Page 22 - Focus March 2018

Addiction Medicine |
Robert Hansen, director of addiction services at the Marshall University Joan C. Edwards School of Medicine and Marshall Health, speaks with a reporter.
Terry Horton, M.D., chief of Addiction Medicine at Christiana Care Health System, addresses participants.
first heard about Christiana Care’s work in addiction medicine from a National Public Radio story on Project Engage. The program’s ability to identify those with addiction at a reachable moment grabbed her attention.
“What I needed to know was how you were doing it,” she said.
Grigson came away from the workshop with 21 main points and an outline for how it might be adapted at her organization.
Damon Hamilton of Geisinger Health System attended the workshop to develop insight about how to identify patients and develop a continuum of care, including MAT clinics. “We’re not there yet,” he said. “We’re just beginning.”
Peer coaches are essential to the team
Christiana Care Chief of Addiction Medicine Terry Horton, M.D., FACP, FASAM, said treating the chronic brain disorder of addiction with a combination of medication-assisted treatment and therapy is saving lives.
“It all starts with using the hospital and emergency department to find reachable moments and enroll patients into long-term care in as little as 12 hours,” Dr. Horton said. “Peer counselors are a key component of that moment, but they don’t have pixie dust; they need to be trained and integrated with staff.”
Finding the right counselors, he said, is less about looking for technical aptitude and more about attitude. “You have to have heart and be able to engage,” he said. “We knew we could teach everything else.”
20 CHRISTIANA CARE HEALTH SYSTEM
Karyl Thomas Rattay, M.D., MS, director of the Delaware Division of Public Health, speaks with health care experts about the opioid crisis during the Addiction Medicine Workshop at Christiana Care Health System.
Merely including peer coaches does not ensure success. Training and robust integration with staff are necessary for peer coaches to reach their potential — both with patients and staff.
These relationships among peers and providers, Christiana Care learned, would be a crucial way to break down stereotypes of people with addiction.
Making a business case
In addition to the underlying moral imperative to treat addiction, Dr. Horton also noted the system must be financially sustainable before it can take root and spread.
Developing a solid business case to make optimal addiction care affordable is crucial, he said. “Good care has to be good business or it doesn’t get adopted."
Tapping Medicaid funds to pay for prevention is one promising option being explored for the future. Preventing a handful of major cases, such as endocarditis, an infection of cardiac tissue that can result from intravenous drug use, could reduce costs by hundreds of thousands of dollars.
“Savings from one endocarditis case could support many peer counselors and treatment with suboxone,” Dr. Horton said.
He said the ideas implemented by Christiana Care, including Project Engage, have created a “rope bridge” between recovery and the hospital. Ideally, he said, that bridge should reach into the community. The workshop was also an opportunity for Christiana Care to learn about just such an effort in West Virginia.
“It’s a two-way street,” Dr. Lang said. “We don’t have it all figured out.”