Opportunities to Improve Opioid Use Disorder and Infectious Disease Services Integrating Responses to a Dual Epidemic (2020) / Chapter Skim
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1 Introduction
1 Introduction
Pages 19-34
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From page 19... ...
. Infectious diseases related to OUD and co-occurring stimulant use disorders include HIV, hepatitis A virus, hepatitis B virus (HBV)
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To achieve these goals, it is important to recognize that OUD and infectious diseases are inextricably linked. Integrating medical services in primary care settings, behavioral health settings, health homes, or any other medical setting (e.g., emergency departments)
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When SUD treatment is moved from a stand-alone clinic to a general medical setting, the emphasis can expand to encompass harm reduction more broadly (a concept explained in more depth later in the introduction) including vaccinations, sexual health care, and preventing and treating infectious diseases.
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addresses both OUD and infectious diseases, primarily through the routes of transmission of injection drug use and high-risk sexual behaviors that are common among people who use drugs.2 The committee met in February, May, and June 2019 and also held a number of conference calls to continue deliberations. The committee identified programs working to integrate opioid and infectious disease services to include in its review, and National Academies staff conducted semi- tructured interviews with program informants.
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The committee notes a number of difficulties in identifying programs that met the inclusion criteria. A database of integrated programs does not exist, so the committee took purposeful steps to identify candidates through existing literature and networks of experts; suggestions were gathered from OIDP, committee members, and other experts working in OUD or infectious disease services or both.
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National Academies staff reached out to these programs to further explore their eligibility for inclusion; two were included in the committee's review. The final programs selected, in consultation with OIDP, were the following: • ARCare -- Little Rock, AR • King County Department of Public Health -- Seattle, WA • Southcentral Foundation -- Anchorage, AK • Greater Lawrence Family Health Centers -- Lawrence, MA • Plumas County Public Health Agency -- Quincy, CA • LifeSpring Health Systems -- Jeffersonville, IN • CrescentCare -- New Orleans, LA • Evergreen Health -- Buffalo, NY • Bronx Transitions Clinic -- Bronx, NY • Whitman-Walker Health -- Washington, DC • Philadelphia FIGHT Community Health Centers -- Philadelphia, PA The foundation for the report's conclusions and recommendations came from several sources.
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. This framework was intended for primary and behavioral health care organizations to improve patient outcomes by providing objective descriptions of integration along a continuum: the "sixlevel framework can be used for planning; creating a common language to discuss integration, progress, and financing; supporting assessment and benchmarking efforts; explaining integration efforts to stakeholders; and clarifying differences in vision" between otherwise disparate organizations.
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. For instance, if a number of the programs independently mentioned one particular policy as a barrier to providing integrated services, it was presented as a primary barrier.
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identified six broad themes of harm reduction and examples of how they can be applied to health care settings: • Humanism: Providers have respect for patients and the decisions they make, providing care without moral judgments. • Pragmatism: Providers have realistic expectations and support a range of options for reducing harm.
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At the syringe service locations, other services include testing for HIV, viral hepatitis, tuberculosis, and other infections to which people who use drugs are prone; treatment readiness counseling and case management services; education about harms associated with drug use and how to minimize them; and safe dis posal of contaminated equipment. The syringe service is a primary referral source for other services.
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In general, core OUD and infectious disease services are performed by the primary care team, with referrals out to specialty care for patients with complex mental health histories. In 2017, GLFHC began to restructure programs such that HIV, hepatitis, and substance use disorder (SUD)
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LifeSpring operates on a medical home model, where a patient's needs are addressed in one visit and one location whenever possible. LifeSpring treats HIV, viral hepatitis, and OUD in primary care, as well as promoting harm reduction through PrEP, condom distribution, and a colocated syringe service (run by the local health department)
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While OUD treatment initially was primarily focused on sobriety, CrescentCare has transitioned to a harm-reduction approach since implementing its syringe service program. The choice to integrate OUD services into primary care -- along with HIV/viral hepatitis services -- was driven by the syringe service program already located in the clinic and the harm-reduction outlook of the staff.
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BTC is fully integrated into the community health center's normal workflow (Montefiore Comprehensive Health Care Center) and sees about 150–200 patients per year, the majority of whom have chronic health conditions.
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Because of its history, FIGHT has always "met patients where they are at." Recently, FIGHT saw a need in the community and responded to increased deaths in Philadelphia due to fentanyl overdose. Overall, there was broad support for integrating OUD and infectious disease services, including from the medical/clinical staff and from leadership.
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From page 34... ...
Chapter 2 provides an overview of the relationship between OUD and infectious diseases, with a particular focus on the historical dissociation between these two types of care and the need for greater integration. Chapter 3 outlines nine barriers to effective integration of OUD and infectious disease services and provides findings from the literature and interviews conducted with 11 programs seeking to provide integrated services, as well as the committee's recommendations.
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