buprenorphine in a federally qualified health center...integrated substance abuse treatment:...
TRANSCRIPT
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Integrated Substance Abuse Treatment: Buprenorphine in a Federally Qualified Health
Center
Nancy Paull, MS CEO Stanley Street Treatment & Resources, Inc
Genie L. Bailey, MD Stanley Street Treatment & Resource Inc.
Warren Alpert Medical School of Brown University
Michael D. Stein, MD Warren Alpert Medical School of Brown University and Butler Hospital
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Overview of Family HealthCare Center
• Established as leadership realized our patients were not receiving adequate primary medical care for diseases related to substance use, mental health issues, HIV and AIDS
• Opened its doors in 1996
• Currently classified as a 330 Federally Qualified Health Center (FQHC)
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As an organization, SSTAR is committed to providing
Buprenorphine treatment to our health center patients
SSTAR’s Primary Health Care Model
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SSTAR requires that every physician hired in the health center have or obtain a DEA waiver for
Buprenorphine treatment
In addition, SSTAR has hired: • Three full time RNs • Part time program assistant
SSTAR’s Primary Health Care Model
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SSTAR’s Primary Health Care Model
• Promotes Medical Home Model
• Allows substance abuse treatment with increased privacy and confidentiality
• Allows better medical care for substance abuse related diseases
• Safe and convenient in-home use allows more normal routines and higher quality of life
• Integrated treatment will decrease stigma
( hopefully!!)
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SSTAR’s Primary Health Care Model
• Patients in our program MUST receive their primary health care at Sstar
• Most requests come directly from the patients • All requests are screened: phone prescreen • Medical clearance is required before
acceptance into the program • Nursing intake required before induction • Induction date and time arranged with patient • UDS must be clear of non-prescription
substances day of induction (exception: MJ)
7/19/2012 6
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SSTAR’s Primary Health Care Model
• Client attends weekly Relapse Prevention group for 12 weeks and then IF abstinent and adherent may begin monthly group and med visits
• Once long term sobriety established, may be given refills and seen by MD every three months
• Individual counseling is offered and available to all patients.
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Notable Features of Sstar Model
• Collaborative care model Alford DP, LaBelle CT, Kretsch N, etal. Collaborative Care of Opioid-Addicted Patients in Primary Care using Buprenorphine. Arch Intern Med, Mar 2011; 171(3):425-437.
• On-site induction
• Significant physician involvement
• Regular multi-disciplinary team meetings
• Psychosocial treatment done within Behavioral Health Clinic system
• Harm reduction attitude—efforts made to keep patients in treatment
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How Are We Doing?
Access: Average wait time between initial contact and enrollment:
State wide- 11.75 days
Sstar- 3.69 days Massachusetts Department of Public Health: Bureau of Substance Abuse Services and HIV/AIDS Bureau. OBOT Admission/Enrollment Profile, 7/1/2011-3/31/2012, p39.
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How Are we Doing?
0%
5%
10%
15%
20%
25%
30%
1-12
mths
12-24
mths
2-3 yrs 3-5 yrs > 6 yrs
Time in Treatment, n=221
Average length =892days
or 30 months!!
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• Total Revenue $ 669,581
• Total Expenses $ 395,037
• Suplus: HC $ 274,544
• Surplus BH $ 16,689
How Are We Doing?
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• Physician Stigma
• Technology not keeping pace for Integrated Care
• DPH regulatory and licensing bureaucracy
• Managed Care Carve Outs
Barriers to Care
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• Open a satellite in spring 2012:
FQHC with a methadone clinic & behavioral health component
• Will be offering training/consultation to FQHC’s who would like to incorporate suboxone in primary care- Late Fall 2012
Next Steps for SSTAR
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PPPpP
• Deborah Ekstrom, President/CEO, Community Healthlink • Craig Wiener, Ed.D, Clinical Director, Family Health Center of
Worcester • Charles Faris, President/CEO, Spectrum Health Systems • Leah Gallivan, COO, Edward M. Kennedy Health Center • Harry Shulman, President/CEO, South Shore Mental Health • Cynthia Sierra, Senior Director of Public Policy, Public Affairs,
Program Development at Manet Community Health Center • Katherine Wilson, President/CEO, Behavioral Health Network • Jay Breines, Executive Director, Holyoke Health Center