Medicatin Assisted Treatment fr Opiid Use Disrder in Rural Clrad
Why is piid use disrder getting s much attentin? Opiid Use Disrder (OUD) has seen an epidemic rise in the United States ver the past decade. Mre than 250 millin prescriptins fr piids are written each year alng with increasing rates f illegal herin use. Greater than 4 millin Americans reprt using prescriptin pain medicine fr nn-medical reasns. Mre Americans die each year f drug verdse than mtr vehicle accidents. Opiid verdses killed 41 Clradans per mnth in 2014. Center fr Behaviral Health Statistics and Quality. (2015). Behaviral health trends in the United StatesResults frm the 2014 Natinal Survey n Drug Use anhealth (HHS Publicatin N. SMA 15-4927, NSDUH Series H-50). Retrieved frm http://www.samhsa.gv/data/ http://archive.samhsa.gv/data/2k12/nsduh115/sr115-nnmedical-use-pain-relievers.htm. Accessed February 2, 2016. http://www.clradhealthinstitute.rg/key-issues/detail/cmmunity-health/clrad-cunty-drug-verdse-death-rate. Accessed February 12, 2016.
Why is piid use disrder getting s much attentin? Clrad has utpaced the rest f the natin and recently ranked as high as number 2 in the natin fr rates f self-reprted nnmedical use f prescriptin pain killers. Over the past 5 years, the High Plains Research Netwrk (HPRN) and its Cmmunity Advisry Cuncil (C.A.C.) identified OUD as a primary cncern t ur physicians, practices, and cmmunity members. Center fr Behaviral Health Statistics and Quality. (2015). Behaviral health trends in the United StatesResults frm the 2014 Natinal Survey n Drug Use anhealth (HHS Publicatin N. SMA 15-4927, NSDUH Series H-50). Retrieved frm http://www.samhsa.gv/data/ http://archive.samhsa.gv/data/2k12/nsduh115/sr115-nnmedical-use-pain-relievers.htm. Accessed February 2, 2016. http://www.clradhealthinstitute.rg/key-issues/detail/cmmunity-health/clrad-cunty-drug-verdse-death-rate. Accessed February 12, 2016.
Figure 1. Clrad drug verdse death rate, 2014 IT MATTTRs cvers 24 cunties in eastern Clrad (16), San Luis Valley (6) and 2 between!
Except sme wind
Challenges arund treating OUD? Prescribing piids Limited access t diagnstic and treatment services fr OUD Cmplete lack f Medicatin Assisted Treatment (MAT)
[i] BupPractice http://www.buppractice.cm/buppracticev4?page=list. Accessed February 12, 2016. Cmpnents f MAT Training : Tpic Basics abut prescribing buprenrphine Impact f Opiid Use Disrder epidemilgy, incidence, prevalence, risks Pharmaclgy f buprenrphine and ther piids Detectin and diagnsis f piid use disrder Learning Objectives Recgnize the need fr piid use disrder (OUD) treatment given its prevalence Apply a patient-centered apprach in a buprenrphine practice Describe buprenrphine's status as a cntrlled substance and the laws gverning the prescribing f this medicatin Describe the requirements t receive a waiver t prescribe buprenrphine Explain the prcess f becming certified t prescribe buprenrphine fr OUD Realize the likelihd f encuntering herin use and prescriptin piid misuse in patients in the United States Predict the ptential impact f OUD in terms f patient mrbidity and mrtality Anticipate c-mrbid negative health effects in patients having OUD Recgnize and treat patients with dual diagnsis based n the interrelatinships between OUD and mental illness Relate the functins f piid receptrs t the clinical effects and treatment f OUD Cmpare the pharmaclgy f piid agnists, partial agnists, and antagnists Relate pharmaclgical prperties f buprenrphine and nalxne t physilgical effects in patients Apply cncepts relevant t addictin, including verdse, tlerance, and withdrawal, t piid use Use mtivatinal interviewing skills t ptimize patient cmmunicatin in a buprenrphine practice Screen fr OUD thrugh patient interviews and standardized screening instruments Assess patients fr signs and symptms f OUD Diagnse patients with OUD using current DSM criteria
Assessing patients fr treatment Buprenrphine inductin Maintenance f buprenrphine Assess patients' apprpriateness fr ffice-based buprenrphine treatment Identify patients wh are unlikely candidates fr ffice-based buprenrphine treatment Anticipate cmmn medical and psychiatric prblems in patients with OUD that may cmplicate its treatment Adjust treatment prtcls t meet needs f patient grups having specific additinal requirements, including adlescents, pregnant wmen, and geriatric patients Develp an individualized buprenrphine treatment plans fr patient Determine what referral is apprpriate fr the treatment f OUD, when ffice-based treatment is nt indicated fr a patient Prepare patients t get ready t start taking buprenrphine successfully Demnstrate a thrugh understanding f dsing guidelines t start patients n buprenrphine treatment Titrate buprenrphine dse t address the individual patient's needs Recgnize, anticipate, and treat cmplicatins f buprenrphine use in yur patients during inductin Prvide the treatment and mnitring that is rutinely required thrughut the maintenance phase f buprenrphine treatment Mdify buprenrphine maintenance treatment as needed fr patients needing pain management r having substance use prblems Fllw prcedures fr patient selectin, ptimal tapering f dse, minimizing symptms, and prviding apprpriate fllw-up when terminating buprenrphine Use buprenrphine fr medically-supervised detxificatin f patients with OUD
