Prevention In The Health Care System

1. Prevention In The Health Care System Tanya Meeks CMA, LMR, TCM, CRC,TOR Prevention Educator Central Kentucky Harm Reduction Coalitions

2. Faculty Disclosure I or my spouse have not had any relevant financial relationships in last 12 months with commercial interests

3. Educational Need/Practice Gap Substance abuse has traditionally been seen as a social or criminal problem, prevention services were not typically considered a responsibility of health care systems and because of this services for prevention and treatment have been delivered separately from other mental health and general health care services. This has caused people needing care for substance use disorders to have access to only a limited range of treatment options that are generally not covered by insurance.

4. Educational Need/Practice Gap Most people with substance use disorders do not seek treatment on their own, many because they do not believe they need it or they are not ready for it, and others because they are not aware that treatment exists or how to access it. But individuals with substance use disorders often do access the health care system for other reasons, including acute health problems like illness, injury, or overdose, as well as chronic health conditions such as HIV/AIDS, Hep C, heart disease, or depression. Thus, screening for substance abuse disorders in diverse health care settings is the first step to identifying substance use problems and engaging patients in the appropriate level of care.

5. Need = The issue/problem that underlies the practice gap When health care is not well integrated or coordinated across the systems, patients fall through cracks leading to missed opportunities for prevention or early intervention, ineffective referrals, incomplete treatment, high rates of hospital and emergency department readmissions, and individual tragedies that could have been prevented. A recent study found that doctors continue to prescribe opioids for 91 percent of patients who suffered a non-fatal overdose, with 63 percent of those patients continuing to receive high doses; 17 percent of these patients overdosed again within 2 years. Effective coordination between emergency departments, primary care providers and mental health providers can help to prevent these tragedies.

6. Objectives Upon completion of this educational activity, you will be able to: Understand the importance in integrating substance use disorder preventive services and mainstream health care.

7. Substance use disorders are medical conditions and their treatment has impacts on and is impacted by other mental and physical health conditions. Integration can help: • address health disparities. • reduce health care costs for both patients and family members, and improve general health outcomes. • increase the quality, effectiveness, and efficiency of health care. • could reduce intake/treatment wait times at substance use disorder treatment facilities.

8. Medical professionals have an import role in early prevention, by screening their patients for drug use, providing brief interventions, referring them to substance abuse treatment if necessary, and providing ongoing monitoring and follow-up. Screening and prevention education do not have to be time-consuming and can be integrated into general medical settings. • Screening. Assessment tools administered during annual routine medical checkups can detect drug use before it becomes a serious problem. The purpose of screening is to look for evidence of any use of drugs or abuse of prescription drugs and assess how severe the problem is. Results from screens can indicate whether a more extensive assessment and possible treatment are necessary. Screening as a part of routine care also helps to reduce the stigma associated with being identified as having a drug problem. • Brief Intervention. Patients who report using drugs can be given a brief intervention to reduce their drug use and other risky behaviors. Specifically, they should be advised how continued drug use may harm their general health, and other areas of their life, including family relationships, education and profession. Patients reporting no substance use should be screened again.during their next physical

9. Harm Reduction Education. Harm Reduction refers to policies, programs and practices which aim to reduce the negative health, social and economic consequences that may result from the use of both legal and illegal drugs, without necessarily reducing drug use examples include: Needle distribution and safe disposal, medication substitution i.e. methadone, Narcan distribution, wound care education, outreach and peer support program referrals, impaired driving prevention education. • Referral. Patients with substance use disorders or those that appear to be developing a substance use disorder may need a referral to substance abuse treatment for more extensive assessment and care. • Follow-up. For patients in treatment, medical professionals can offer ongoing support of treatment participation and abstinence from drugs during follow-up visits. Patients who relapse or show signs of continuing to use drugs may need to be referred back to treatment. • Before prescribing medications that can potentially be abused, clinicians can assess patients for risk factors such as mental illness or a family history of substance abuse, consider an alternative medication with less abuse potential, more closely monitor patients at high risk, reduce the length of time between visits for refills so fewer pills are on hand, and educate both patients and their families about appropriate use and potential risks of prescription medications, including the dangers of sharing them with others.

10. Expected Outcome Effective integration of prevention, treatment, and recovery services across health care systems is key to addressing substance misuse and its consequences and it represents the most promising way to improve access to quality of treatment. The use of Health IT is expanding to support greater communication and collaboration among providers, fostering better integrated and collaborative care, while at the same time protecting patient privacy. It also has the potential for expanding access to care, extending the workforce, improving care coordination, reaching individuals who are resistant to engaging in traditional treatment settings, and providing outcomes and recovery monitoring. 1) World Health Organization. Health systems strengthening glossary, G-H. Health Systems. 2015. [August 16, 2016]. Retrieved from http://www​.who.int/ healthsystems​/hss_glossary/en/index5.html. 2) HealthIT​.gov. Meaningful use definition & objectives. 2015. [July 29, 2016]. Retrieved from https://www​.healthit​.gov/providers-professionals​/meaningful-use-definition-objectives. 3) SAMHSA-HRSA Center for Integrated Health Solutions. What is integrated care? 2016. [April 28, 2016]. Retrieved from http://www​.integration​.samhsa.gov/resource​/what-is-integrated-care. 4) Institute of Medicine (IOM). Best care at lower cost: The path to continuously learning health care in America. Washington, DC: The National Academies Press; 2013. (0309260736) 5) The Centers for Disease Control and Prevention (CDC) summarizes strength of evidence as: “Well-supported”: when evidence is derived from multiple controlled trials or large-scale population studies; “Supported”: when evidence is derived from rigorous but fewer or smaller trials; and “Promising”: when evidence is derived from a practical or clinical sense and is widely practiced.