A new report outlined the strategies community
health centers use to successfully offer patient access to MAT treatment for
opioid use disorder.
By Sara Heath
April 08, 2019 - Organizational support, provider
education, and community health partnerships are essential for expanding
patient access to care and to medication-assisted treatment (MAT) for opioid
use disorder, according to a recent report from the Kaiser Family
Foundation (KFF).
MAT is widely regarded as the gold standard in OUD treatment and
works by combining opioid use medication with behavioral health and primary
care access.
These programs require extensive provider training, especially
for the use of buprenorphine, one of the OUD medications used in MAT. This
provider training, combined with societal stigma and some funding barriers,
makes it difficult for healthcare organizations to offer MAT services.
But in community health clinics, the care sites in which MAT
services may be most needed, healthcare providers have garnered organizational
support, offered provider education, and leaned on community health
partnerships to ensure patient access to MAT, the KFF report noted.
Specifically, MAT offerings are strong in Healthcare for
Homeless (HCH) programs, which are embedded within some community health centers across the
country. Because these programs face mandates for offering certain substance
used disorder treatments, they have developed key strategies for successful
patient care access.
“Because of the unique needs of their patients, HCH programs are
required to offer SUD treatment services, though not buprenorphine-based MAT
specifically, as part of their special populations grant,” the researchers
said. “As a result, many of these clinical settings have developed treatment
models that integrate primary care and behavioral health services, provide
intensive supports, and emphasize lower-barrier approaches to accessing care.”
In 2017 alone, HCH programs accounted for only 4 percent of all community
health clinic visits, but over one-third of MAT visits in community health
clinic facilities. HCH programs employ 37 percent of all community providers
allowed to deliver buprenorphine, a medication used in MAT.
HCH programs likely deliver more MAT services because they see a
higher volume of patients who are diagnosed with OUD. That notwithstanding, the
KFF researchers acknowledged these care sites’ unique capabilities to deliver
MAT.
Having organization “champions” who advocate for the delivery of
MAT services is essential, the report authors stated. It is often difficult to
garner leadership buy-in for MAT, especially when leaders do not believe MAT is
an evidence-based treatment option or do not believe that SUD is a high
priority for the clinic.
Organization champions were key to addressing these challenges,
according to HCH program leaders.
“These champions worked to help leadership recognize MAT as a
valuable service consistent with the HCH program’s mission,” the report authors
stated. “Recruiting champions who can speak to the concerns from both primary
care and behavioral health staff can facilitate coordination across the two
disciplines.”
Champions were also responsible for consulting with other HCH
programs that had successfully implemented MAT services and addressing the concerns
of organizational leadership.
Successful clinics also invested heavily in their staff. While
some providers may know about the benefits of MAT services, they may not be
qualified to deliver these services.
“Respondents from successful MAT programs reported conducting
regular trainings on addiction, harm reduction, motivational interviewing, and
other evidence-based approaches to build effective skills for engaging patients
in treatment,” the authors reported.
Some organizations paired less-experienced primary care
providers with those who had long delivered MAT services. Other approaches
included incremental service delivery, meaning the HCH program began delivering
MAT to only a few patients and then expanded that pool as providers became more
comfortable the with service delivery.
Fostering care coordination between primary
care and behavioral health providers, training administrative staff, and
setting and sticking to participation expectations was also essential.
It was also crucial to allow providers the flexibility within
their schedules to deliver MAT. Patients receiving MAT require frequent
provider outreach, although that outreach does not need to take up an extensive
period of time. These needs can create some scheduling issues, making
flexibility essential.
Successful HCH programs block off specific parts of the day
for MAT patients, ensuring that those patient needs to not interfere with the
health needs of other patients. Flexible hours and walk-in availability also
provided the flexibility that MAT patients needed.
Finally, leaning on community health partnerships allowed HCH
programs to deliver effective MAT treatment. For example, partnerships with
local hospitals, clinics, and homeless shelters facilitated the referral
system.
Many HCH programs would supply these partners with the first
dose of buprenorphine, as well as training, to begin the MAT treatment process.
From there, community partners would refer patients to the HCH program.
HCH program leaders also created partnerships with homeless
service providers to help patients overcome institutional barriers to MAT. Many
homeless shelters deny patients who are using opioids or who are taking
medications for opioid use disorder, prompting patients to choose between
housing and MAT services.
These partnerships focused on homeless shelter education,
ideally knocking down this barrier.
Although HCH programs have been successful in implementing MAT
service delivery, there is still room to grow, the KFF researchers stated.
“Looking ahead, HCH programs will likely continue to make more
investments in provider training and capacity, find additional strategies to
grow programs to meet patient need, and ensure that MAT services are provided
as part of the standard of care for OUD,” the report authors concluded.
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