Eagleville Hospital Board of Directors Plays Important Role in Adoption of MAT with Guidance of the Medication Research Partnership

Submitted by: 05/08/2014 by Maureen Fitzgerald

The Medication Research Partnership (MRP), launched in 2011, is a five-year project testing the Advancing Recovery model that NIATx designed as a framework for implementing evidence-based practices such as medication-assisted treatment (MAT). The partnership is a collaborative led by NIATx, Aetna Behavioral Health, Oregon Health and Science University (OHSU), the Treatment Research Institute in Philadelphia, and the University of California San Francisco.

Eagleville Hospital, located northwest of Philadelphia in in Montgomery County, Pennsylvania is one of 12 treatment providers participating in the MRP. Eagleville Hospital is the state’s only hospital specifically licensed to provide inpatient substance-use disorder treatment. Services include medical detoxification, rehabilitation, and specialized treatment for co-occurring disorders. The hospital is currently certified by state regulation to use methadone and Suboxone for opioid detoxification in its detoxification units and to maintain the treatment needs of individuals on methadone or buprenorphine regimens in rehabilitation services. At the time of the study, the hospital was not authorized to initiate methadone or buprenorphine.

In Pennsylvania, treatment providers are not permitted to initiate MAT without regulatory waiver and, for the non-profit setting, the state additionally requires written approval by the facility’s governing board. As a participant in the MRP, Eagleville’s team set out to investigate the barriers to initiating MAT in an inpatient setting, and to determine the criteria for which a chronically-ill substance user might benefit from initiation while in treatment, with immediate, pre-planned referral to a community-based methadone and/or buprenorphine provider. With the assistance of the MRP collaborative, Eagleville’s medical and clinical leadership staff reviewed clinical guidelines and chose to pursue expanded certification of MAT in its rehabilitation units—but only with support of its Board of Directors and the hospital community.  

Achieving a shift of culture that recognized MAT as one path to recovery required extensive education, review of scientific evidence, and advocacy from experts and persons in recovery. This process began in October 2011.

 An important first step was to engage the hospital’s board of directors and staff in this dialogue through surveys, educational presentations, committee meetings, and joint meetings of the board and clinical staff. The hospital is fortunate to have a dedicated board of directors that includes members who have served on the board for many years; some members have multigenerational family involvement. When MAT was proposed as an additional treatment, the board expressed strong concerns about abandoning the abstinence-only approach that the hospital has embraced for more than 40 years.

The hospital staff also includes many long-time employees and others who have achieved recovery through an abstinence-only model. Staff expressed similar concerns regarding MAT not constituting “real recovery.” Another concern expressed was that initiating MAT for select patients might encourage others in inpatient treatment to reject abstinence-based recovery.

The hospital Board of Directors maintained oversight and involvement in this project. Their involvement was extensive and addressed concerns of implementation, fit for its population and staff, and the deeper question of making a cultural shift from a model of complete abstinence towards harm reduction. Members participated in a variety of ways: by inviting several experts in MAT to present their experiences, through discussions with Eagleville Hospital psychiatrists and physicians, and in review of evidence-based literature.

A change team was formed consisting of the director of quality management, the director of nursing, psychiatry and medical staff, the Chief Executive Officer, Chief Clinical Officer, and the Director of Counseling. A staff survey was conducted to ascertain current understanding and beliefs about MAT. Both clinical experts and people in recovery contributed to the education and training provided to board members and staff. Staff reported a greater level of comfort and acceptance of expanded use of MAT as a result of these efforts.

The change team reviewed regulations and literature to make sure that current best practices in MAT could be achieved and followed. Policies and procedures were reviewed and revised to be consistent with evidence-based practice and to satisfy regulatory requirements.

After nearly a year of deliberation, with governing board approval, Eagleville submitted a formal application to the state’s Department of Drug and Alcohol programs for the expanded certification. The hospital’s change team initiated dialog with the state regulatory agency and is awaiting the results of the request for expanded certification. This process has been underway for approximately one year.

Once the state regulatory body approves the expanded certification, the change team will implement a pilot for a small segment of the hospital’s patient population. This phase will be monitored closely to assure that patient selection and initiation protocols are followed. The board of directors will continue its oversight of the initiative through reporting by the Quality Management Department. Eagleville looks forward to continued partnership with MRP and sharing the outcome of this initiative.

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