Hanover Hospital and its affiliated healthcare clinics has become a model for how a healthcare system that is fully engaged in embracing evidence-based treatment of opioid use disorders can make significant change.
A little more than a year ago, PCSS reached out to Hanover Hospital to participate in a five-state pilot program to create a medication assisted treatment (MAT) program. Since then, PCSS has worked closely with clinicians, administrators, and support staff to increase understanding of preventing, identifying, and treating OUD. The project provided technical assistance (TA) to healthcare organizations and providers for the use and/or expansion of SUD services, including medication assisted treatment (MAT) with a focus on opioid use disorder (OUD). Each site was assigned a facilitating organization, PCSS clinical experts, and recruited a local “champion” to lead the charge.
Andrew Saxon, MD, was the PCSS clinical expert who worked with Hanover. Dr. Saxon, an Addiction Psychiatrist and lead clinician for the American Psychiatric Association (APA) implementation team, said the success is a direct result of Hanover’s champion Michael Peck, DO. “They had the good fortune of having a leader like Dr. Peck,” Dr. Saxon said. “They exceeded my greatest expectations.”
Prior to the pilot’s launch, Dr. Peck, and his wife, Susan Peck, DO, an OB-GYN, were the only clinicians in the system regularly treating patients with OUD, despite the fact the rural area of Pennsylvania had seen a marked increase in opioid misuse and overdoses. “We had very little buy-in for MAT from the medical community,” Dr. Michael Peck says.
“The goal was to education everyone so people weren’t so afraid” to treat patients with addictions, Dr. Susan Peck said.
Hanover, with a population of just more than 15,000, is located in York County, an area hard hit by the opioid epidemic. Hanover Hospital had three advantages over many rural communities throughout the country: an enthusiastic champion, an administration that fully support the idea of treating patients with addictions, and PCSS with its vast resources, says Dr. Saxon.
This initiative started with a needs assessment to define barriers to overcome in providing MAT. Immediately, the first task was basic education on substance use disorders. PCSS created an SUD 101 course to give everyone at the hospital and its affiliated clinics a better understanding of the patients they were treating. Everyone, from receptionists to nurses to physicians and administrators were recommended to take the course. As a result, PCSS’s Core Curriculum on Pain is now a mandatory training for all prescribers thanks to the full support of Hanover’s CEO Michael Gaskins.
The Hanover team continued to meet with PCSS once a month to discuss next steps. Now, with more than double the clinicians actively treating patients with OUD, the tide is turning, Dr. Michael Peck says. Initially, given the PCSS trainings were mandatory, there was a bit of grumbling. Gaskins “stood his ground in a couple of very difficult situations. Our CEO really stood behind us.” And while not everyone who has taken the waiver course is prescribing buprenorphine, everyone on the staff is far more educated—and more likely to screen for addiction—than in the past.
The momentum is growing, Dr. Michael Peck said. “The more success stories we have, the more people will say, ‘Wow, this is really working.’”
Dr. Susan Peck says she finds treating those with addictions far more gratifying than even delivering babies. “You see such a profound change in these people. They are making such a huge change in their lives. It’s really thrilling. We have 19 people in college,” she said, adding that those same people might not be alive if not for the treatment they received.
In her practice, Dr. Peck not only treats women, she also treats their partners. She’s realized that the success rate of her patients increases when the entire family unit is involved in treatment.
Each prescribing clinician associated with the hospital is required to complete the PCSS pain curriculum and each eligible clinician was also mandated to take the eight-hour waiver course (or 24 hours for nurse practitioners and physician assistants). While not everyone who has taken the MAT waiver course has applied to prescribe buprenorphine or is prescribing and treating OUD, the knowledge learned by taking the course has changed the overall standards of treatment for addiction, the physicians agreed.
Another barrier in treating their patients, Hanover was a local pharmacist who “was not supportive” and refused to fill prescriptions for buprenorphine, Dr. Michael Peck says. The APA, a PCSS partner organization, worked with the local chain and determined this was not a company-wide policy, Dr. Saxon said. Another barrier specific to the area was a lack of psychiatrists, making it difficult for patients to seek behavioral health treatment, a key component of MAT. This region has few psychiatrists and the waiting list to see one is months long. Hanover is looking into introducing tele-psychiatry to fill in that gap, Dr. Saxon said. Last year, Hanover became part of a larger system—UPMC Pinnacle—which may allow the hospital access to more behavioral health clinicians. Efforts are underway to incorporate tele-psychiatry using University of Pittsburgh Medical Center resources.
No matter the challenges, both Drs. Peck believe things will continue to improve. Dr. Michael Peck’s advice to others facing similar challenges as Hanover? “You’re going to feel like you’re beat and then you see that you’ve saved someone’s life and that keeps you going.”
Both Drs. Pecks were effusive in their praise of the resources PCSS has provided. The key, Dr. Michael Peck says, is knowing everyone on the staff is taking evidenced-based courses created by clinical experts. “PCSS was key because it gave us core courses. We couldn’t have done it without PCSS.”
PCSS will profile all five PCSS implementation sites, outlining challenges and lessons learned, so stay tuned! If your healthcare system has seen similar successes thanks to PCSS trainings, please let us know.