Finding ways to improve public health while controlling costs is a major concern in today’s global health care environment. Given the large number of chronic and acute health problems linked with opioid dependence, one effective approach is to provide better access to medication-assisted treatment (MAT).This is according to Thomas F. Kresina, PhD, and Robert Lubran, MA. MPH, authors of “Improving Public Health Through Access to and Utilization of Medication Assisted Treatment,” a review published October 2011 in The International Journal of Environmental Research and Public Health.
The article aroused AT Forum’s curiosity, so we spoke with the authors about their work. Both authors are affiliated with the Substance Abuse and Mental Health Services Administration (SAMHSA) and are helping other nations address opioid addiction and HIV/AIDS. We learned some of the ways health care is changing—through linked services, onsite services with linkages where needed, vans, electronic record systems with interoperability—and how opioid treatment programs (OTPs) are adapting to these changes and using new practices to help nations with HIV problems related to opioid misuse.
Dr. Kresina and Mr. Lubran stressed that in addition to keeping patients in treatment, MAT can improve public health by integrating its services with primary medical care and with the comprehensive social, psychological, and community services that address all of an individual’s needs. This is true worldwide as well as here in the U.S.
Providing MAT and Primary Medical Care
Some evolving changes in health care delivery systems in the U.S. are spreading to countries that have major HIV and opioid issues. An example is coordinated care, where the OTP is part of a care system that comprises case managers, care coordinators, and recovery coaches. These team members make sure that patients with multiple medical and mental health problems obtain treatment from a mental health worker, or diabetes doctor, or a doctor at the HIV clinic, then return to the OTP for follow-up care.
Another example is the “one-stop shopping” OTP that has most services onsite and needs only a few referral resources, such as cardiology, diabetes, or ob-gyne. Used increasingly in the U.S. and migrating abroad is a system of electronic record-keeping that integrates the OTP record with the primary-care clinic record. Each linked caregiver can see how others are looking after the patient so they can prescribe appropriate treatment and contact other providers if they have questions.
A Global Health Care Effort
Dr. Kresina is part of the one-U.S. Government approach to foreign assistance where all U.S. agencies contribute to efforts of the State Department. He provides technical assistance on substance abuse treatment and pharmacologic therapy as part of the President’s Emergency Plan for AIDS Relief (PEPFAR)—a highly effective initiative to expand access to HIV/AIDS prevention, care, and treatment worldwide. Depending on the culture and willingness of each nation, PEPFAR helps those impacted by the global increase in opioid abuse by establishing MAT as a way of counteracting the HIV/AIDS epidemic. Dr. Kresina provides technical assistance to establish models of care that use best practices learned here, and has been successful in promoting evidence-based treatment paradigms in Vietnam, Russia, Ukraine, China, and Africa.
Dr. Kresina described the authors’ vision of helping other countries improve their public health—as is happening here in the U.S.—by providing access to MAT and comprehensive services, “so that mainstream medicine can incorporate issues like integrated care into the primary care services they provide—and extend that to include substance abuse treatment, mental health services, and medication-assisted treatment. In other words, not just treating HIV/AIDS, but incorporating a comprehensive approach into the existing health structure,” benefiting not only the patient, but the community, and, ultimately, worldwide health.
Kresina TF, Lubran R. Improving public health through access to and utilization of medication assisted treatment. Int J Environ Res Public Health. 2011;8:4102-4117. doi:10.3390/ijerph8104102.
Free access to the article is available at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210600/?tool=pubmed. Accessed February 20, 2012.
