Open Access Model and the Urgency of Treatment
In addition to Lynn Madden’s roles as CEO and President of the APT Foundation, she is also Assistant Professor in the Department of Internal Medicine at Yale. Earlier in the month she spoke to a group of staff and community members about the journey APT has taken as an organization to reduce barriers to entering treatment. Learn how her team approached the problem, what they decided to do in response to what they learned, and the impact those changes had on their business model, patient census, treatment providers, and the international research community.
1.00 How APT is framing the problem of access to opioid treatment in a different way.
1:30 Grim realities & the urgency of treatment.
1:50 Introducing APT’s Open Access Model
2:20 APT offers primary care services alongside prevention services and treatment of other chronic illnesses.
2:30 Medications for Opioid Use Disorder (MOUD): Methadone, Buprenorphine and Naltrexone
3:20 Barriers to significant MOUD access
4:00 Calculating the costs to society of keeping these barriers in place
7:15 Our conceptual framework is that Opioid Use Disorder is both a public health issue AND a social justice issue.
8:30 Complicating effects of substance use disorders on COVID-19
9:30 COVID, OUD, HIV and HCV cause disproportionate harm to Black/brown communities due to their heavily overlapping negative consequences.
10:45 OD Deaths Chart – with a spike between Jan and July 2020
11:30 Use of Fentanyl on the rise, contributing to 90,000 OD death in the US in 2020
11:45 Seeing the real picture: for every fatal OD there are 30 non-fatal OD events.
12:20 In terms of preventable deaths, we are experiencing the equivalent of a large plane crash every single day.
13:15 The non-fatal OD event is an opportunity to intervene and help individuals navigate intro treatment.
13:50 Lack of access to syringe service programs is a major driver of continuing outbreaks of HIV.
14:40 For those who already have HIV, substance use complicates the prognosis.
16:00 Treatment is prevention!
17:20 Risk-taking behaviors of all kinds go up with the use of any drug.
18:35 It protects the community for more people to know they have HCV and get treatment.
19:00 Structural challenges: costs, regulations, etc.
20:30 Stigma and myths about MOUD
21:00 The problem of underdosing can become a negative feedback loop, leaving patients and providers alike to mistakenly believe that “treatment doesn’t work.”
21:30 Continuing treatment for 3-5 years is the recommended floor. Some need it for life.
22:30 Same day access is the best case. Within 72 hours is a magic window. Treatment entry within this timeframe is associated with reduced death and decreased all cause mortality.
23:40 In 2007 APT began to systematically identify barriers to treatment, focusing on a single metric: Wait Time.
26:45 Today it’s about 3 hours from the time someone walks in until they are invited into the appropriate level of care.
27:10 Snapshot of recent US census data as it relates to this issue
28:10 What we found: people will enter treatment when there is a smooth pathway.
29:50 People who enter treatment right away do as well as people who wait.
30:30 Demographics of who is now entering treatment.
32:30 Advocacy to cover the cost of treatment.
33:00 End of presentation / beginning of Q&A. 23 participants made comments, such as:
How can we decrease the stigma for MOUD?
Is access to MOUD dependent on participation in other services?
What has APT done to bring in more of a customer-driven approach?
38:00 Given good choices, patients will act in their own best interests.
39:45 Researchers and clinicians in 5 other states and several other countries are now trying to replicate our model.
APT-funded research and extensive publication of results in peer-reviewed journals is one way we are supporting their efforts.
In Eastern Europe and Central Asia in particular, treatment protocols are advancing, and we have seen lots of interest and engagement with APT.
Open Access is an opportunity for those suffering with Opioid Use Disorder to not only begin treatment but also begin to get care for other illnesses. For providers, it becomes an opportunity to look at people in a more holistic way.
In Ukraine, the entire country adopted an Open Access Model in 2014. The effect was to quadruple the number of people in treatment.
45:10 Capacity and artificial constraints
47:40 Open vs Closed Groups
48:00 Business models and making ends meet. Revenues are created by people using services. Those revenues get reinvested to hire more people to deliver more services.
49:00 Listen to what people actually want to do inside the organization.
“They told us because we asked!
…At APT, we engage in endless remembering to re-engineer ourselves in response to our own data.” – Lynn Madden, CEO & President
50:10 The challenge of interfacing with professional groups that do not understand treatment.
52:30 APT now has twice as many employees compared to 2007. We are also seriously committed to medical education. Interns are worth the extra work!
53:45 Build a coalition of the willing.
54:15 The concept of “braided lines of service” as a way to build treatment efficiency.
55:50 The challenge under the hood is the issue of scale-up. We need a dramatic response to take place.
57:20 Hiring, recruitment and orientation practices.
We manage culture change by being change agents.
57:30 Sustainability of Open Access.
At APT we avoid tendencies to default to the traditional ways of doing things. This takes time, commitment and repetition. We just keep doing the work, at home and in these wider spheres.
APT has speakers available to present to various groups. Please, just ask! Contact Us at (203) 781-4600.
“Your commitment to person-centered care is a breath of fresh air.”
– an APT Community Forum Participant
The “Opioid Crisis” is about real people affected by a chronic and progressive illness, trying to live their lives as best they can. Everybody knows somebody, and APT is here to help!
