Medication Partnership Project

The Horsham ClinicChange Team = BJ Sellman; Team Leader Dr. Michael FrostDates = 5/22/12 to present

What is our aim?

The Horsham Clinic is striving to increase its utilization of FDA Approved Medications for Alcohol Use/Dependence Disorders.

Medications targeted for project include: Disulfiram (Antabuse), Naltrexone, Extended Release Naltrexone (Vivitrol), and Acamprosate (Campral).

What changes have we made?

Our first PDSA cycle was entitled “Physician Education”. Our Plan was to introduce project and educate physicians regarding targeted medications and effectiveness.

Do steps included: a Physician inservice and the development of a binder for each Attending containing information re: meds and outcome studies.

We collected data for three months. Data showed minimal improvement from baseline. We abandoned the education cycle and made a process change which led to our 2nd PDSA.

2nd PDSA

Our second PDSA was entitled “Detox Process” with the aim of having the “detox” Physician (i.e. Dr. Frost) initiate MAT as part of the detox protocols rather than having the Attending Psychiatrists do the assessment and prescribing.

Our Do steps included meeting with the CEO and obtaining Executive support for the change in procedure. We then met with the Attending Psychiatrists in order to create buy in. Meeting was successful and Dr. Frost began to initiate Campral or Naltrexone during the detox stage of treatment. The Attendings were only responsible for continuing the medications until discharge. As a result of this process change, our results began to improve.

What were the results?

Baseline data = utilization rate of 9% (6/65) June 2012 utilization rate = 28% (8/29) July 2012 utilization rate = 39% (19/49) August 2012 utilization rate = 40% (20/50) Sept 2012 utilization rate = 39% (18/46) Oct 2012 utilization rate = 22% (11/49)

Barriers

Even though the second PDSA was successful, barriers to success continued.

Dr. Frost remains the primary physician who initiates MAT. If a patient is not in need of detox, he/she is treated solely by the Attending Psychiatrist and less likely to be offered MAT.

Another barrier arise when Dr. Frost is away from the facility for a period of time. Physicians that cover for Dr. Frost are not as familiar with MAT and do not routinely consider this option.

The Change Team is unsure of the next steps. We could re-visit the Physician Education cycle and expand our efforts or perhaps begin a new education cycle with our nurses. If the nurses become more educated about treatment options, it is unclear if this will impact the physician prescribing practices.