Hospital program brings rapid-access addiction medicine to clinics across Ontario

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By Jen Brailsford

In 2017, more than 1,200 opioid-related deaths were reported in Ontario—up from 867 in 2016. As these numbers continue to climb, the need to find sustainable healthcare solutions addressing addiction is greater than ever.

In 2015, the Mentoring, Education, and Clinical Tools for Addiction: Primary Care-Hospital Integration (META:PHI) program, housed at Women’s College Hospital (WCH), developed the Rapid-Access Addiction Medicine (RAAM) clinic model. The RAAM model helps patients overcome alcohol, opioid and other drug addictions by providing integrated, barrier-free care, where patients without an appointment can be seen in under three days.

“After receiving urgent care following an overdose many patients are released back into the community without being referred to an ongoing treatment program or are faced with an extended wait to enter a program,” explains Dr. Meldon Kahan, medical director of the Substance Use Service at WCH. “These wait times can often be up to eight months, and don’t include a coordinated plan for recovery.”

Key to the effectiveness of the RAAM model is that clinics not only see patients rapidly but also create a continuum of care by liaising between emergency departments, addictions specialists, primary care providers and front-line community services, such as withdrawal management centres and shelters.

After piloting the model in seven Ontario communities, META:PHI was funded by the Toronto Central Local Health Integration Network to bring RAAM clinics to Toronto-area hospitals. In 2017, WCH opened downtown Toronto’s first addiction clinic to accept all patients—from self-referrals to those referred by family doctors, hospitals, emergency departments and community groups. The WCH RAAM clinic has proven to be a success, seeing 256 unique patients in its first 16 months of operation.

The clinic is open to both referrals and walk-ins three mornings per week. During their first visit, patients participate in an initial assessment with an addiction physician to discuss treatment goals and planning, which typically includes both psychotherapy and pharmacotherapy. They may also meet with a nurse, social worker or addiction worker, depending on their needs.

The patient is encouraged to visit the clinic regularly until they and their treatment team are confident that the patient is stabilized, whether with an optimal medication dose or having established a lifestyle that supports their recovery goals. At this point, ongoing treatment is transferred to their primary care provider who can provide a more holistic healthcare plan.

Searching for the sustainable health-care unicorn

The barrier-free model has proven such a success that META:PHI was funded by Adopting Research to Improve Care (ARTIC) to support a secondary spread, helping to bring RAAM clinics to hospitals and healthcare centres across Ontario.  Since the pilot, the program has grown from seven participating clinics in 2016 to more than 55 RAAM sites across Ontario today.

The reason for this rapid expansion? Healthcare providers are noticing that RAAM sites are alleviating demand on the healthcare system and reducing overall costs by engaging patients before there is an emergency. In communities with rapid-access clinics, hospitals are seeing a decline in emergency department visits and a reduction in hospital stays by those that access RAAM services.

“Feedback from communities that have adopted the RAAM model has been overwhelmingly positive, and the purpose of META:PHI is to support the continued spread of the model by providing clinicians in diverse care settings with the tools they need to deliver high-quality, evidence-based care to patients with substance use disorders,” explains Kate Hardy, META:PHI project manager, WCH. “We do this by providing opportunities for education, training, mentorship and networking.”

The support provided by META:PHI includes an online community of practice for clinicians and administrators, where participants can access addiction-related Q&As and case discussions, an online repository of clinical and educational materials hosted on the program’s website.

Additionally, the META:PHI team hosts regular conferences that healthcare teams can attend in-person or remotely. In September 2018, the program hosted approximately 150 physicians, social workers, addiction workers, administrators and policy makers from across Ontario at a two-day conference to share and discuss the latest best practices, elements of high-quality care and case-based learning, amongst other tools.

As awareness and support for the program grows, the META:PHI team at WCH is optimistic that the RAAM model will continue to spread and improve care for patients with addiction while building capacity within the provincial healthcare system.

Jen Brailsford is Communications Lead at Women’s College Hospital.