Medication-assisted treatment (MAT) providers need ongoing support and education throughout the implementation process. This support may come from external resources or internal initiatives within the practice. While working with these patients is rewarding, providing MAT services can be stressful, particularly early in the implementation process. It is important that providers have proper support and practice self-care to avoid burnout.
The practice develops a team-based approach to foster open communication, identify and share concerns, and provide mutual support. The practice provides ongoing training, education, and qualified clinical supervision to ensure that treatment models and practices are implemented with fidelity.
How Do You Do It?
Ensure Adequate Support
Identify Consulting Resources. Connect with programs in your State or region to help support staff as they develop proficiency in working with this patient population. These resources may include:
- State government programs,
- Project ECHO programs,
- Specialty hub programs, and
- Collaborative care programs.
Consulting resources and mentoring programs also are available through the Providers Clinical Support System and the American Academy of Addiction Psychiatry. These programs can help improve providers’ confidence and skills when treating patients with opioid use disorder. Expert consultants can answer questions, provide clinical guidance, and offer support.
Formal practice facilitation or practice coaching can also help practices organize implementation and quality improvement processes as they integrate MAT services. The availability of these services may vary. For example, some States have built a practice facilitation component into the technical assistance they offer through the State Targeted Response to the Opioid Crisis Grants. Learn more about How a Practice Facilitator Can Support Your Practice (PDF—.11 MB).
Providers also do not necessarily need formal consultations or support. Sometimes, it can be just as beneficial for practices starting MAT to find other programs or providers in the local community who already offer MAT services. These practices may want to reach out to MAT providers and ask if they would be willing to spend some time talking about their experience or let practice staff participate in a site visit. This informal peer support can be very helpful to ease providers’ concerns.
Implement Models of Clinical Supervision and Strategies To Improve Employee Retention. Practices and organizations can also implement other strategies to help improve employee retention and avoid provider burnout. They should ensure adequate support from coworkers and provide clinical supervision. After medical and behavioral health providers are trained, effective clinical supervision is needed to monitor their work, ensure high-quality care is delivered, and address challenging clinical situations.
While supervision is important to improve healthcare quality across conditions in primary care, it can be critical to support the team-based approach and address the complex needs of patients with opioid use disorder. Internal clinical supervision and collaboration are vital for sustaining services and maintaining provider energy and patient safety. The following models may help:
- Team meetings or “huddles”—members of the clinical care team can hold regular meetings to discuss clinical staffing, during which they identify patients who are struggling and discuss next steps for the treatment plan. Practices should decide the frequency of these meetings based on their scheduling and patient workflows. The West Virginia University Comprehensive Opioid Addiction Treatment model includes a team huddle before every group medication management or therapy session. During this huddle, the team discusses the results of patients’ urine drug screens; self-disclosures of substance use; and treatment plan adherence (e.g., attendance at self-help group meetings).
- Case presentations—providers present challenging cases to the larger clinical staff. This model of supervision may work particularly well for care teams within a federally qualified health center, health system with multiple practices implementing MAT, or academic medical center.
- Peer mentors or prescriber teams—practices can partner prescribing providers within the program or with others in the community to serve as peer provider mentors. This model can help create a collaborative culture and strengthen relationships between providers. Alternatively, practices can pair prescribers with a case manager or care coordinator (possibly a social worker or nurse care manager) on the clinical care team to coordinate care for each patient and intensively work together.
- Ad hoc support—supervising physicians or program directors should also offer all staff support on an ad hoc, as needed basis. Knowing one-on-one support is available can go far in reassuring new prescribing providers. Supervisors should ask for a personal phone number, pager, or other mechanism for staff to get in contact whenever it is needed.
To deliver the best care possible for their patients, it is also important that providers practice self-care. Stress and burnout are issues faced by providers across primary care practices and ambulatory settings. Sometimes adding new services, such as MAT, to already busy schedules and competing priorities can create an additional burden. A number of organizations have created resources to help providers improve their work life and find joy in practice. For example, the American Medical Association developed practice improvement strategies for professional well-being.
At the practice-level, leadership can help support providers by:
- Scheduling breaks throughout the day,
- Setting aside time in providers’ schedules for continuing education and consulting resources, and
- Providing a forum or mechanism for providers to relay concerns about caseloads or workflows.
Maintain or Develop Knowledge and Skills Through Continuing Education
Throughout the implementation process and after, it is important that providers seek continuing education about MAT and addiction medicine in general. With increased awareness and funding to address the opioid epidemic, the field is rapidly evolving. New approaches, treatment models, and medication formulations are emerging. Providers need to stay up to date on the latest information and strategies to treat patients with opioid use disorder. See the resources below for continuing education opportunities.
What Not To Do
- Don’t fail to take advantage of available resources such as mentoring and Project ECHO that can help you become comfortable managing more complex patients.
- Don’t underemphasize the need for ongoing monitoring and supervision to avoid drift from the practices and models your program is implementing.