Collaborative Approaches to Screening and Treatment (CAST) Victoria Sanchez, Dr. P.H., MPH

1. Collaborative Approaches to Screening and Treatment (CAST) Victoria Sanchez, Dr. P.H., MPH KamillaVenner, Ph.D Rob Williams, M.D., MPH Jacque Garcia, MPH Andrew Sussman, Ph.D, MCRP 1st Annual UNM National Health Disparities Conference May 23, 2011

2. Overview • I. Goals (rationale) • II. Activities • III. Challenges • IV. Plans

3. Goals • Overall Project Goal: work with primary care practices and communities to develop ways to improve the delivery of screening and treatment services for people with substance use disorders • Background: • Challenges to communities • Challenges to primary care practices

4. Community Impact • Acute Alcohol and Opiate Use in New Mexico: • Alcohol: • NM has had the highest alcohol-related death rate since 1997 • in 2005, it was 138% higher than the national rate • Opiates: • NM has the highest drug-induced death rates in the country • The overdose death rate from a combination of illicit and prescription drugs increased 150% in the past five years. • Attributable to heroin and prescription opioids • The Costs and Disproportionate Burden: • Enormous physical, social, and economic costs • Health Disparity: Hispanic and American Indian populations • New Mexico Department of Health, The State of Health In New Mexico 2009. 2009, NM Department of Health. • New Mexico Department of Health. New Mexico Substance Abuse Epidemiology Profile. http://www.health.state.nm.us/erd/HealthData/SubstanceAbuse/2010%20New%20Mexico%20Substance%20Abuse%20Epidemiology%20Profile.pdf. 5.22.11

5. Rationale • The View from Primary Care: • Medical problems due to alcohol/opiate use are commonly seen in primary care • Up to 20% of patients have unhealthy drinking patterns • Screening is strongly endorsed by leading preventive service guideline groups • Evidence of efficacious behavioral and medication treatment options • Despite these recommendations and need, these services are consistently underutilized in primary care settings • Lack of perceived self-efficacy • Competing clinical demands • Professional satisfaction • Bradley KA, Kivlahan DR, Williams EC. Brief Approaches to Alcohol Screening: Practical Alternatives for Primary Care. 2009. J Gen Intern Med 24(7):881–3. • SaitzR, et al. Professional satisfaction experienced when caring for substance abusing patients. 2002. J Gen Intern Med 17:373-376.

6. The Need • Alcohol and Opiate use problem in NM • Significant social, physical and economic consequences • Disproportionate burden to Hispanic/AI populations • Challenges in Primary Care Service Delivery • Availability of efficacious behavioral and medical treatments • Lack of success in integration • CAST project: • Translational research to identify feasible and appropriate practice and community approaches

7. Research Questions • What are primary care practices currently doing to screen for and treat AUDs/OUDs? • What makes screening and treatment of AUDs/OUDs difficult or more possible in primary care settings? • Project Goal: work with primary care practices and communities to develop ways to improve the delivery of screening and treatment services. • These approaches will be flexible and need to fit different practice and community contexts

8. Research Involving Outpatient Settings Network (RIOS Net) • New Mexico Practice-Based Research Network • 200+ members • academic (UNM) • community health centers • IHS primary care practices • Mostly underserved, minority populations • Members set priorities

9. CAST Project: Activities • Phase 1: • Survey primary care providers that serve Hispanic and American Indian communities; find out what they are currently doing and the challenges • Phase 2: • Complete up to 12 case studies in primary care practices throughout NM; work to identify challenges to improve these services • Phase 3: • Use what we learn to improve screening and treatment for AUDs/OUDs with a few primary care practices (2 pilot interventions) • Throughout the Project: • Partner with community members and substance use service providers throughout the State to better understand these problems and identify appropriate solutions

10. CAST Project: Challenges • Project/logistical • NM is big • Wide range of practice/organizational settings and diverse social/cultural populations • Being participatory; creating authentic partnerships • 2) Easy to identify problems…but what are the solutions? • Primary Care Practice: Increasing screening/treatment efforts as practice change rather than individual change (knowledge based) • Development of “flexible” interventions that share core elements but fit in different settings • Sustainability—solutions that are not strictly resource dependent

11. CAST Project: Plans • Moving Forward: • Finalizing Phase 1 survey and community engagement • Developing partnerships with key stakeholders • Prepare for Phase 2: primary care practice assessments

12. QUESTIONS?