Addiction Consult Team collaborating to support primary care
Opioid use disorders have continued to rise since the pandemic began — and many of our ambulatory care providers are stepping up to better serve the needs of patients with this chronic disease.
In the past two years, Michigan Medicine has more than tripledthe number of primary care physicians (PCPs) providing treatment to patients with substance use disorders (SUDs), including those using opioids, indicating that an increasing number of doctors in the Department of Family Medicine have stepped up to care for this population.
“In September 2019, we had only eight PCPs prescribing buprenorphine, which treats opioid dependence, to only 30 patients. Now, we have more than 30 PCPs prescribing to over 120 patients,” said Hae Mi Choe, Pharm.D., chief quality and innovations officer for the U-M Medical Group. “Within family medicine in particular, we’ve seen a significant increase in willingness to treat this chronic disease using this gold standard treatment as part of a patient’s routine primary care.”
Once more PCPs came onboard to care for this population, the next challenge was how to identify and connect patients with SUD to ongoing care — a challenge that is exacerbated by the stigma that such patients face. The Addiction Consult Team (ACT) which successfully launched its SUD treatment services to all emergency departments (EDs) and inpatient facilities in June, decided to take on this challenge. Knowing they could make a difference, the team (which includes a specially-trained physician, social worker, pharmacist, peer recovery coach and nurse navigator) quickly rallied to connect to ongoing primary care and also reach out to discharged hospital patients who could benefit from ACT resources.
Understanding the patient
To help support PCPs, a dedicated nurse navigator works in partnership with primary care teams for follow up treatments. The most important part of this work is offering a listening ear.
“I approach each patient with the understanding that they have most likely had many negative experiences in the health care system due to stigma around substance use disorders,” Preston said. “I want to hear their story and show them that I care about what happens to them. If they are ready for treatment, I have a lot of information and resources to share. If they aren’t ready for treatment, I want them to know that if they ever are ready, I am here for them.”
Preston believes that understanding the patient’s story is the first step in reducing the stigma of SUDs.
“My hope is that we can offer the highest standard of care to our patients with SUDs, just like we do for other chronic illnesses,” Preston said. “We want to normalize care for this group of patients. When treated with compassion and evidenced based therapies, people with SUDs can and do get better. That is something providers in the inpatient setting often don’t get to see. They usually only see people in crisis. Because I work in the outpatient setting, I see them in recovery. It’s the best feeling in the world when you have helped someone change their life.”
Reconnecting with discharged patients
In some cases, team members discovered patients who visited the hospital but had missed the opportunity to connect with ACT. Members of the interprofessional team seek out those discharged patients and make calls to offer support services.
“This group can be difficult to connect with because often times they don’t have a working phone,” said peer recovery coach Michelle Brauninger. “When we do reach them, we focus on meeting our patients where they’re at and helping identify their goals. We focus on motivation for recovery and helping to maintain that motivation.”
A post-discharge call can change a life, according to nurse navigator Yolanda Preston.
“There was a patient that was discharged from the ED on a weekend without ever seeing the ACT,” Preston said. “I was able to reach this patient the day after discharge and coordinate his outpatient treatment with a new primary care physician (PCP) who could continue his treatment with Suboxone, a medication that treats opioid use disorder. This patient has been really successful and told us that we ‘saved his life.’”
“I would ask all providers and staff at Michigan Medicine to become more knowledgeable in the evidenced-based treatments available for SUDs,” Preston said.
Approximately 20 million people in the U.S. have substance use disorders. Last year, over 93,000 people died of overdoses, and over 70,000 of those involved opioids — the highest number ever seen for opioid-related deaths in one year.
As Preston added: “These are OUR patients. This is OUR community. It may even be our own families. We can do better, and we must do better.”
ACT is on-site for consultation in the hospital setting (adult or pediatrics) from 8 a.m. until 4 p.m., Monday-Friday, and will respond to after-hours consults during business hours. Providers in the outpatient space wanting resources or coordination support with patients on buprenorphine can reach out to Yolanda Preston, nurse navigator, or seek expert consultation through the Michigan Opioid Collaborative.
The ACT service is just one initiative within the three-pronged approach of Rewrite the Script’s response to the opioid crisis. The team is also focused on promoting the use of pain profiles, which capture the patients “pain story” to facilitate pain treatment across the care and life continuum, and expanding non-pharmacologic options for pain including acupuncture, healing touch, aromatherapy, art/music, guided imagery, mindfulness and a greater incorporation of movement.
Stay tuned for other Headlines articles about progress in these areas.