Primary Health Care

Opioid Response Initiative

PCN Strategic Leads Forum February 24, 2018

1

http://www.health.alberta.ca/default.html http://www.albertahealthservices.ca/default.aspx

Overview ● Opioid Crisis in Alberta

● The Primary Health Care Opioid Response Initiative

● Tools and Resources to Support Capacity Building

2

The Opioid Crisis in Alberta Overview of the Issue and Alberta’s Response

3

Number of apparent accidental fentanyl toxicity deaths, by Zone (based on place of death) and quarter. Jan. 1, 2016 to Sept. 30, 2017

4

Opioid Deaths

Of those that died of an opioid–related poisoning since 2016, within the year before their overdose: • 46% were known to have a mental health issue (including anxiety,

depression, etc.) • 16% were diagnosed with an opioid use disorder (opioid addiction) • 76% of deaths were illicit opioid poisoning from fentanyl or a non-

fentanyl opioid not dispensed from pharmacy

5

Opioid Deaths

• 14% in Fort McMurray, Grande Prairie, Lethbridge, Medicine Hat, Red Deer • 21% occurred outside an urban centre • 70% of all opioid-related deaths within Edmonton and Calgary occurred outside of

centralized urban core of the cities, whereas the highest rates of opioid-related deaths occurred within the centralized urban core of those cities.

Scope of problem is much bigger

https://www.cdc.gov/drugoverdose/pdf/PolicyImpact-PrescriptionPainkillerOD-a.pdf

7

https://www.cdc.gov/drugoverdose/pdf/PolicyImpact-PrescriptionPainkillerOD-a.pdf

Minister’s Opioid Emergency Response Commission

 Inception: May 31, 2017

 Mandate: to develop recommendations for, and facilitate implementation of, urgent coordinated actions to effectively address the crisis.

 As of November 2017, the Commission has made 12 publicly posted recommendations.

8

What is the Issue?

 This is an issue in Primary Care – opioid use affects people in all walks of life

 Primary Care requires additional resources to support them in treating patients in what has been historically been considered a specialty service

 We need Primary Care involvement in order to increase access to treatment

 We need to increase understanding and acceptance across the health system for a harm reduction approach to patients

9

MOERC Recommendation The Commission recommends the Minister support the proposal and funding request from Primary Care Networks and their partners to increase and accelerate the participation of primary care in the urgent opioid response in the following areas:

 Urgent Treatment  Optimization of existing Primary Care Networks Programming  Opioid related population based health service planning and

integration  Education and knowledge translation targeted to primary care

10

Why the Primary Care Initiative Matters

 Ability to reach more Albertans than any other Commission recommended initiative

 Will improve access to Overdose Response (Take Home Naloxone) kits, expand and improve Opioid Agonist Therapy and related primary care services, and better equip physicians to be able to treat patients with Opioid Use Disorder, using a harm reduction approach

 Plays an important supporting role to other response activities

11

Key Opportunities

 Opioid Response Initiative can act as a test case for the Zone Service Planning approach; there are resources to enable, engage, and involve

 Opportunity to impact key priority areas for action

 Builds on foundational work underway to strengthen the primary health care system in Alberta

12

PCN Objectives

13

Catalyst for Patient’s Medical Home

 Accessible  Continuous Care  Patient and Family

Centered  Comprehensive Team-

Based  Community and

Population Focused

14

The Primary Health Care Opioid Response Initiative Overview of the Initiative

15

PHC Opioid Response Initiative Grant

$9.5 million in one-time funding, focused on three key priority areas for action:

 Urgent Opioid Response

 Enhanced Opioid Related Service Delivery through PCN Zone Committee Engagement, Planning and Implementation

 Enhanced Provider Decision Support, Knowledge Translation & Education in Primary Health Care

16

Provincial Response and Support

Multi-partner initiative focused on supporting coordination and integration of activities across primary care.

 Zone PCN Committee Support Teams

 Alberta College of Family Physicians

 AMA Integrated Programs (TOP, PMP, PCN PMO)

 Alberta Health Services

17

Goal 1: Improve access, continuity and care delivery within primary care settings for individuals using opioids. Objectives 1.1 Albertans using opioids have access to a primary care provider and team that they know and trust

1.2 Patients with complex health needs including Opioid Use Disorder are engaged to develop a plan of care with their primary care provider and team

1.3 Expand and improve the capacity within PCNs to support member practices to implement practice changes related to opioid prescribing, monitoring of opioid use, pain management, patient self-management support, and Opioid Agonist Therapy (OAT)

1.4 AHS zone services and PCNs support primary care clinics to increase access to and distribution of Overdose Response Kits (THN) and OAT

18

Goal 2: Implement relevant and practical evidence informed decision supports and knowledge translation tools, including mentorship to better equip and educate primary care providers and teams, including clinics and PCNs; to support patients using opioids and/or with Opioid Use Disorder.

19

Objectives 2.1 Within a harm reduction, approach develop and support implementation of provider and

patient education, decision support tools, knowledge translation strategies, practice change

tools and resources

2.2 Engage primary care providers to participate in the PACT initiative (Care Planning

initiative) to facilitate the identification of patients using opioids and proactively reach out to

those patients identified to develop a person centred care plan

2.3 Develop and implement a capacity building plan and approach to support distribution and

uptake of decision supports, tools, resources and education in zones, PCNs and primary care

practices

2.4 Develop and coordinate a mentorship collaborative network(s) within each zone related

to opioid use

Goal 3: Enhance coordination of care between primary care practices and other service delivery partners for patients using opioids including those with Opioid Use Disorder.

20

Objectives 3.2 Primary, specialty care and community teams work together to identify opportunities for

improved coordination and continuity of care across or within service areas; such as primary care

clinics, Primary Care Networks, specialists, AHS specialty care programs, hospitals, acute care

services, community services, social services, and other community supports.

3.2 Primary care teams work together to develop comprehensive and accessible care pathways

exist, for patients using opioids, including Opioid Use Disorder, between primary care, specialty

programs, specialists and hospital in each zone

3.3 Utilizing a harm reduction approach, interdisciplinary teams of providers within primary care

settings work collaboratively with patients and their families to develop and implement

successful care planning processes

3.4 Patients using opioids are collaboratively supported to transition between primary and

specialty care as needed

Goal 4: Use a population health based approach to develop and implement a service plan for the integrated delivery of opioid related care.

21

Objectives 4.1 Based on identified population and community needs, PCN Zone Committees

develop and implement a service plan focusing on opioid related care

4.2 PCN Zone Committees are able to gain experience and apply learnings from

opioid service planning in identifying and responding to other health needs of a

population

4.3 PCN Zone Committees prioritize the development of comprehensive and

accessible care pathways across the continuum

Populations of Focus

Sub-populations of relevance in optimizing care for patients using opioids:  Non-medical - often referred to as ‘recreational’ use or the well at risk

 Pain management – individuals with acute, sub-acute and chronic pain; implications include prescribing practices for opioids and non- pharmacological treatments of pain

 Substance misuse and addiction – individuals whose da