Primary

medicine

Treating Opioid Addiction in Primary Care Benefits Both Patients and Cash-Strapped Medical Practices

Press release content from PR Newswire. The AP news staff was not involved in its creation.

ANN ARBOR, Mich., Nov. 11, 2020 /PRNewswire/ — Buprenorphine-based treatment for opioid addiction is in short supply in many areas of the United States. And while many physicians want to offer it, clinics are unsure how to offer buprenorphine therapy in a financially sustainable way. Cost and revenue analysis from a team of Harvard Medical School researchers finds that even cash-strapped primary practices in high-poverty rural and urban communities can offer financially sustainable buprenorphine-based opioid addiction treatment.

The team, led by Sanjay Basu, MD, PhD, a Harvard primary care physician and epidemiologist and Jonathan E. Fried, MD, MPH, an internal medicine resident at Brigham and Women’s Hospital, interviewed practice managers and identified four common approaches to delivering buprenorphine-based treatment in primary care practices. The approaches differed based on who in the clinic delivered the majority of face-to-face care, the presence of nurse care managers, and whether care was delivered in traditional one-on-one or group settings.

The research team then used microsimulation modeling to identify the cost and financial benefit of delivering buprenorphine-based treatment in a variety of primary care settings, including Federally Qualified Health Centers (FQHC), non-FQHCs in both rural and urban high poverty areas,, and practices outside of high poverty areas. They found that all four approaches to care produced positive net revenue after the first year in a variety of practice settings, and net revenues were consistently highest for rural practices.

Physician-led treatment and shared medical visits, both of which relied on nurse care managers, consistently produced the greatest net revenue gains, generating from $29,000 to $70,000 per full-time physician per year across the practice types.

Additionally, net revenues were positive for all primary care practices that had at least nine patients in buprenorphine treatment per provider at any given time and no-show rates less than 34 percent. The findings suggest that in the current fee-for-service–dominated environment, offering office-based therapy for opioid addiction with buprenorphine can be a financially sustainable choice for cash-strapped primary care practices, despite hurdles.

Financing Buprenorphine Treatment in Primary Care: A Microsimulation Model

Jonathan E. Fried, et al

Center for Primary Care, Harvard Medical School, Boston, Massachusetts

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SOURCE Annals of Family Medicine

Source Article

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medicine

Primary Care Journals Address Systemic Racism in Medicine

Editors-in-chief at 10 leading family medicine journals have banded together to address systemic racism in research, healthcare, and the medical profession.



Dr Sumi Sexton

Sumi Sexton, MD, editor-in-chief of American Family Physician (AFP), told Medscape Medical News she had been working on changes at her journal that would answer the need for action that was made clear by this summer’s Black Lives Matter protests and realized the issue was much bigger than one journal. She proposed the collaboration with the other editors.

The editors wrote a joint statement explaining what they plan to do collectively. It was published online October 15 ahead of print and will be published in all 10 journals at the beginning of the year.

Following the action by family medicine editors, the American College of Physicians issued a statement expressing commitment to being an antiracist organization. It calls on all doctors to speak out against hate and discrimination and to act against institutional and systemic racism. The statement also apologizes for the organization’s own past actions: “ACP acknowledges and regrets its own historical organizational injustices and inequities, and past racism, discrimination and exclusionary practices throughout its history, whether intentional or unintentional, by act or omission.”

Family Medicine Journals Plan Changes

Changes will differ at each family medicine publication, according to Sexton and other interviewees. Some specific changes at AFP, for example, include creating a medical editor role dedicated to diversity, equity, and inclusion to ensure that content is not only accurate but also that more content addresses racism, Sexton said.

AFP is creating a Web page dedicated to diversity and will now capitalize the word “Black” in racial and cultural references. Recent calls for papers have included emphasis on finding authors from underrepresented groups and on mentoring new authors.

“We really need to enable our colleagues,” Sexton said.

The journals are also pooling their published research on topics of racism and inclusion and have established a joint bibliography.

The steps are important, Sexton said, because reform in research will start a “cascade of action” that will result in better patient care.

“Our mission is to care for the individual as a whole person,” Sexton said. “This is part of that mission.”

Increasing Diversity on Editorial Boards

Family physician Kameron Leigh Matthews, MD, chief medical officer for the Veterans Health Administration in Washington, DC, praised the journals’ plan.

She noted that the groups are addressing diversity on their editorial boards as well as evaluating content.

Effective change must also happen regarding the people reviewing the content, she told Medscape Medical News. “It has to be both.



Dr Kameron Matthews

“I’m very proud as a family physician that our editors came together and are giving the right response. It’s not enough to say we stand against racism. They’re actually offering concrete actions that they will take as editors and that will influence healthcare,” she said.

Matthews pointed to an example of what can happen when the editorial process fails and racism is introduced in research.

She

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health

Promise to Expand Intermountain Healthcare, Primary Children’s Hospital Pediatric Behavioral Health Services Inspires $10 Million Gift

Gift to the Intermountain Foundation will help Intermountain Healthcare and Primary Children’s expand and enhance behavioral health services to improve mental wellness in children and teens and help prevent mental health crises.

Greg and Julie Cook
Greg and Julie Cook
Greg and Julie Cook

Salt Lake City, Utah, Oct. 27, 2020 (GLOBE NEWSWIRE) — Intermountain Healthcare and Intermountain Primary Children’s Hospital are launching a bold plan to enhance mental and behavioral health services for children and teens in crisis throughout the Intermountain West – an effort that has inspired an extraordinary $10 million gift from Utah community leaders Greg and Julie Cook.  

The Cooks’ generous and transformational gift to the Intermountain Foundation will help Intermountain Healthcare and the experts at Primary Children’s expand and enhance behavioral health services to improve mental wellness in children and teens and help prevent mental health crises. 

Suicide is a leading cause of death among children ages 10-17 years. Intermountain Healthcare’s hospital emergency departments have seen a more than 300 percent increase in pediatric mental health crises over the past eight years, and an estimated 40 percent of kids who have depression are not getting care, said Katy Welkie, RN, MBA, CEO of Primary Children’s Hospital and Vice President of Intermountain Children’s Health. 

“The COVID-19 pandemic has also highlighted the ongoing need for additional mental, behavioral, and emotional health resources,” Welkie said. “It is our responsibility as a community of passionate, motivated, and family-driven individuals to tackle this crisis head on. Thanks to the generous gift given by the Cook family, we will continue to build on our primary promise to offer additional support for children in our community.”

For teenagers like Holland, these services are critical to achieving a hopeful future.

“I think I just stopped caring. I was living like it was my last day, every day. I didn’t feel like I had a future, or anywhere to go,” said Holland, 16, recalling her struggle before getting help from Intermountain Primary Children’s Hospital’s behavioral health services. “I’m really grateful that there’s someone to talk to now.” 

With the help of the Cooks’ gift, Intermountain Healthcare and Primary Children’s Hospital will begin to offer: 

  • A new pediatric assessment, referral, and consultation service to screen, triage, and place children in the right services, both virtually and in person. Services will include both crisis response and stabilization, as well as a full array of treatment options.

  • Expansion of available care options, including a call center, TeleHealth services, and in-home crisis services. The call center will connect families to local providers and services throughout the Intermountain West.

  • A new pediatric behavioral health unit located at the second Primary Children’s Hospital campus being built in Lehi. Offering both inpatient and outpatient services, the new hospital will include a 12-bed behavioral health unit with private outdoor space conducive to healing and spiritual health. 

The new Lehi hospital location was selected to ensure the shortest drive time possible for the rapidly growing Utah County community.

“When we learned about Intermountain’s effort to

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