Tailoring treatment to patient needs and circumstances is fundamental to patient-centered care. Early in the treatment process, it is important to conduct a comprehensive assessment to determine unique patient characteristics. However, only the essential parts of this comprehensive screening and assessment should occur before starting patients on medication.
Beginning a patient on medication as quickly and as safely as possible can improve outcomes and reduce risk. The results of the full assessment should be used to inform a collaborative treatment planning approach. Providers should periodically reassess needs, circumstances, and progress to update the care plan throughout treatment.
The practice conducts screenings and assessments to identify the patient’s particular needs, preferences, and barriers to treatment. Medications are started as soon as safely possible without waiting to complete the comprehensive assessment. The results of these assessments are used to inform customized treatment plans developed through shared decision making.
How Do You Do It?
Assess Individualized Needs
When patients go through intake, a comprehensive assessment of their needs can help inform treatment planning. It should ask about1:
- Ability to participate in treatment—Potential barriers (e.g., scheduling of appointments, transportation, and child care); triggers and life stressors; and personal support systems.
- Considerations for decisionmaking—Goals for life and treatment; patient concerns and preferences about medications for opioid use disorder; and any prior use of medications for opioid use disorder and their reason for discontinuation.
- Other medical information—List of current medications and associated allergies; medical, mental health, and substance use histories; and current opioid use and co-occurring substance use.
A trained staff member, such as a physician, nurse, care manager, care coordinator, or social worker, should conduct the intake assessment. Staff roles and responsibilities for intake will depend on what works best for the practice’s workflows and allows team members to work at the top of their qualifications.
A basic physical examination should also be conducted, along with any relevant laboratory tests (such as hepatic function, urine drug screens, pregnancy test, hepatitis panel, HIV, and complete blood count).1 Signs of opioid withdrawal should be assessed and recorded, using a screening tool such as the Clinical Opiate Withdrawal Scale (PDF—606 KB).
Individuals with opioid use disorder often have complex needs, including co-occurring medical and behavioral health disorders, as well as risk for suicide and need for chronic pain management. While some providers and practices will not be willing or able to offer treatment for these services directly, screening for these issues in the intake process can help providers fully understand the patients’ needs and connect them with appropriate care. For patients whose medical or psychosocial needs are so complex that they may not be appropriate candidates for office-based treatment, consider connecting them to a higher level of treatment.
What Not To Do
- Don’t allow comprehensive screening and assessments upon intake to delay patients’ access to medications.
- Don’t assume patient needs will stay the same throughout the course of treatment. Conduct periodic assessments to help inform adjustments and updates to the treatment plan.
Presents a sample intake questionnaire for patient treatment-planning questions.
Provides a sample for buprenorphine treatment intake history and physical.
- Substance Abuse and Mental Health Services Administration. Treatment Improvement Protocol 63: Medications for Opioid Use Disorder. Part 3: Pharmacotherapy for Opioid Use Disorder. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018. Publication No. SMA18-5063PT3. https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Pharmacotherapy-for-Opioid-Use-Disorder-Part-3-of-5-/SMA18-5063PT3. Accessed May 20, 2019.