Overcoming Barriers to MOUD at Discharge: Ensuring Continuity of Care from Skilled Nursing Facilities

EP 01

🎙 Special Series: Advances in Buprenorphine Education

This episode is part of a special series on improving hospital and clinic-based buprenorphine treatment for opioid use disorder.

 

In this episode of ASAM Practice Pearls, Dr. Stephen Holt is joined by addiction medicine experts Dr. Carolyn Chan and Dr. Shawn Cohen. They explore key challenges and solutions in ensuring continuity of care for patients receiving medication for opioid use disorder (MOUD) during discharge from skilled nursing facilities.

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Host

Stephen Holt, MD, MS, FACP, FASAM

Dr. Stephen Holt has been an attending physician at Yale-New Haven Hospital since 2008 and is an Associate Professor of Medicine at Yale School of Medicine. He is the Director of the Yale Addiction Recovery Clinic and the Associate Program Director for Yale's Primary Care Internal Medicine Residency Program. He is board-certified in Addiction Medicine and Internal Medicine. He has published and lectures frequently on a variety of addiction medicine topics and has won numerous teaching awards at the local, regional, and national levels.

Experts

Carolyn Chan, MD, MHS

Dr. Carolyn Chan is board-certified in both internal and addiction medicine. She completed her IM residency at UH Hospitals Cleveland Medical Center, followed by an addiction medicine and medical education fellowship at Yale. She provides care in both inpatient and outpatient addiction medicine settings. Currently, she is the Program Director of the University of Cincinnati Addiction Medicine Fellowship and is committed to educating all health professionals on how to provide evidence-based care to individuals with substance use disorders.

Shawn Cohen, MD

Dr. Shawn Cohen is an addiction medicine doctor at Yale New Haven Hospital. He provides care on a hospital-based addiction consult service and is interested in lowering barriers to MOUD, improving the care of patients experiencing alcohol withdrawal, and making the hospital a more person-centered and less stigmatizing place for people who use substances.

📖 Show Segments

• 00:03 - Introduction
• 02:35 - Barriers to Continuity of Care
• 07:43 - Navigating Prior Authorizations
• 10:24 - Methadone Discharge Planning
• 14:19 - Extended-release Buprenorphine at Discharge
• 17:44 - Engaging Family and Caregivers
• 19:23 - Staff Education and Advocacy
• 22:14 - Discharge Planning Example Scenarios
• 25:11 - Revisit Case Scenario
• 25:50 - Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Build relationships with local stakeholders. Collaborate with nursing facility administrators, intake personnel, and buprenorphine clinics to facilitate smoother transitions for patients.
• Address stigma and education gaps. Work closely with facilities to improve their understanding of MOUD and the importance of comprehensive addiction treatment.
• Be proactive in discharge planning. Arrange follow-up appointments and maintain open communication with all relevant parties to prevent care gaps.
• Anticipate common barriers. Stay ahead of issues like prior authorizations by verifying medication access before discharge.
• Strive for incremental improvements. Small changes can lead to significant advancements in patient care over time.
• Emphasize clear communication. Ensure nursing homes and facilities fully understand discharge plans and patient needs.
• Encourage patient engagement. Motivate patients to involve their support systems in their recovery journey.

🔗 Resources

• ASAM’s Advanced Buprenorphine Education Series: Explore here.
• Skilled Nursing Facility SUD Toolkit (Massachusetts): Access here.
• Methadone 72-Hour Rule in Hospitals: Read more.
• Methadone 72-Hour Rule in Bridge Clinics: Read more.
• DOJ Guidance: ADA & Opioid Treatment Discrimination: View PDF.
• Legal Action Center Toolkit on Healthcare Discrimination: Access here.
• Grand Rounds on MOUD in Skilled Nursing Facilities: Watch here.

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!