“I feel safe here” Mariya Masyukova, Sc. B. Medical Student Aaron Fox, M.D., M.S. Assistant Professor of Medicine, Division of General Internal Medicine

“I feel safe here”

• Mariya Masyukova, Sc. B.

Medical Student

• Aaron Fox, M.D., M.S.

Assistant Professor of Medicine, Division of General Internal Medicine

Group medical visits in buprenorphine treatment

Outline

Introduction

Development of Group Medical Visits for Buprenorphine Treatment

Implementation of Group Medical Visits for Buprenorphine Treatment

Preliminary evaluation

Division of General Internal Medicine

Science at the heart of medicine

Defining the Problem

Buprenorphine maintenance is an effective treatment for opiate dependence, but is limited by:

● Provider capacity● Institutional resources ● Patient competing needs● Patient comorbidities

How to intensify treatment?

Group Medical Visits for Buprenorphine

aka Shared Medical Appointments

Rationale:

• Social support

• Structure for skill-building and education

• Patient-provider time

• Multidisciplinary, patient-centered

DEVELOPMENT



Setting

Federally-Qualified Health Center in South Bronx, NY

- 10 attending general internists prescribe buprenorphine in primary care

- Clinical pharmacist coordinator

- Social workers available for counseling

The core team

IMPLEMENTATION



Group patients

Patients in buprenorphine treatment referred by their provider if:

– Ongoing substance use

– Extensive psychosocial needs

– Sub-optimal outcomes despite individual buprenorphine treatment



Group day

30 minutes:

Nursing assessment

Urine toxicology

Self-assessment materials

90 minutes:

Group session

30 minutes:

Individual needs

Session Content

PRELIMINARY EVALUATION



Patient characteristicsPatient characteristics N=20 patients (attended

at least 1 group visit in the first 6 months)

Age (years) 53 (34-66)

Male sex 15 (75%)

Race 10 Hispanic (50%)

10 black (50%)

Public Insurance 20 (100%)

Chronic illness diagnosis 18 (90%)

Axis I diagnosis 16 (80%)

HIV+ 6 (30%)



Feasibility

In the first 6 months... ● 13 group visits ● 33 patients were referred and contacted● 20 patients attended at least 1 session ● 13 patients attended ≥ 2 sessions

In each group....● 4 to 10 attendees (median of 6)

• Median attendance per patient: 3 sessions



Challenges

1. Administrative

– Space, staffing, structure

2. For patients

– Time, unmet needs, group dynamics

3. For providers

– Time, care coordination



Conclusions

Group medical visits are an acceptable model of buprenorphine maintenance treatment intensification.

Implementing group medical visits for buprenorphine treatment is feasible in an urban FQHC.



“We're coming here cause we want to. If we just had to see that one doctor, that works all right for a little while,

but we need more. So the group comes in...”

-56 year-old male participant

“At least every other Wednesday, I know for a certain amount of time, I’m gonna be here, I’m gonna feel safe, I’m gonna learn something, and be around people I feel

comfortable with.”

-59 year-old female participant

Feedback from patients

Future directionsAdd more sessions (e.g. Spanish speaking group)

Optimize structure and content

Assess effectiveness

Improve collaboration with patients' individual primary care providers

Apply for R34 to evaluate model effectiveness with RCT

Acknowledgments Mentors/Advisors:

Dr. Aaron Fox

Montefiore DGIM Substance Abuse Affinity Group

Dr. Sara Doorley

Team:

Dr. Aaron Fox, Dr. Angela Giovanniello, Maritza Casillas, and Jennifer Sanchez

Araceli Diaz, Elenita D'Aloia, and the other nursing and support staff.

Administrative:

Dr. Joseph DeLuca and the CHCC.

Funders

K23 DA034541

Clinical Research Training Program at Albert Einstein

Our patients and participants.

Documents

“I feel safe here” Mariya Masyukova, Sc. B. Medical Student Aaron Fox, M.D., M.S. Assistant Professor of Medicine, Division of General Internal Medicine