Though more than 22 million individuals in the United States have untreated substance use disorder, only 2.5 million are able to annually access treatment at a specialty facility. So it’s no surprise that substance use treatment is a key area of need for people experiencing homelessness and patients with low incomes that rely on Venice Family Clinic as their medical home.
Primary care is an ideal setting in which to treat substance use disorder. Primary care providers are usually the first contact most people have with the health care system, and most people visit their primary care provider at least once every two years. Substance use treatment also offers an opportunity to further integrate services offered at a patient-centered medical home – allowing health centers to overcome barriers to access and care delivery, and better meet the needs of our patients.
Venice Family Clinic (VFC) was proud to partner with the RAND Corporation on a five-year study on how to integrate substance use treatment into primary health care settings. Funded by the National Institute on Drug Abuse, “Substance Use, Motivation, and Medication Integrated Treatment” (SUMMIT) looked at ways to help VFC medical and behavioral health providers use existing, evidence-based practices to identify and treat patients with substance use disorders. Approximately 400 patients participated in the study.
At VFC, the project was led by Associate Medical Director Dr. Karen Lamp who said that the “SUMMIT project gave our staff the opportunity to work with a phenomenal team from RAND. The funding provided a full year to plan our work, train our medical providers and behavioral health staff in addiction treatments and then implement the project in a careful and thoughtful way.” For our patients, the impact was evident immediately. “SUMMIT changed our way of thinking in our approach to people with substance use disorders,” says Dr. Lamp. “We no longer ‘turf’ them out, rather we can embrace them within the scope of our primary care practice here at VFC.”
VFC now screens all patients for alcohol use disorders at every visit. Staff members learned new ways to identify substance use disorders
and provide evidence-based treatment, including Medication-Assisted Treatment (MAT), which uses medication, usually in combination with counseling and behavioral therapies, to treat opiate and alcohol use disorders. VFC medical providers learned about MAT and saw successful outcomes in utilizing these interventions for interested and eligible patients. Staff also recognized the critical importance of a warm hand-off from a care coordinator or case manager in connecting patients to behavioral health services. And, since the study concluded, several VFC staff members have elected to pursue additional education in addiction medicine.
“What has really impressed me is how eager the providers have been to have something tangible to provide their patients with substance use disorders,” said Katherine Watkins, MD MSHS, Senior Natural Scientist at RAND Corporation who served as principal investigator on the study. “Often the provider knew there was a problem, but didn’t have anything to offer the patient other than a referral to specialty care, which the patients didn’t want, which led to a sense of helplessness and frustration. Having a treatment that works and that is appropriate for delivery in primary care has really empowered providers and helped them feel optimistic about their ability to help this group of patients.”
In March 2016, Venice Family Clinic received a grant from the Human Resources & Services Administration (HRSA) for Substance Abuse Service Expansion, allowing Venice Family Clinic to further expand Medication-Assisted Treatment programs. The implementation experience we gained from the SUMMIT program was identified as a key strength in our successful funding application. So, though our RAND study is coming to a close, our commitment to treat substance use disorders continues to grow, as we work to develop resources to address this critical need for individuals across our community.
For more about Venice Family Clinic and RAND’s SUMMIT project:
Understand the Study Protocol: “An Organizational Readiness Intervention and Randomized Controlled Trial to Test Strategies for Implementing Substance Use Disorder Treatment into Primary Care”, which was published in May 2015. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-015-0256-7
Access the Guide: “Primary-Care Procedures for Medication-Assisted Treatment of Alcohol or Opioid Dependence”, which was released by RAND in March 2016. https://www.rand.org/pubs/tools/TL148.html
DID YOU KNOW:
CCALAC, Los Angeles County, and CPCA are sponsoring Community Clinics: Drug Medi-Cal Coverage (SB1335), a bill authored by California State Senator Holly Mitchell. SB 1335 will help community clinics more easily provide substance use disorder treatment and medically necessary specialty mental health services to under-resourced communities by allowing federally qualified health centers (FQHCs) and rural health clinics (RHCs) to elect reimbursement on a fee-for-service (FFS) basis instead of the prospective payment system (PPS) basis, thereby expanding the services offered and provider types available at FQHCs and RHCs.