Recipe for Success: Case History of ‘Sustaining Medication-Assisted Treatment for Opioid Use Disorder: Expert Perspectives From a Multidisciplinary Care Team’

By Jill Rovitzky Black, Senior Director, Grant and Content Development; and Angie Ladas, VP, Education Strategy and Collaborative Partnerships

Outcomes Assessments: Adelfo San Valentin, Outcomes Manager; Grantor: Alkermes

Opioid use and misuse in the United States, and the accompanying exponential increase in opioid-related deaths, represent a grim public health crisis. While not every opioid overdose death occurs in an individual with opioid use disorder (OUD), this chronic disease also is increasing in prevalence1 yet, according to the National Academies of Sciences, Engineering, and Medicine, the majority of Americans with OUD receive no treatment for their condition.2

Even when patients succeed in accessing care from addiction treatment centers or other OUD-specific settings, they face multiple barriers surrounding initiation and continuation of medication-assisted treatment (MAT), which has been shown to improve outcomes.3 These barriers include:

  • Institutional policies and clinician biases that regard MAT as merely swapping one drug for another
  • Inadequate integration of MAT with counseling and behavioral therapy as part of a comprehensive, individualized treatment plan
  • Suboptimal clinician understanding of the varying characteristics of available types of MAT and their relative risks, benefits and indications — knowledge that is critical not only for prescribers but also for other healthcare professionals working with patients being treated for OUD

Multiple forces created the current opioid crisis and multiple strategies are needed to address it. Those strategies clearly include education that empowers the healthcare professionals who provide their expertise and support to patients in recovery. To bridge documented knowledge and practice gaps and achieve these goals, Haymarket Medical Education (HME), with support from an educational grant from Alkermes, developed and produced a four-part educational initiative under the umbrella title “Sustaining Medication-Assisted Treatment for Opioid Use Disorder: Expert Perspectives From a Multidisciplinary Care Team.”

The second half of that title embodies the core of the educational design and a key element in the success of this initiative. Effective OUD management depends on collaboration among stakeholders from an array of professions and disciplines. With that in mind, HME gathered a nine-member faculty panel, all with a clinical focus on substance use disorders, to both represent and speak to the multidisciplinary care team. A psychiatrist who specializes in addiction medicine served as moderator for all four activities in the series. They were joined by faculty who represented the following professions:

  • Physician assistant
  • Behavioral pharmacologist
  • Advanced practice nurse
  • Licensed professional counselor
  • Addiction counselor
  • Social worker
  • Pharmacist
  • Primary care physician (also a patient in recovery)

Having nailed down the multidisciplinary care team that would be the source of expert perspectives, the next question was, “How best to provide the education?” HME turned to the myCME™ Town Wall, an innovative meeting platform that allows faculty to participate remotely but engage in dynamic, real-time conversation from remote locations, led by an in-studio moderator (Table 1). The faulty — and selected slides and graphics — appear together on a massive virtual wall. While HME has successfully leveraged this platform for nearly three years for both live and enduring activities, the Town Wall has emerged as an especially important option during the COVID-19 pandemic. Neither faculty nor participants need venture out to engage in education that effectively replicates the lively interchange of face-to-face activities.

Table 1: myCME Town Wall™ Creates a Learning Community

HME-1.png

For each of the four half-hour sessions, two individuals took the lead with brief, focused presentations reflecting their particular area of expertise, but all faculty could participate in collegial conversation. Over the series, all faculty members contributed equally, regardless of their usual professional role or position in a clinical hierarchy, modeling the collaborative care that is essential in OUD management. The educational architecture reinforced important elements of the educational content: clinicians play interrelated roles in providing stigma-free treatment; optimal treatment integrates psychosocial and behavioral therapy in combination with pharmacotherapy, accompanied by patient education and shared decision making. Together, these elements support safe and effective initiation of treatment and subsequent sustained adherence. To give the activities a home and learners a destination, we developed the “Substance Use Disorder Learning Center” on myCME, our educational website (Table 2). The learning center was designed to include the OUD initiative and future related activities, as well as a curated collection of noncertified resources for clinicians and their patients.

Table 2: Substance Abuse Disorder Learning Center — A Go-To Destination for OUD Resources

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When you have an impressive faculty, robust content and a winning educational design, what more do you need? Well, learners. Our recruitment efforts reached beyond the HME/myCME audiences that typically consist of physicians, nurse practitioners, physician assistants, nurses and pharmacists. To meet the certification needs of additional members of the OUD care team, HME collaborated with AffinityCE to certify the activities for a grand total of seven credit types.

