A Low Threshold Clinic for Medically Complex Patients with Substance Use Disorder (1 CME)
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Building Bridges in Times of Crisis: an urgent care and post discharge clinic for medically complex patients with addiction Massachusetts is among the states hit hardest by the opioid epidemic, with an estimated 1,659 lives lost in Massachusetts in 2015. The expected death toll for 2016 is even higher. In the context of the current crisis, low threshold treatment models which target high risk populations are needed. Recent Department of Public Health data found that starting pharmacotherapy for opioid use disorder following a non-fatal overdose reduced the risk of death in the subsequent year by more than 50%, yet less than 5% of those who survive overdose begin treatment. Overdose risk increases after periods of reduced tolerance, including hospitalization. Despite the risks, a minority of patients engage in addiction treatment following hospital discharge. The Mass General Bridge Clinic is an immediate access clinic which provides low threshold transitional support and treatment to patients following hospitalization or directly from the emergency department (ED) and other outpatient clinics. The clinic predominantly serves individuals who would otherwise be unable to access care. The goal of the clinic is first and foremost engagement, followed by rapid treatment initiation, stabilization, and linkage to community-based treatment. This clinic also serves in a complementary role to an inpatient addiction consult team, providing ongoing care to patients started on addiction pharmacotherapy in the hospital and allowing a pathway for same-day initiation of pharmacotherapy for ED patients. The clinical care team is multidisciplinary and includes an addiction medicine physician, a psychiatric nurse practitioner, a psychiatric clinical pharmacist, a recovery coach, a patient service coordinator, and a resource specialist. This focus session will describe the nuts and bolts of starting and running this type of a clinic model, review lessons learned, and discuss early outcomes. Objectives: 1. Describe the need for low threshold treatment models for medically complex patients with substance use disorder. 2. Identify the types of services and supports patients leaving an inpatient medical setting or emergency department require to enhance engagement, stabilization, and treatment success. 3. Develop a blueprint for starting innovative treatment models for high-risk and medically complex patient populations. References: 1.http://www.mass.gov/eohhs/docs... 2. D'Onofrio G, et al. JAMA. 2015. 3. Liebschutz JM, et al. JAMA Intern Med. 2014. 4. Naeger S, et al. J Subst Abuse Treat. 2016.
Dr. Sarah Wakeman, MD, FASAM
Medical Director, Substance Use Disorder Initiative, Massachusetts General Hospital
Sarah E. Wakeman, MD is the Medical Director for the Mass General Hospital Substance Use Disorder Initiative, program director of the Mass General Addiction Medicine fellowship, and an Assistant Professor of Medicine at Harvard Medical School. She is also the Medical Director of the Mass General Hospital Addiction Consult Team, co-chair of the Mass General Opioid Task Force, clinical co-lead of the Partners Healthcare Substance Use Disorder Initiative, and co-chair of the Partners Healthcare Opioid Steering Committee. She is the Chief Medical Officer of RIZE Massachusetts, a state-wide, private sector initiative created to build a $50 million fund to implement and evaluate innovative interventions to address the opioid overdose crisis.
She received her A.B. from Brown University and her M.D. from Brown Medical School. She completed residency training in internal medicine and served as Chief Medical Resident at Mass General Hospital. She is a diplomate and fellow of the American Board of Addiction Medicine and board certified in Addiction Medicine by the American Board of Preventive Medicine. She is chair of the policy committee for the Massachusetts Society of Addiction Medicine. She served on Massachusetts' Governor Baker’s Opioid Addiction Working Group. Nationally, she served as chair of the American Society of Addiction Medicine Drug Court Task Force and serves on their Ethics Committee.
Clinically she provides specialty addiction and general medical care in the inpatient and outpatient setting at Mass General Hospital and the Mass General Charlestown Health Center. Her research interests include evaluating models for integrated substance use disorder treatment in general medical settings, low threshold treatment models, recovery coaching, physician attitudes and practice related to substance use disorder, and screening for substance use in primary care.
Dr. Laura G. Kehoe, MD, MPH, FASAM
Medical Director, MGH SUD Bridge Cliic, Assistant Professor in Medicine, Massachusetts General Hospital/Harvard Medical School
Dr. Kehoe is the medical director of the Massachusetts General Hospital Substance Use Disorder Bridge Clinic, an immediate access, low barrier transitional clinic, which is a component of MGH’s Substance Use Disorder Initiative. She is an Assistant Professor of Medicine at Harvard Medical School and she received her A.B. from Washington University in St. Louis, her MD from Tufts University School of Medicine, and her MPH from Boston University School of Public Health. She completed her residency in internal medicine at Massachusetts General Hospital, and is board certified in both internal medicine and addiction medicine. She has cared for patients in primary care, inpatient, residential and outpatient addiction treatment settings, and as a medical director at a Boston area methadone maintenance treatment program.
Dr. Kehoe was the co-chair of the hospital-wide Substance Use Disorder Education Committee, leads buprenorphine trainings for the MGH ED "Get Waivered" program, and supervises MGH addiction medicine fellowship trainees.
She teaches locally, regionally and nationally, is a PCSS mentor, member of ASAM's Prisoner Health Interest Group and the Annual Conference Planning Committee, and Secretary of Massachusetts ASAM chapter.
In addition to providing clinical care and teaching, Dr. Kehoe co-founded W.A.T.E.R.town (Watertown Access to Treatment Education and Recovery), a community coalition working to expand prevention, intervention and treatment for people with substance use disorder in Watertown, MA, for which she received the Harvard Medical School Dean’s Community Service Faculty Award.
Jessica L. Moreno
Dr. Jessica Moreno is a Board-Certified Psychiatric Pharmacist in a co-funded faculty role at Northeastern University and her clinical practice site is at Massachusetts General Hospital where she works on the inpatient Addictions Consult Team and in the outpatient Bridge Clinic. The MGH Bridge Clinic is a post-discharge clinic that provides transitional addiction treatment to patients following release from the hospital or the emergency department while working to establish longitudinal community-based care. She received her BSE in Chemical Engineering and Doctor of Pharmacy at the University of Michigan. She completed a post-doctoral industry fellowship program at Massachusetts College of Pharmacy and Health Sciences in conjunction with Cubist Pharmaceuticals. She then went on to complete a PGY1 pharmacy residency at the Ann Arbor VA Medical Center and PGY2 psychiatric pharmacy residency at the William S. Middleton VA Hospital in Madison, WI. Her clinical role exclusively involves patients with substance use disorders. She makes treatment recommendations to the interdisciplinary teams she works with and, in the outpatient setting, she is developing clinical pharmacy services with the ultimate goal of having collaborative drug therapy management. Her faculty role consists of teaching Doctor of Pharmacy students in the experiential setting at her clinical practic site as well as developing and delivering the psychiatric lectures in a core curriculum course called Comprehensive Disease Management at Northeastern. Regarding research, she is currently the primary investigator on three retrospective studies that will be used as foundations for future prospective, randomized research in the field of substance use disorders.
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