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DACCO Behavioral Health, Inc. NIATx Tampa Meeting Expanding MAT Treatment

DACCO Behavioral Health implemented changes to increase the number of individuals engaged in medication-assisted treatment (MAT) for opioid addiction, improve retention rates, and ensure appropriate medication options based on screening criteria. This initiative resulted in increased enrollment, improved intake process efficiency, successful community partnerships, and enhanced patient retention. Next steps include exploring extended engagement periods, expanding services for pregnant and postpartum women, and assessing the need for waivers for providers. The program has had a positive impact on patient satisfaction, changed attitudes in the legal system, and filled treatment gaps in Hillsborough County. Sustainability efforts include monitoring patient engagement, continuing Medicaid coverage, transitioning to a more accessible EHR system, and seeking alternative funding sources.

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DACCO Behavioral Health, Inc. NIATx Tampa Meeting Expanding MAT Treatment

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  1. DACCO Behavioral Health, Inc.NIATx Tampa MeetingExpanding MAT Treatment Meghan Mahoum-Nassar, LMHC Jennifer Deak, RN Lori Sestito, RN Debra Thomas, LMHCMay 9th, 2019

  2. Aims • Increase number of opiate addicted individuals engaged in treatment receiving medication assisted treatment (MAT) • Improve retention of patients enrolled in MAT • Ensure patients are presented with the appropriate medication options based on screening criteria

  3. Changes • Developed a screening form to triage new intakes • Methadone vs Subutex vs Sublicaid vs Suboxone vs Vivtrol • Obtained a waiver for the APRN to provide MAT • Adjusted the intake process to • Get patients in front of the prescriber faster • Admit patients testing positive for benzodiazepines • Worked with community partners on referrals: • Tampa Police Department • Tampa General Hospital Emergency Department • Hillsborough County Jail • Adjusted the timeframe for physician follow-up appointments to increase new patient retention • Provided NARCAN kits to patients identified as at-risk for overdose

  4. Results • Screening form to triage new intakes results: • Increased OBOT enrollment from 1 to 68 • Total buprenorphine enrollment 99 (OBOT & Clinic) • Waiver for the APRN results: • Increased patient census at the Lakeland from 50 to 160 • Adjusted the intake results: • Increased the number of patients who completed the intake process vs leaving before seeing the prescriber • Community partner referrals results: • TPD – bringing in referrals • 30% of TGH ED Referrals engage in MAT (benchmark 22%) • County Jail – dosing pregnant patients and warm hand-off to clinic for MAT. In-jail vivitrol injections. • Adjusted the timeframe for physician follow-up results: • Improved new patient retention by 10% at 30 days • NARCAN kits results: • Word of mouth referrals requesting Narcan kits

  5. Next Steps • Explore increasing engagement to 180 days – currently experiencing a high level of patient turnover • Explore engagement with pregnant & postpartum women by medication type • Explore whether waivers are still needed for APRNs under the new guidelines to expand provider availability • Revise the restricted medication list to allow patients with medical marijuana cards to progress in phase as part of harm reduction • Approved to open a dosing clinic in the Brandon/Riverview area to expand the population served

  6. Impact • Very high levels of patient satisfaction reported • 100% of MAT patients surveyed in the Tampa and Lakeland offices reported being satisfied with the program teaching them ways to manage/improve their behavioral health since July 2017 • 93% of Tampa MAT patients reported they would recommend DACCO to their friends/family if they needed treatment • 98% of Lakeland MAT patients reported they would recommend DACCO to their friends/family if they needed treatment • Changed attitudes in the courts by educating judges and court liaisons on MAT • Filled treatment gaps in Hillsborough County for hospitals, Medicaid patients, and jail releases

  7. Sustainability • Continued monitoring of patient engagement/retention at 30/60/180 days quarterly in the Medical & Pharmacy Committee • Continue providing services to patients with Medicaid coverage • Medicaid has formulary options to keep costs low • Medicaid covers sublicaid injections • Transitioning to a new EHR where data will be more easily accessible/readily available to determine the impact of changes • Concerns on the STR/SOR grants as well as federal funding running dry

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