Using the most evidence-based treatments for substance use disorders (SUDs) won’t matter if treatment programs can’t keep patients engaged in their care. Leaders of provider organizations and health plans have learned that a comprehensive, whole-person approach becomes essential to maximizing patient engagement.
The gap between the number of people with SUDs who need treatment and the number who receive it remains stubbornly large. Fewer than one in five individuals who need substance use treatment receive any care in a typical year. Programs must understand and address the many patient- and system-level barriers to engaging patients in treatment and recovery support over the long term.
Maintaining patient engagement requires commitment from every role within a treatment facility. First impressions can mean a lot. Program leaders are increasingly asking whether their facilities have been welcoming enough to members of marginalized groups, for example. At last month’s National Association of Addiction Treatment Providers (NAATP) conference’s discussion of the association’s groundbreaking FoRSE outcomes project, leaders revealed that basic data on patient race was missing from half or more of the patient records at some participating facilities. In looking at this more closely, some participants discovered that their facilities’ customer service team members were uncomfortable asking prospective patients about race. This certainly can’t help facilities in addressing potential barriers to engagement for patients who already might come in wary of healthcare providers.
As leaders at the Agency for Healthcare Research and Quality (AHRQ) wrote on the topic of engaging patients in treatment for opioid use disorder, treatment programs must “recognize that the patient experience at the clinic may undermine efforts to provide care, as punitive or dismissive staff may discourage patient follow-up.” Programs also should “understand that, while staff attitudes and behaviors are important to all patients, patients with substance use disorders can be particularly sensitive to these interactions,” given the stigmatizing attitudes these individuals often encounter in daily life.
How a treatment program is structured also plays a critical role in maintaining patient engagement. Does your program truly embrace individualized approaches based on each patient’s particular needs, or are all patients expected to adjust to your program’s requirements?
John F. Kelly, Ph.D., one of the field’s foremost researchers in addiction, last month delivered a powerful talk at last month’s NAATP conference, in a session titled “The Research Science & Political Science of Substance Use Disorder Treatment.” Kelly pointed out that studies have shown that when patients choose a modality of treatment that they see as the right fit for them, they do at least as well as they would if a treatment plan had been chosen for them. So while for some patients the traditional 28-day stay in a 12 Step-focused residential program might prove ideal, for others the answer might lie in a flexible-stay program with a harm reduction approach.
Kelly, the Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine at Harvard Medical School, also emphasized how the effort to maintain patient engagement needs to extend well beyond the treatment stay. He stated that even after a recovering patient achieves remission from SUD, it will be another four to five years before that person is no more likely than someone in the general public to once again meet criteria for SUD. The individual, social, financial and cultural variables that comprise a patient’s “recovery capital” remain critical to long-term outcomes. Moreover, treatment programs’ ability to help patients build this recovery capital makes a difference as they try to demonstrate to payers and policy-makers that their services produced the desired results.
An emerging frontier in research, Kelly explained, is exploring whether factors such as social interaction, recovery housing and stable employment actually produce changes to the brain that make the patient less susceptible to relapse in the long term.
How effectively SUD treatment is linked with other medical needs, including mental health care, also has an impact on keeping patients in treatment. A 2019 report from the U.S. Department of Health and Human Services (HHS), based on interviews with leaders of high-performing health plans, found that these executives highly valued a model of care emphasizing coordination of all physical and behavioral health services. “Interviewees from every health plan described their plan’s care model and culture as integral to their success with initiating and engaging beneficiaries in treatment,” stated the report, Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment.
The report, from HHS’s Office of the Assistant Secretary for Planning and Evaluation, also pointed out that high-performing health plans prioritized quality improvement activities that led to better management of patient conditions. “Quality improvement efforts include developing new staff positions to support activities, investing in software to develop data analytic capabilities, and facilitating secure communications with beneficiaries and providers.”
We at Sigmund have invested heavily in outcome technology, and we can help the field move closer to having the data to support true care coordination and to enhance outcomes becomes common practice across the industry.
Our behavioral health EHR includes a natively developed engagement and outcomes suite, designed specifically for the comprehensive needs of the industry. Whether it be industry standard outcome measures, or organizationally defined and configured analytics, our tools empower users to analyze data accurately and effectively, with a substantial benefit to patient care.
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