to discuss new guidelines with patients County Health Department: Reminder to all health dept. staff launch is taking place Health Alert sent by Health Officers to all licensed clinicians/prescribers in County Press-releases / targeted media outreach Local Media Coverage - Articles in Press Democrat & radio interviews

13 Facebook Ads & Posts - Ran during week of implementation & 2 weeks post implementation

14 Outreach Post-Launch Patients: Opioid risks/alternative Therapies brochures in waiting areas Public Television (KRCB) Video Clinicians/Prescribers: Included in On-boarding of new staff Practice Mgmt. practices instituted Ongoing training of guidelines County Health Department: Technical Assistance to Hospitals/Clinics Evaluation/Monitoring - Surveys Announcements by Health Officer to Sonoma County Medical Association Members Dissemination of post launch survey findings Tracking impact on prescribing practices in County CURES / CDPH Dashboard Monitoring for unintended consequences such as increase in heroin use

15 The KRCB Video on Risks of Opioids Through Health Connections KRCB is the local Sonoma County PBS Affiliate

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17 Post-Implementation Survey County-wide guidelines for safe management of non-palliative pain in both primary care and emergency departments launched in January In May 2017, a survey was conducted which asked providers how the guidelines were implemented, as well as any successes or challenges. 16 providers took the survey, with 14 people completing it. 9 completed surveys were from primary care, with 5 from emergency departments.

18 Primary Care 9 Completed Surveys: All respondents notified staff of the guidelines implementation using memos/ s and/or in staff meetings. All respondents engaged in one or more Practice Management activities including development of their own guidelines for opioid refills, standard practices regarding use of treatment agreements and/or monitoring practices. Some reported updating their current guidelines and already using robust P&P. 8/9 respondents facilities reported engaging in one or more Quality Improvement activities such as implementing a chart review process, developing a patient registry, and/or developing an oversight committee Most respondents conducted training for staff related to implementation of guidelines. Some reported updating onboarding practices and ongoing training or lectures for existing staff. Two thirds of respondents engaged in some type of Provider Performance Monitoring activities, such as creating incentive plans for clinicians or incorporating opioid monitoring criteria in performance evaluations. Additional activities: 8/9 reported implanting additional opioid guidelines from other agencies; 4/9 reported participating in safe med disposal, and 6/9 reported co-prescribing naloxone Challenges: themes include data availability and in practice data tracking, logistical issues in finding time for training and prioritizing this work, and supporting providers and staff in dealing with difficult patients. Successes: themes include providers being compliant with the guidelines, the value of consistent practices across patients, increased wellbeing for patients, and reductions in overall MEDs.

19 Emergency Department 5 out of 7 Completed Surveys All respondents displayed guidelines poster in the ED lobby and/or treatment rooms. 3/5 respondents engaged in one or more Practice Management Activities: Developed their own guidelines for opioid refills and/or developed standard practices regarding the use of treatment agreements/monitoring practices, and 1/5 reported developing own guidelines for refills only 3/5 respondents facilities reported engaging in one or more Quality Improvement activities: 2/5 reported implementing a chart review process, 1/5 reported developing a patient registry, and 1/5 reported developing an oversight committee 4/5 respondents facilities are conducting training for staff related to implementation of the guidelines, including 3/5 updating onboarding practices and 2/5 providing training or lecture series for existing staff. 2/5 respondents facilities engaged in Provider Performance Monitoring Activities, specifically monitoring individual provider prescribing patterns and providing feedback. Additional activities: 2/5 reported implanting additional opioid guidelines from other agencies; 3/5 reported participating in safe med disposal. Challenges: themes include dealing with difficult patients. Successes: themes include the existence of the guidelines aiding providers communicating with patients the reasons for avoiding narcotics, a reduction in patients requesting opioid prescriptions, and a reduction in repeat visits.

20 Sonoma County Resources nal-drug-poisoning.pdf escribing

21 Questions?

22 Presenter Information Melissa Struzzo, MPH