A new report outlined the strategies community health centers use to successfully offer patient access to MAT treatment for opioid use disorder.
Organizational support, provider education, and community health partnerships are essential for expanding patient access to care and to medication-assisted treatment for opioid use disorder, according to a recent report from the Kaiser Family Foundation.
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 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.
Date: April 12, 2019