“I feel safe here”
Group medical visits in buprenorphine treatment
• Mariya Masyukova, Sc. B.
Medical Student
• Aaron Fox, M.D., M.S.
Assistant Professor of Medicine, Division of General Internal Medicine
Outline
Introduction
Development of Group Medical Visits for
Buprenorphine Treatment
Implementation of Group Medical Visits for
Buprenorphine Treatment
Preliminary evaluation
Defining the Problem
Buprenorphine maintenance is an effective treatment for
opiate dependence, but is limited by:
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Provider capacity
Institutional resources
Patient competing needs
Patient comorbidities
How to intensify treatment?
Science at the heart of medicine
Division of General Internal Medicine
Group Medical Visits for Buprenorphine
aka Shared Medical Appointments
Rationale:
• Social support
• Structure for skill-building and education
• Patient-provider time
• Multidisciplinary, patient-centered
DEVELOPMENT
Setting
Federally-Qualified Health Center in South Bronx, NY
- 10 attending general internists prescribe
buprenorphine in primary care
- Clinical pharmacist coordinator
- Social workers available for counseling
Science at the heart of medicine
Division of General Internal Medicine
The core team
IMPLEMENTATION
Group patients
Patients in buprenorphine treatment referred by their
provider if:
– Ongoing substance use
– Extensive psychosocial needs
– Sub-optimal outcomes despite individual buprenorphine
treatment
Science at the heart of medicine
Division of General Internal Medicine
Group day
30 minutes:
Nursing assessment
Urine toxicology
Self-assessment materials
90 minutes:
Group session
30 minutes:
Individual needs
Science at the heart of medicine
Division of General Internal Medicine
Session Content
PRELIMINARY EVALUATION
Patient characteristics
Patient characteristics
N=20 patients (attended
at least 1 group visit in the
first 6 months)
Age (years)
53 (34-66)
Male sex
15 (75%)
Race
10 Hispanic 10 black
(50%)
(50%)
Public Insurance
20 (100%)
Chronic illness diagnosis 18 (90%)
Axis I diagnosis
16 (80%)
HIV+
6 (30%)
Science at the heart of medicine
Division of General Internal Medicine
Feasibility
In the first 6 months...
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13 group visits
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33 patients were referred and contacted
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20 patients attended at least 1 session
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13 patients attended ≥ 2 sessions
In each group....
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4 to 10 attendees (median of 6)
• Median attendance per patient: 3 sessions
Science at the heart of medicine
Division of General Internal Medicine
Challenges
1. Administrative
– Space, staffing, structure
2. For patients
– Time, unmet needs, group dynamics
3. For providers
– Time, care coordination
Science at the heart of medicine
Division of General Internal Medicine
Conclusions
Group medical visits are an acceptable
model of buprenorphine maintenance
treatment intensification.
Implementing group medical visits for
buprenorphine treatment is feasible in an
urban FQHC.
Science at the heart of medicine
Division of General Internal Medicine
Feedback from patients
“We're coming here cause we want to. If we just had to
see that one doctor, that works all right for a little while,
but we need more. So the group comes in...”
-56 year-old male participant
“At least every other Wednesday, I know for a certain
amount of time, I’m gonna be here, I’m gonna feel
safe, I’m gonna learn something, and be around people
I feel comfortable with.”
-59 year-old female participant
Science at the heart of medicine
Division of General Internal Medicine
Future directions
Add more sessions (e.g. Spanish speaking group)
Optimize structure and content
Assess effectiveness
Improve collaboration with patients' individual primary
care providers
Apply for R34 to evaluate model effectiveness with RCT
Acknowledgments
Mentors/Advisors:
Dr. Aaron Fox
Montefiore DGIM Substance Abuse Affinity Group
Dr. Sara Doorley
Team:
Dr. Aaron Fox, Dr. Angela Giovanniello, Maritza Casillas, and Jennifer
Sanchez
Araceli Diaz, Elenita D'Aloia, and the other nursing and support staff.
Administrative:
Dr. Joseph DeLuca and the CHCC.
Funders
K23 DA034541
Clinical Research Training Program at Albert Einstein
Our patients and participants.