Transcript Medication Partnership Project

Medication Partnership Project
The Horsham Clinic
Change Team = BJ Sellman; Team Leader
Dr. Michael Frost
Dates = 5/22/12 to present
What is our aim?
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The Horsham Clinic is striving to increase its
utilization of FDA Approved Medications for
Alcohol Use/Dependence Disorders.
Medications targeted for project include:
Disulfiram (Antabuse), Naltrexone, Extended
Release Naltrexone (Vivitrol), and
Acamprosate (Campral).
What changes have we made?
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Our first PDSA cycle was entitled “Physician Education”. Our
Plan was to introduce project and educate physicians regarding
targeted medications and effectiveness.
Do steps included: a Physician inservice and the development
of a binder for each Attending containing information re: meds
and outcome studies.
We collected data for three months. Data showed minimal
improvement from baseline. We abandoned the education cycle
and made a process change which led to our 2nd PDSA.
2nd PDSA
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Our second PDSA was entitled “Detox Process” with the aim of
having the “detox” Physician (i.e. Dr. Frost) initiate MAT as part
of the detox protocols rather than having the Attending
Psychiatrists do the assessment and prescribing.
Our Do steps included meeting with the CEO and obtaining
Executive support for the change in procedure. We then met
with the Attending Psychiatrists in order to create buy in.
Meeting was successful and Dr. Frost began to initiate Campral
or Naltrexone during the detox stage of treatment. The
Attendings were only responsible for continuing the
medications until discharge. As a result of this process change,
our results began to improve.
What were the results?
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Baseline data = utilization rate of 9% (6/65)
June 2012 utilization rate = 28% (8/29)
July 2012 utilization rate = 39% (19/49)
August 2012 utilization rate = 40% (20/50)
Sept 2012 utilization rate = 39% (18/46)
Oct 2012 utilization rate = 22% (11/49)
Barriers
Even though the second PDSA was successful, barriers to success continued.
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Dr. Frost remains the primary physician who initiates MAT. If a patient is not in
need of detox, he/she is treated solely by the Attending Psychiatrist and less
likely to be offered MAT.
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Another barrier arise when Dr. Frost is away from the facility for a period of
time. Physicians that cover for Dr. Frost are not as familiar with MAT and do not
routinely consider this option.
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The Change Team is unsure of the next steps. We could re-visit the Physician
Education cycle and expand our efforts or perhaps begin a new education cycle
with our nurses. If the nurses become more educated about treatment options,
it is unclear if this will impact the physician prescribing practices.