Headline
Initiative successfully implemented several evidence-based and promising addiction care models across multiple medical settings, including an inpatient addiction consult team, a low-threshold bridge clinic, peer recovery coaches, and office-based addiction treatment (OBAT) nurses.
Context
Medical settings can be important touchpoints to initiate substance use disorder (SUD) treatment, but few general medical settings provide integrated physical health and SUD services. To better serve and improve outcomes for people with SUD, Massachusetts General Hospital implemented several addiction care models across multiple settings, including:
- an inpatient addiction consult team, which is an interdisciplinary team that provides assessment, motivational counseling, and linkages;
- a low-threshold bridge clinic for high-risk patients to receive assessments and same day initiation of pharmacotherapy;
- peer recovery coaches integrated into primary care medical teams; and
- OBAT nurses, who monitor patients with SUD in primary care settings and can provide support for medications for addiction treatment.
This five-year evaluation reported on patient characteristics, medication treatment initiation, and duration.
Findings
This initiative received a high volume of referrals, which suggests a high need for addiction care in medical settings more broadly. The study also found that most patients had complex health and social needs: the majority had a psychiatric co-morbidity; over one-third had Hepatitis C; more than a quarter were experiencing homelessness. Compared with other studies focused on expanding access to buprenorphine, this study had a higher buprenorphine initiation rate and longer treatment duration with buprenorphine, particularly among patients treated in primary care by OBAT nurses and recovery coaches.
Takeaways
These findings suggest the feasibility of establishing integrated addiction care models in medical settings as well as the significant impact that low-threshold SUD pharmacotherapy can have for patients with SUD.
