Peer recovery helping patients with addiction seek treatment

Before RWJBarnabas Health started its Peer Recovery Program, clinicians struggled to help patients with substance use disorder.

Physicians and nurses at the New Jersey-based system were treating patients who overdosed from opioids and other drugs but lacked the training and tools to discuss long-term treatment options after discharge. “Hospital personnel were not equipped to respond and intervene in an appropriate way to engage them and get them into treatment,” said Connie Greene, vice president of the RWJBarnabas Health Institute for Prevention and Recovery. “It was very difficult for our staff.”

It’s a problem for providers around the country. Research shows patients with substance use disorder rarely get treatment. Of the 21.7 million people age 12 and older who needed substance use disorder treatment in 2015, just 10.8% received it.

So, with support from a $1.8 million state grant in 2016, 11-hospital RWJBarnabas hired individuals in long-term recovery from substance use disorder to engage patients in discussions about seeking addiction treatment post discharge. The individuals, called peer recovery specialists, are trained on how to interact with someone in crisis as well as motivational interviewing.

STRATEGIES

Screen all patients for substance abuse disorder and alert specialists to at-risk patients.

Call patients frequently post-discharge to check in with them.

Host events for patients and families to discuss recovery experiences.

Since the specialists joined RWJBarnabas, more patients are getting help for their substance use disorders. Of the 12,859 patients the peer recovery specialists saw in the first nine months of 2019, 89.1% accepted the services and 91.4% of those patients received services post discharge.

“It really speaks to great patient acceptance” of the program, said Nancy Holecek, chief nursing officer of the northern region at RWJBarnabas.

The program did reduce readmissions, she added. Of patients seen in July and August 2019, about 1 in 7 who accepted bedside Peer Recovery Program services had a 30-day ED revisit, compared with approximately 1 in 5 who declined the services.

More than 100 peer recovery specialists are employed by RWJBarnabas. A specialist is available 24/7 at all hospitals. They are alerted when a patient has been administered naloxone or buprenorphine, or if the patient screens as a high risk for a substance use disorder such as alcohol abuse. All patients in the emergency department and inpatient units are screened by nurses.

Peer recovery specialists enter the patient’s room at a vulnerable moment in their lives but can relate to them, said Angela Cicchino, a peer recovery specialist and supervisor of the program. “(We) can say, ‘I know exactly how it feels to be in this bed,’ ” she said.

Patients are typically open to speaking with the peer recovery specialist and discussing next steps to begin recovery. The specialist then calls in a clinical navigator, who works with the patient on a discharge plan, taking into consideration their insurance and social risk factors.

Even if the patient isn’t interested in discussing recovery options, the specialist calls the patient consistently after discharge and gives them a card with contact info. “Now they know there is help out there,” Cicchino said. “Eventually something is going to happen, and if we can plant the seed, they remember us; that is really what we look to do.”

For patients who agree to get treatment after departing the hospital, the specialist calls them three times the first week, twice the second week and once a week for six more weeks. The calls then taper off to once every three months. The specialist is mainly checking in with the patient to see how their recovery is going. Once a week each hospital site also hosts gatherings for patients and their family members to discuss their experiences with recovery. Families are thankful for the program, Cicchino said.

Clinical staffers also appreciate the peer recovery specialists, Holecek said. “We didn’t have the understanding about the disease in such a deep way, we didn’t have the resources” before the peer recovery program, she said.

The grant will end in September 2020, but Greene said the system plans to keep the program going. The state has approved including peer recovery specialists as a reimbursable service in its Medicaid program, which will help with funding.

https://www.modernhealthcare.com/care-delivery/peer-recovery-helping-patients-addiction-seek-treatment