Posted by & filed under Noah's Notes.

PCHC has been a national leader in the development of what is known as the “integrated model of primary care”.  That is, in addition to a primary care provider and their team, our patients also have access to mental health providers (psychotherapists and psychiatric specialists) and their care is coordinated and communicated in a manner that improves safety, improves efficiency and convenience for patients, saves costs and, we think, improves care.

Sometimes this approach is successful and we can often cite specific cases in which patients have uniquely benefitted from this model of care.  But often we simply can’t know.  It can take years to identify true trends in healthcare and even then it requires sophisticated analytics and consistency in care and documentation, which can be elusive in busy primary care settings.  So it is always exciting when others can demonstrate that the integrated model of care that is, in fact, the right model.  An article published recently in JAMA Internal Medicine did just that.

Entitled “Integrated primary care models expand access to opioid abuse treatment”, it immediately caught my eye, and my preference for the title-as-most-important-finding approach was satisfied as well.  But there was much more to the study than that.  In fact they found that patients with substance use disorder had greater access to treatment and were more likely to refrain from using drugs when they received their care in an integrated primary care setting compared to being referred to an addiction specialist.  39% of patients with use disorders in the integrated settings received treatment for their addiction, as opposed to just 17% of those in non-integrated primary care practices.  And 32% of those receiving treatment for use disorders in the integrated model reported abstaining from opioids or alcohol after 6 months, compared to 22% in the non-integrated model.  These findings are critically important.  An article by Steven Ross Johnson in Modern Health Care points out that there are over 20 million Americans with use disorders and over 15 million of them have alcohol use disorder, 2 million people in this country abuse prescription opioids and/or heroin and only a small fraction (about 10%) receive treatment for their problem.   2/3 of those receiving treatment access it through addiction specialty practices.

This is a clarion call to integrated primary care practices like PCHC.  We have the resources to treat use disorders and there is now evidence not only that we can be effective, but that we are a better model for the delivery of this care.  It makes intuitive sense.  Having an interdisciplinary team of primary care and mental health providers, partnered with resources like care management and clinical pharmacists, (and in our case chiropractors and physical therapists) removes important barriers to care, allows for much more powerful communication and coordination of care, strengthens patient safety and engagement, and goes a long way to creating a trauma informed, stigma free environment in which people can receive care.

Our work together here at PCHC includes the treatment of more than 300 people with opioid use disorder this year alone.  We have expanded from one site to 4 sites providing this vital service.  We now have 24 people with X waivers which allow them to prescribe Suboxone for the treatment of opioid use disorder, we are collaborating with all of the region’s health care organizations to assure that this need is met, and we are providing education, technical assistance and peer support to other like-minded agencies across the state.  As more integrated primary care settings embrace this aspect of our work as fundamental to the role of a primary care provider we will increase the impact and improve the health of Mainers everywhere.

Noah Nesin, MD

Dr. Nesin, Vice President of Medical Affairs for PCHC, is a family doctor with 30 years of experience.

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