Inventive Program Gets Patients with OUD to Treatment in a Week or Less

Inventive Program Gets Patients with OUD to Treatment in a Week or Less—from the ED

By: Joshua Lynch DO, Lucy Connery MPH, & Caleigh Loughran

The U.S. Department of Health and Human Services, after declaring the opioid crisis a public health emergency in 2017, released a five-point strategy to prioritize improving access to prevention, treatment, and recovery supports. The plan also targeted overdose-reversing drug availability and distribution, strengthening health data reporting, supporting innovative research, and advancing pain management practices.

The University at Buffalo Department of Emergency Medicine and UB|MD Emergency Medicine had set out a year earlier to decrease opioid prescribing in their emergency departments. Guidelines were established for patients and prescribers for appropriate opioid prescribing, which were endorsed by every major health system and urgent care organization in Western New York to ensure consistency across the region. The EDs of the major academic health centers in Buffalo subsequently saw a greater than 50 percent decline in opioid prescribing from 2015 to 2018.

The program started when one of us (JL), with the support of UB|MD EM, developed Medications for Addiction Treatment and Electronic Referrals (MATTERS), a public health model for prevention and treatment. It began with an aggressive effort to train emergency physicians and advanced practice providers in responsible opioid prescribing, emergency department-initiated buprenorphine treatment, and rapid referrals to outpatient treatment.

Participating EDs and treatment organizations agreed to a common set of values to ensure consistency of the treatment approach across the network. Patients initially were referred from a hospital to one of three clinics to ensure proof of concept. Proving success in the Greater Buffalo area, the MATTERS Network expanded across New York State in partnership with regional health systems, county health departments, and the New York State Department of Health.

Automatic Process

The MATTERS’ Electronic Referral System was developed with the NYSDOH and is securely housed on its health commerce system. The referral process is completed in three stages:

• Patient Phase: Collection of demographics, insurance status, brief medical history, concurrent drug use, and other factors.

• Provider Phase: A health care, social work, or administrative professional enters information on the referral.

• Follow-Up Phase: Patients choose from hundreds of available appointments at their preferred treatment organizations. The clinic options include appointment dates, distance from the patient’s home, and the various treatment options offered at each location.

A lot happens automatically once the patient completes the referral process:

• Uninsured patients are issued a medication voucher to cover the cost of up to 14 days of buprenorphine.

• All patients needing transportation assistance receive a voucher for a roundtrip ride to their first clinic appointment.

• Patients who opt in to peer support services are referred via fax to a regional outreach organization.

• Referral information is emailed or texted to the patient. MATTERS referrals typically take three to five minutes to complete, all without making a single phone call.

Efficient System

The MATTERS referral process combines multiple steps into one efficient system to make emergency referrals easy for patients and clinicians. The program is equally as simple and effective to implement in rural hospitals with single-provider coverage as busy tertiary care centers in New York City. The automated platform also demonstrated applicability to non-emergency medical environments, and it has been integrated into primary care offices, OB/Gyn practices, correctional facilities, and court systems.

The MATTERS Network had more than 50 referral sites, 150 treatment organizations, and 1000 pharmacies participating by Spring 2022. The expansion of the network means better results for patients: Nearly 95 percent of MATTERS referrals connect patients to a treatment appointment in fewer than seven days.

The MATTERS team partnered with two virtual emergency departments in Western New York during the COVID-19 pandemic to connect patients to quality care via telemedicine. Patients can be prescribed buprenorphine and receive a referral without ever presenting in person to the emergency department. MATTERS continues to leverage regional telemedicine services to improve access to medications for opioid use disorder.

The network recently onboarded REACH (Respectful, Equitable Access to Compassionate Health Care) Medical, a low-threshold harm reduction medical practice in Ithaca, NY, to provide rapid evaluations and follow-up appointments to patients with opioid and substance use disorders.

The MATTERS Network has deployed nine regional care coordinators into health hubs certified by the Office of Addiction Services and Supports across New York State in the past year. They assist with expansion through stakeholder outreach, onboarding, and engagement, and they follow up with referred patients in their region to ensure continuity of care. More information on the MATTERS Network is available at www.mattersnetwork.org or by emailing referrals@mattersnetwork.org.

The MATTERS team extends its appreciation to the New York State Department of Health for its contribution to the electronic referral platform.