It can be daunting for patients suffering from an opioid use disorder (OUD) to figure out how to get into treatment and find the resources that can help set them on the road to recovery.
That’s why Melrose-Wakefield Hospital and Lawrence Memorial Hospital – part of Medford, Mass.-based Hallmark Health – created a program that seeks to bridge the gap between being hospitalized and detox, and getting patients into long-term treatment.
“Collaborative Outreach and Adaptable Care at Hallmark Health” – or COACHH – gives patients access to pharmacist and primary care consultants, social workers, nurse practitioners and community health workers. Patients receive individualized care plans that cater to the often complex issues that lead to and stem from OUD.
The COACHH team meets patients when they come into the hospital. Patients get a card and phone number during that first bedside encounter. Some are receptive; others may call weeks or months later and want to meet with one of the program’s coaches.
COACHH staff will visit patients “where they are,” says program executive director Carol Plotkin. That could be in their homes or a park or coffee shops.
“We know patients with OUD have manageability issues,” Plotkin says. “So for them to try to get to a specific appointment and take two buses to get there – it really sets them up to fail. Meeting them where they are at is critical.”
The program helps clients with basic needs, like housing, food and health care – and works to build trust. Staff will help clients get medications, like Narcan, an overdose reversal drug, and others that can help wiith withdrawal from opioid use.
“We tell them, ‘it doesn’t matter if you are continuing to use opioids, we want to help you with whatever you need help with,’ and that sustained engagement seems to be the key to our success in ultimately getting people into treatment,” Plotkin says.
The nearly two-year-old program serves about 250 people. It was born out Hallmark Health’s frustration with the growing opioid epidemic in the communities it serves. In 2013, the health system began initiatives targeted at reducing opioid use in patients who visited the emergency department (ED) complaining of back pain.
Hallmark Health developed a training program for physicians and staff that covered best practices managing patients presenting with back pain who requested or would benefit from opioids. The training listed a variety of alternative treatments for those patients.
The health system also trained providers to use a prescription drug monitoring program that allowed physicians to determine if patients had previously used opioids. And it implemented a series of ways to connect patients to care outside of the ED, such as by only providing one or two days’ worth of prescription painkillers then referring the patient to a primary care doctor.
Over a six-month period, from January 2014 to July 2014, Hallmark Health’s “lower back pain bundle” program reduced opioid prescription writing in the ED by 26% from baseline at Melrose-Wakefield Hospital and 43% from baseline at Lawrence Memorial.
“This has been a long standing source of frustration for us,” Plotkin says of the epidemic confronting her state. The Massachusetts Public Health Commission reported in August that 4.4% of the state’s residents, age 11 or older, had an OUD in 2015, the most recent year analyzed in the report. That compared to 8% of state residents who had diabetes.
COACHH is another critical piece of the health system’s arsenal for tackling the epidemic – and removing the stigma surrounding OUD. “We think of ourselves as ambassadors to combat the stigma,” says Plotkin, who adds that public attitudes about OUD are changing as more people recognize it as an illness and not a personal failure or weakness.
Plotkin believes COACHH offers a model for other hospitals and health systems and community organizations.
“Our clients feel connected to the health system and know that there are people in the health care system who they can turn to over and over again,” Plotkin says. “That is a tremendous turning point in their lives.”