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News: Inventive program gets patients with OUD on treatment… : Emergency medicine news

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opioid crisis, substance use disorder, electronic referrals

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The US Department of Health and Human Services, after declaring the opioid crisis a public health emergency in 2017, released a five-point strategy to prioritize improving access to prevention, treatment and recovery aids. The plan also targeted the availability and distribution of drugs to reverse overdoses, strengthening the communication of health data, supporting innovative research and advancing pain management practices.

The University at Buffalo Department of Emergency Medicine and UB|MD Emergency Medicine had decided a year earlier to reduce the prescription of opioids in their emergency departments. Guidelines have been established for patients and prescribers for the appropriate prescribing of opioids, which have been endorsed by all major health systems and emergency care organizations in Western New York to ensure consistency. throughout the region. Emergency departments at Buffalo’s major academic health centers subsequently saw a more than 50% drop in opioid prescribing from 2015 to 2018.

The program began when one of us (JL), with support from UB|MD EM, developed Medications for Addiction Treatment and Electronic Referrals (MATTERS), a public health model for prevention and treatment . It began with an aggressive effort to train emergency physicians and advanced practice providers on responsible opioid prescribing, emergency department-initiated buprenorphine treatment, and prompt referral to outpatient treatment. .

Participating emergency services and treatment organizations have agreed on a set of common values ​​to ensure consistency of approach to treatment across the network. Patients were first referred from a hospital to one of three clinics to ensure proof of concept. Demonstrating success in the Greater Buffalo area, the MATTERS network has expanded throughout New York State in partnership with regional health systems, county health departments, and the Department of Health of New York State.

Automatic process

MATTERS’ electronic referral system was developed with NYSDOH and is hosted securely on its health commerce system. The SEO process takes place in three stages:

  • Patient phase: collection of demographic data, insurance status, brief medical history, concomitant medication use and other factors.
  • Provider phase: A health, social work, or administrative professional enters the referral information.
  • Tracking Phase: Patients choose from hundreds of appointments available at their preferred treatment organizations. Clinic options include appointment dates, distance from the patient’s home, and the various treatment options available at each location.

Many things happen automatically once the patient completes the referral process:

  • Uninsured patients receive a drug voucher to cover the cost of up to 14 days of buprenorphine.
  • All patients requiring transportation assistance receive a round trip voucher to their first clinic appointment.
  • Patients who choose peer support services are referred by fax to a regional outreach organization.
  • Referral information is emailed or texted to the patient. MATTERS referrals typically take three to five minutes, all without making a single phone call.

Efficient system

The MATTERS referral process combines several steps into one efficient system to facilitate emergency referrals for patients and clinicians. The program is just as simple and effective to implement in rural hospitals with single-provider coverage as it is in busy tertiary care centers in New York City. The automated platform has also demonstrated applicability to non-emergency medical environments and has been integrated into primary care offices, obstetrics and gynecology practices, correctional facilities and court systems.

The MATTERS Network had over 50 referral sites, 150 treatment organizations and 1,000 participating pharmacies as of spring 2022. Network expansion means better patient outcomes: nearly 95% of MATTERS referrals connect patients to an appointment you processing in less than seven days. .

The MATTERS team has partnered with two virtual emergency departments in Western New York during the COVID-19 pandemic to connect patients to quality care through telemedicine. Patients can be prescribed buprenorphine and receive a referral without ever coming to the emergency department in person. MATTERS continues to leverage regional telemedicine services to improve access to medications for opioid use disorders.

The network recently incorporated REACH (Respectful, Equitable Access to Compassionate Health Care) Medical, a low-threshold harm reduction medical practice in Ithaca, NY, to provide rapid assessments and follow-up appointments for patients with medical conditions. related to opioid and substance use.

The MATTERS Network has deployed nine regional care coordinators to health centers certified by the Office of Substance Abuse Services and Supports in New York State over the past year. They help scale through outreach, onboarding and stakeholder engagement, and they follow up on referrals in their region to ensure continuity of care. More information on the MATTERS network is available at www.mattersnetwork.org or by mail [email protected].

The MATTERS team expresses its gratitude to the New York State Department of Health for its contribution to the electronic reference platform.

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Clockwise from top left:Dr Lynchis an emergency physician and EMS medical director in Buffalo, technical advisor to the Erie County and New York State Departments of Health, and a professor at the University at Buffalo and Lake Erie College of Osteopathic Medicine. Follow him on Twitter@jlynchdo. Mrs Conneryis the Research and Outreach Coordinator at UB|MD Emergency Medicine, Assistant Professor in the MPH Department at Daemen University, and Director of Partnerships and Sponsorships for the Young Non-Profit Professional Network Board of Directors. Follow her on Twitter@lucyconnerymph. Mrs. Loughranis a program manager for the MATTERS network and previously worked as an emergency service technician and practical nurse. Follow BUSINESS@matters_networkand emergency medicine UB|MD@UBMDEmergMed.