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Promoting the Use of Injectable Naltrexone (Vivitrol) in Colorado. Staff Training , Patient Screening , Medication Administration , and Payor Source Development Addiction Research and Treatment Services (ARTS). AIM (Plan). Baseline use of Vivitrol is 0; started screening

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promoting the use of injectable naltrexone vivitrol in colorado

Promoting the Use of Injectable Naltrexone (Vivitrol) in Colorado

Staff Training, Patient Screening, Medication Administration, and Payor Source Development

Addiction Research and Treatment Services (ARTS)

aim plan
AIM (Plan)

Baseline use of Vivitrol is 0; started screening

& dosing in February 2009

4 targets to enhance adoption & utilization:

  • Train and motivate staff Methadonedispensingnurses able

to do injections rather than just physicians

  • Promote better screening of potential patients by

counselors

  • Reduce no-shows for injection appointments
  • Increase the number of payor sources
change do
Change (Do)
  • Schedule and reinforce multiple trainings:

injection procedure (separate nurse training), effectiveness of this new pharmacological treatment, patient selection

  • Devise new Assessment and Screening form

to better target potential patients, track counselor behavior for incentives, and reinforce staff training

  • Institute reminder calls for injection appts.

tested at primary siteto increase show rate and compliance, thus improving outcomes

  • Work with Medicaid and others

to increase payor sources and build sustainability beyond life of donated supply

results study
RESULTS (study)

Reminder

Calls

Overall

Utilization

Patients on naltrexone (Vivitrol)

next steps act
NEXT STEPS (Act)
  • No additional training needed at this time. Staff are on board.
  • Screenings are increasing: Continue to encourage more widespread screening at our 6 clinics
  • Reminder calls worked: continue, expand to other sites
  • Payor sources are still limited: we have been successful with donations, sample program and Signal “mini-grant”, but need to move beyond this for sustainability. Medicaid billing is in the works (need new provider number, correct taxonomy code and separate NPI).Plan to work with child welfare agencies and probation offices.
impact business case lessons learned
IMPACT (Business Case, Lessons Learned)
  • Potential problem with physician slots

Program Medical Director requires 1 hour history & physical visit with each client → Physician time is expensive and is prioritized for methadone/buprenorphine intakes. Program cannot afford to purchase additional physician time.

  • Payor source development needs to address cost of physician time.
  • Much better utilization and compliance with injectable form vs. oral form (historical data)
  • ARTS model of methadone dispensing nurses providing the injections at our 3 OTP sites is working quite well

Addiction Research and Treatment Services (ARTS)

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