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IMPLEMENTING VIVITROL AS A CHANGE PROJECT Angela Bonaguidi, Jael Dorado, Eric Ennis (Change Team Leader), Jan Morgan, Marie Officer, Denise Vincioni, Dr. William Swafford, Greg Tipton, Ira Tropp, Addiction Research and Treatment Services, University of Colorado Denver, School of Medicine.

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IMPLEMENTING VIVITROL AS A CHANGE PROJECTAngela Bonaguidi, Jael Dorado, Eric Ennis (Change Team Leader), Jan Morgan, Marie Officer,

Denise Vincioni, Dr. William Swafford, Greg Tipton, Ira Tropp,

Addiction Research and Treatment Services, University of Colorado Denver, School of Medicine

Introduction

ARTS is a comprehensive community-based substance abuse treatment program in our 38th year of operation. We have offered oral naltrexone for many years, but have seen low utilization of this pharmacologic treatment in our alcohol dependent patients. We operate 3 MAT clinic sites and 3 non-MAT clinic sites, all with some alcohol dependent patients.

Protocol

Developed agency level procedures for acquisition and administration of Vivitrol, and data collection for this project

Change Team Composition:

Eric Ennis (Outpatient Director)

Dr. Bill Swafford (Medical Director)

Jan Morgan (Manager of Nursing Operations and Clinic Coordinator)

Jael Dorado (Dispensing Nurse)

Denise Vincioini (Clinic Coordinator)

Ira Tropp (Clinic Coordinator)

Marie Officer (Counselor)

Angela Bonaguidi (Counselor)

Greg Tipton (Counselor)

First Change Cycle:

How can we promote the use of depot naltrexone?

P

We need

depot naltrexone

for our

patients!

  • Form Change Team
  • Identify promising Change Team composition
  • In-service training on Vivitrol
  • Establish baseline
  • Staff incentives
  • All 9 Change Team members can earn individual incentives for assessing and identifying appropriate patients and by promoting engagement and retention
  • Clinic sites can earn incentives to be shared among that clinic’s staff by having patients from that site 1) initiate treatment; and 2) continue treatment
  • Incentives also available for staff successfully promoting the appropriate use of oral naltrexone

D

A

  • Formalize Change Team
  • Hold first meeting
  • Set goal
  • First version of Signal incentive
  • proposal under RWJ A.R. grant
  • Assign 3 Team members to be “Study Coordinators”
  • Instruct team members to spread the word at their clinic sites

S

  • Counselors begin to successfully identify interested patients from current caseloads
  • Change Team members
  • remain invested
  • Exchange ideas with Signal MAT Change Team

Change Team member not pictured:

Dr. Bill Swafford

Business Case:

More and better services with better outcomes = more referrals = more revenue flowing into program

Second Change Cycle:

How can we best identify and “qualify” patients while incentivizing staff?

  • Anticipated Change Projects:
  • Improving retention through optimizing referral and injection procedures
  • Improving access through increasing number of payor sources utilized (see anticipated goal below)

P

  • Consider impact of budget reduction for ARTS incentives
  • Plan to spread the word with our patients and referral sources

A

D

  • Submit revised incentive proposal
  • Modify eligibility criteria based on Signal Change Team work (includes other providers)
  • Create “Quality Assessment”
  • Screening sheet for use at 6 clinic sites
  • Modify Signal incentive proposal to accommodate reduced budget and keep staff motivated

S

Counselors identify patients who are not only interested but also eligible according to specific clear criteria