The HME marketing team then stepped up to the plate, using a comprehensive multichannel approach that included emails, behavioral-based ad modules, mobile promotions, social media, promotion through Haymarket’s additional medical sites and geo-location targeting to reach clinicians at drug treatment centers. In addition, via myCME, we promoted the activities to the primary care clinicians who share responsibility for the well-being of patients with OUD and who are on the front lines of screening, diagnosis and referral. Using HayloCME, Haymarket’s powerful data engine that combines our first-party data with third-party data such as ICD-10 and CPT codes, we drove awareness of the educational activities to 26,000 clinicians through validated mobile devices.

Through those efforts — and inherent clinician interest in the high-stakes content — we substantially exceeded our projected participation numbers, ending up with more than 17,000 learner visits by the time the activities expired. Nearly 3,400 passed the post-test, and 3,155 claimed certificates (Table 5).

Table 3: Activity Participation

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We achieved an overall 72% relative improvement in knowledge across learning objectives, with the largest relative increase demonstrated on items regarding individualizing treatment for OUD utilizing MAT (Table 4).

Table 4: Relative Improvement in Knowledge

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We were particularly gratified to report substantial gains in planned implementation of recommended clinical strategies in the immediate post-activity assessment and then in actual self-reported use of those strategies 60 days later.

Before participating in the initiative, learners reported that they used most of the recommended strategies a little less than “sometimes.” The only exception was avoiding language that stigmatizes patients, which learners reported using closer to “often.” Immediately following their participation, learners committed to implementing the strategies between “sometimes” and “often.” After two months, learners reported they “often” used these strategies in everyday practice (Table 5).

Table 5: Implemented Changes in Practice

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When asked about changes to involvement as part of a collaborative care team, follow-up survey respondents indicated that they had involved more of their colleagues across disciplines as part of the care continuum. Within two months of completing the activity, 40% of respondents had made some change to team practices.

To complement the objective data analysis in our outcomes process, we also collect qualitative data through open-ended questions, asking learners about what they valued in the education and what else they need to know. Respondents made it clear that the theme of collaboration resonated with them, along with improved communication among professionals and with patients and caregivers, increased awareness of stigmatizing language surrounding OUD and its treatment, and the compelling need to continue educating themselves, their colleagues and their patients.

Specific statements stand out as endorsements of the value of the education. An internal medicine physician wrote, “[I will] definitely make sure that the social worker is involved with every patient who has OUD.” An emergency physician indicated an intent for “close communication with social work and psychiatry, and possible initiation of treatment from the ED.” A primary care nurse practitioner resolved to “be better with my support and language, including body language, and role play with colleagues.” A primary care physician focused on knowledge acquisition: “Before, I was reluctant to prescribe for OUD because I did not understand the mechanisms by which these medications work.” In a comment that is simultaneously a heartwarming validation of making this education available to a broad audience and a chilling reminder of the widespread impact of OUD, a pediatric nurse practitioner cited the value of “an increased awareness of OUD and treatment options, as those who I see with OUD are often caretakers of my patient population.”

“Sustaining Medication-Assisted Treatment for Opioid Use Disorder: Expert Perspectives From a Multidisciplinary Care Team” was more than ordinarily challenging to plan and execute. Identifying, recruiting — even scheduling conference calls with — a nine-member multiprofessional faculty was not easy. Navigating and reconciling the varying requirements for seven credit types was complex. Recruiting among less familiar learner audiences presented new demands. On balance, though, all those extra efforts were outweighed by the value of the education. We can stand back and appreciate the powerful ripple effect that clinician education can play in the lives of patients and their families.

Perhaps the greatest indication of the impact of this education is the estimated 177 patients who benefited each week from the activities. On the follow-up survey, 70% of respondents indicated that they saw improvements in their patients as a result of incorporating their planned changes into practice. Based on these clinicians’ self-report, an average of 5–6 patients per clinician benefited from their engagement with the education. These data suggest that over the course of one year, approximately 8,850 patients would have been affected by the initiative — a clear indication of success.

References

  1. Center for Behavioral Health Statistics and Quality. Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. (Prepared by RTI International under Contract No. HHSS283201300001C) Rockville, MD: September 2015. (HHS Publication No. SMA 15-4927)
  2. National Academies of Sciences, Engineering, and Medicine. 2019. Medications for opioid use disorder save lives. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25310. Accessed March 31, 2021.
  3. Larochelle MR, Bernson D, Land T, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Ann Intern Med. 2018;169(3):137-145.
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