1

Best Practices in Medication Assisted Treatment

Kiame Mahaniah, MD

CMO, North Shore Community Health

Assistant Professor, Tufts University School of Medicine

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MAT: comparisons

• What is the evidence regarding the options?

-> Behavioral intervention alone versus MAT

-> HAT

-> Methadone vs. Naltrexone IM vs. Buprenorphine

-> Buprenorphine vs. Methadone

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MAT: best practices

• Baseline:

-> integration: why?

• First step:

-> SBIRT

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MAT: best practices

• Baseline

-> policies and processes: but trumping that philosophy

• How is a philosophy determined?

-> patient selection/exclusion

-> team member roles

-> what counts as a strike?

-> management of exceptions

-> patient dismissal/re-entry

5

MAT: best practices

• Baseline

-> Diversion control processes

-> Documentation

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MAT: in practice

• Refining your processes:

-> team meetings

-> outreach to special constituencies

-> outreach to different communities

-> growing your practice

7

MAT: what does the future look like?

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Launch of Screening, Brief Intervention, and Referral to

Treatment (SBIRT) using LEAN

• Implementation of SBIRT in Primary Care – Tower Foundation Grant

• LEAN Process - Project Charter

• Work Flow – Process Map

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Screening Work Flow

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Implementation

• Staff Training on SBIRT

• Development of Protocol; Quick guides

• Pre-screening on Health Risk Assessment Form (Annual/New)

• Further Assessment when Pre-screen positive• AUDIT/DAST• CRAFFT for 12-17 age patients

• Documentation in EMR• Use of Quick Texts; care plans in assessment• Special Quick texts to differentiate adult from pediatric;

ensures confidentiality

4

Data Collection

Salem: Newly up and running; no data to share at this time.

0

50

100

150

200

250

Pat

ien

ts

PFHC Running SBIRT Data

# patients screened

# Positive screens

# BNI's performed

# Referrals

0

100

200

300

400

500

600

700

800

900

Jan

-14

Feb

ruar

y

Mar

ch

Ap

ril

May

Jun

e

July

Au

gust

Sep

tem

be

r

Oct

ob

er

No

vem

be

r

De

cem

ber

Jan

-15

Feb

ruar

y

Pat

ien

ts

GFHC Running SBIRT Data

# Screened to date

# positive screens

# BNI's performed

# referrals

5

Sustainability

• Strengths• Grant Finances

• Relationship with BNI-ART Institute

• Dedicated staff - CHW

• Challenges• Switching from 5 A’s MI

• Increasing responsibilities of MA’s

• EMR issues (rights, etc.)

• Documentation

• Lessons Learned

Continuum of Care: Community-Based Partnerships include:

• Physicians Roundtable

• High-Risk Task Force

• Opiate Prevention Partnership

• Shelter Liaison

• AGH ED SBIRT

• Suboxone Treatment Program