Hospitals Role in Addressing the Opioid Crisis

Transcription

1 Hospitals Role in Addressing the Opioid Crisis Webinar 3: Alcohol and Drug Use Screening September 12, 2017

2 Agenda Screening, Brief Intervention and Referral to Treatment (SBIRT) Marla Oros, RN, MS, President, Mosaic Group The Mercy SBIRT Model LaTanya N. Townsend, LCSW-C, SBIRT Program Manager, Clinical Social Worker, Department of Emergency Medicine, Mercy Medical Center 2

3 SBIRT MHA Webinar SEPTEMBER 12, 2017

4 Substance Use Disorders and Hospitals Each year approximately 20 million individuals visit the ER for an illness or injury: Between 15-20% of these individuals would screen positive for having a substance use disorder. For trauma related visits it increases to 25-50%.

5 Substance Abuse: A National Public Health Crisis There are over 22 million Americans who meet the clinical definition for having a substance use disorder. Only 2.5 million of those Americans have sought treatment. 46% of the U.S. population report having used illicit drugs at least once in their lifetime Drug overdose is the number one cause of injury related deaths in the U.S. Source: CDC, vital signs, 2013

6 Maryland (state) Drug Intoxication Deaths 66% increase in last year 89% of the intoxications deaths in Maryland during 2016 were opioid related.

7 Maryland (State) Intoxication Deaths by Jurisdiction, 2016

8

9 What is SBIRT? Screening: The application of a simple test to determine if a patient is at risk for or may have an alcohol or substance use disorder. Brief Intervention: The explanation of screening results, information on safe use, assessment of readiness to change and advice on change. Referral to Treatment: Patients with positive results on screening are referred for in depth assessment and/or treatment.

10 SBIRT Overview SBIRT is an evidencebased, cost effective model for helping individuals reduce or stop alcohol and other drug use. SBIRT is an effective tool for identifying and treating at-risk and dependent substance users in hundreds of research studies.

11 Rationale for SBIRT Screening, Brief Intervention, and Referral to Treatment (SBIRT) aims to: Identify persons with substance use disorders. Identify those persons who are at high risk for developing a substance use disorder. Referral to Treatment Brief Intervention Help patients reduce or eliminate alcohol or other drug consumption and thereby minimize or avoid associated problems. Motivate patients to accept referrals for more specialized assessment and treatment services.

12 SBIRT Effectiveness Studies Reduced health care costs: For each $1 spent on SBIRT we save $3.81-$5.60. Reduced ED visits 20%. Reduced hospitalizations 37%. Reduced non-fatal injuries 33%. Reduced car crashes 50%. Reduced severity of drug & alcohol use. Reduced employer costs - $771 per staff. Reduced arrests 46%. For references: See SAMHSA-HRSA Center for Integrated Health Solutions SBIRT Fact Sheet

13

14

15

16

17

18 The Mercy SBIRT Model

19 The Mercy SBIRT Model Mercy s SBIRT Model is grounded in a philosophy that SBIRT should be a routine part of care. Key elements: Top to bottom organizational buy-in Standardized protocols EHR modifications All staff trainings and boosters Continuous focus on quality improvement and sustainability

20 The Peer Recovery Coach Model PRC Model Built from our standard SBIRT Model, it integrates peer recovery coaches in the emergency department to deliver BI and RT. Medical Team alerts PRC PRC reviews screening scores, medical history and reason for visit PRC provides BI PRC develops plan with patient, schedules necessary appointments All ED patients screened

21 Mercy Hospital SBIRT Model Universal screening of all patients that enter the emergency department Typically conducted by nurse s as part of triage Risk stratification based on screening score Peer recovery coaches deliver brief interventions Coaches follow patients in hospital to continue intervention Referrals to treatment by coaches with patients based on need and motivation Follow-up by coaches to assure linkage to treatment

22 Benefits of Providing PRC Model Increased buy-in from hospital staff Increased ability to provide integrated health care Increased patient use of community support services Increased patient engagement in substance abuse treatment

23 Why isn t SBIRT a routine part of care in all emergency departments?

24 Identified Challenges ᴓ ᴓ ᴓ ᴓ ᴓ ᴓ ᴓ ᴓ Funding to support program Time to screen patients Time to provide Brief Interventions Lack of training in Substance Use Disorders Concerns about patientprovider relationships Presence of more compelling clinical issues SBIRT not within role or responsibilities Time to make Referral to Treatment

25 Schedule of Webinars June 28 July 11 September 12 New Opioid-Related Requirements Naloxone Prescribing and Dispensing Alcohol and Drug Use Screening October 18 (new date) Overdose Survivors Outreach Project November 14 Buprenorphine in the Emergency Department Materials will be posted at: All webinars are 8:30 9:30 a.m. 25