School of Medicine and Health Sciences Poster Presentations

Title

Optimizing Comprehensive Treatment and Provider Workflows in the Care of Patients Living with Opioid Use Disorder at North Shore Community Health in Salem, MA

Document Type

Poster

Abstract Category

Prevention and Community Health

Keywords

Pre-Exposure Prophylaxis (PrEP), Opioid Use Disorder (OUD), Medication Assisted Treatment (MAT), Adverse Childhood Experiences (ACE), adherence

Publication Date

Spring 5-1-2019

Abstract

Background: While opioid-related overdose is of utmost concern for the MAT providers at North Shore Community Health (NSCH), so is the danger of patients with opioid use disorder (OUD) engaging in high-risk behaviors, leading to possible HIV infection. By facilitating discussion of Pre-Exposure Prophylaxis (PrEP) as routine preventive healthcare for this population, we may see improvement in not only patient access and literacy regarding PrEP but also in the disproportionately high rates of HIV among those facing stigmatizing health disparities. Furthermore, maintaining a database of Adverse Childhood Experience (ACE) scores for each patient at NSCH may guide healthcare providers to design more individualized treatment plans for those most at risk of relapse, non-adherence, or high risk behavior. Objective: To improve the provision of preventive and comprehensive care provided to patients enrolled in Medication Assisted Treatment (MAT) for OUD at NSCH. Goals included: 1. Increasing patient and provider education regarding the use of PrEP in high risk populations, such as those with OUD 2. Evaluating whether obtaining ACE scores helps predict the need for additional resources or specific treatment strategies to improve their retention in the MAT program. Methods: PrEP Study: MAT patients and providers were surveyed regarding their knowledge of PrEP. Patient and provider education was provided using brochures, posters, and informational handouts. A best practice workflow was developed for MAT providers and implemented to ease the introduction of PrEP during patients intakes, inductions, and follow ups. ACEs Study: A chart review of current MAT patients at the Peabody and Salem clinics was completed to determine if their documented ACE scores were predictive of program adherence or non-adherence. Results: Provider knowledge of PrEP and likelihood of mentioning PrEP significantly increased post-education and workflow implementation (p-values 0.0496 and 0.0421 respectively). ACE study data analysis revealed no significant correlation between ACE score and predictable trend in MAT program adherence (p-value 0.495687). Conclusion: With education and workflow optimization, we were able to significantly improve provider's knowledge of PrEP and their likelihood of mentioning PrEP during patient visits. Additionally, because there is no significant correlation between ACE scores and program adherence, we believe it is not a good clinical too to determine likelihood of MAT program adherence. Given the limitations of time on direct patient care, we recommend that discussions about PrEP use with at risk patients occur in lieu of ACE scoring. Determining a MAT patient's level of care should be based on the patient's current behaviors and program progress, rather than their documented ACE score.

Open Access

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Presented at Research Days 2019.

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Optimizing Comprehensive Treatment and Provider Workflows in the Care of Patients Living with Opioid Use Disorder at North Shore Community Health in Salem, MA

Background: While opioid-related overdose is of utmost concern for the MAT providers at North Shore Community Health (NSCH), so is the danger of patients with opioid use disorder (OUD) engaging in high-risk behaviors, leading to possible HIV infection. By facilitating discussion of Pre-Exposure Prophylaxis (PrEP) as routine preventive healthcare for this population, we may see improvement in not only patient access and literacy regarding PrEP but also in the disproportionately high rates of HIV among those facing stigmatizing health disparities. Furthermore, maintaining a database of Adverse Childhood Experience (ACE) scores for each patient at NSCH may guide healthcare providers to design more individualized treatment plans for those most at risk of relapse, non-adherence, or high risk behavior. Objective: To improve the provision of preventive and comprehensive care provided to patients enrolled in Medication Assisted Treatment (MAT) for OUD at NSCH. Goals included: 1. Increasing patient and provider education regarding the use of PrEP in high risk populations, such as those with OUD 2. Evaluating whether obtaining ACE scores helps predict the need for additional resources or specific treatment strategies to improve their retention in the MAT program. Methods: PrEP Study: MAT patients and providers were surveyed regarding their knowledge of PrEP. Patient and provider education was provided using brochures, posters, and informational handouts. A best practice workflow was developed for MAT providers and implemented to ease the introduction of PrEP during patients intakes, inductions, and follow ups. ACEs Study: A chart review of current MAT patients at the Peabody and Salem clinics was completed to determine if their documented ACE scores were predictive of program adherence or non-adherence. Results: Provider knowledge of PrEP and likelihood of mentioning PrEP significantly increased post-education and workflow implementation (p-values 0.0496 and 0.0421 respectively). ACE study data analysis revealed no significant correlation between ACE score and predictable trend in MAT program adherence (p-value 0.495687). Conclusion: With education and workflow optimization, we were able to significantly improve provider's knowledge of PrEP and their likelihood of mentioning PrEP during patient visits. Additionally, because there is no significant correlation between ACE scores and program adherence, we believe it is not a good clinical too to determine likelihood of MAT program adherence. Given the limitations of time on direct patient care, we recommend that discussions about PrEP use with at risk patients occur in lieu of ACE scoring. Determining a MAT patient's level of care should be based on the patient's current behaviors and program progress, rather than their documented ACE score.