Special ppulatins methadne, aging, adlescents, pregnancy Patient management in a primary care MAT prgram Regulatins fr ffice-based piid treatment (OBOT) and MAT MAT Training elements adapted frm ASAM supprted BupPractice nline buprenrphine waiver curse. Mdify buprenrphine treatment as needed fr patients wh are transferring frm methadne treatment t buprenrphine Recgnize, anticipate, and address cmplicatins f buprenrphine treatment in patients using multiple ther substances Recgnize the patient subppulatins having additinal requirements fr treatment mdificatins in ffice-based piid treatment Adapt buprenrphine treatment t the needs f patient subppulatins having additinal requirements Summarize rules and regulatins fr a successful dctr-patient relatinship in fficebased piid treatment Determine what rules and regulatins are needed t prevent and address patient prblematic behavir in ffice-based piid treatment Use a dctr-patient treatment agreement t cmmunicate expectatins and respnsibilities fr bth parties, and enfrce cnsequences f nt meeting expectatins Explain cncepts invlved in the use f urine analysis fr ffice-based treatment f patients with OUD Prepare a practice staff team fr ffice-based buprenrphine practice Determine the pertinent cnfidentiality regulatins (and exceptins) fr treatment f substance use disrder and specifically ffice-based treatment f OUD Fllw the requirements fr medical recrd-keeping in ffice-based piid treatment Prepare an ffice-based piid treatment practice t wrk with health insurance cmpanies r patients t bill fr buprenrphine treatment
One apprach t OUD in rural Clrad: IT MATTTRs Clrad SOuND Team Training Bt Camp Translatin
IT MATTTRs Clrad Creating the cmmunity envirnment cnducive t care fr OUD using MAT Creating the primary care practice envirnment cnducive t care fr OUD using MAT Screening fr OUD in primary care practices Diagnsis f OUD in primary care practices Engaging the patient in MAT delivered in primary care practices Prescribing buprenrphine by primary care physicians in primary care practices Referral t behaviral health in primary care practices and rural cmmunities Mnitring patients in MAT in primary care practices Caring fr the primary care practice MAT Team
IT MATTTRs Clrad Specific Aims 1. Cmplete a cmmunity, prvider, and team-based implementatin f Medicatin Assisted Treatment (MAT) in rural cmmunities and rural primary care practices. a. Translate the cmplex language and cncepts f OUD and MAT int lcally relevant, actinable messages fr rural cmmunities, families, and primary care practices using the Bt Camp Translatin cmmunity translatin methd. b. Cnduct a randmized cntrlled trial f prvider and practice educatin cmparing in-persn Shared Onsite knwledge Dissemiatin (SOuND Team Training ) t web-based Extensin fr Cmmunity Healthcare Outcmes (ECHO Clrad) training. c. Implement OpiSafe, a rbust web-based piid and MAT patient engagement and mnitring system fr participating rural practices. d. Supprt practice implementatin f MAT with nsite lcal practice facilitatrs 2. Identify factrs that facilitate r impede successful implementatin f MAT in rural primary care practices and cmmunities. a. Identify cmmunity member knwledge and attitudinal factrs, and change in knwledge and attitudes tward OUD that impact MAT implementatin. b. Identify training mdel (SOuND Team Training v ECHO Clrad) factrs that impact prvider and practice knwledge, implementatin success, and patient recruitment and retentin. c. Identify practice level factrs (prescriber behavir, OpiSafe, team develpment and activities) that impact MAT delivery, adherence t best-practice guidelines, and patient-reprted utcmes.
OpiSafe OpiSafe Clinical Dashbard (prescriber r staff)
Hyptheses H1. Translating the cmplex language and cncepts f OUD and MAT int lcally relevant actinable messages will imprve the knwledge f and attitudes twards OUD and MAT f lcal cmmunity rganizatinal leaders and staff. H2. Practices that receive nsite MAT training will have a higher level f educatinal prgram participatin and cmpletin, including physician certificatin, than practices that receive telehealth MAT training. H3. Clinicians and practice staff wh receive nsite MAT training will have greater imprvement in knwledge and attitudes regarding OUD than clinicians and practice staff that receive telehealth MAT training. H4. Cmpared t practices that receive telehealth MAT training, practices that receive nsite MAT training will have higher levels f MAT implementatin, including: a) screening fr OUD, b) enrllment f eligible patients in MAT, c) patients prescribed buprenrphine, d) referral fr cunseling regarding psychscial and pharmaclgic treatment ptins fr piid addictin, and e) prvide nging psychlgical supprt. H5. Patients seen at practices that received nsite MAT training will have mre favrable OUD treatment utcmes than patients seen at practices that receive telehealth MAT training, as measured by quarterly assessments thrugh OpiSafe. H6. OpiSafe and practice caching supprt will be perceived as facilitatrs and benefits t enrlling and tracking patients with OUD underging MAT in rural practices.
Other ways t address piid use disrder:
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