Categories > Opioid Response Initiative

Treating Chronic Pain…Who you gonna call?

As family physicians we really do see everything when it comes to our patients.  From prenatal to palliative care, our patients trust that we will help them through all their medical complexities.  In turn, we put pressure on ourselves and our teams to meet their expectations.

A couple of months ago my colleague, the shared care psychiatrist who travels to Pincher Creek to see patients with us, told me that the hardest thing he sees family doctors deal with is chronic pain.  Initially this comment surprised me, but on further reflection, and a review of my next day’s patient list I realized he was absolutely correct.

The increase of opioid use disorder in my practice, the lack of supports for alternatives to medication for pain relief in my area and the new guidelines for pain management and opioid use have led to increased stress and frustration for patients, families, and health care providers.

Like most family doctors, I have relied on my “go to” people to consult with when my patients and I are struggling to manage chronic pain or addiction, including opioid use disorder.  These relationships have helped me to build my capacity to manage increasingly complex issues.

I’m pleased to be the Medical Director for the ACFP’s new Collaborative Mentorship Network for Chronic Pain and Addiction which aims to provide the infrastructure for a more formal mentorship relationship so that all family physicians can feel confident in treating their patients with pain and addiction.

About the Author

Cathy Scrimshaw, BSc (Hons), MD, CCFP, FCFP

Cathy is a fulltime family doctor in Pincher Creek, where she has been doing comprehensive care for over 25 years.  She works with members of the Piikani First Nation and the residents of Pincher Creek.  Last year Cathy was recognized for her continued active involvement in the work of the ACFP by receiving the ACFP Long -term Service Award.  Currently, Cathy is the Medical Director for the Collaborative Mentorship Networks for Chronic Pain and Addiction initiated by Primary Health Care Opioid Response Initiative.

Opioid Response: Take Action

Could she be your patient?

It’s a typical day at the clinic and a new patient arrives without an appointment. She’s in her early 20s and behaves in an agitated fashion, but she’s polite and trying her best not to disrupt anyone else. The body language of other patients in the waiting room shows curiosity, wariness and perhaps a little fear. The patient leans in to the clinic staff and says,

Please, I need to see a doctor. I’m an opioid user and I need help.

Could this happen in your clinic? The answer is YES. In every community across Alberta, there are people with, or at risk of, Opioid Use Disorder (OUD). For Katie, it took getting arrested for her to get the help she required because she could not find the support she needed to start her journey to sobriety.  Watch Katie talk about her road to recovery here. (video courtesy of City of Leduc)

  • When this happens at your clinic, are you and your team willing to support this patient?
  • Do you and your team feel confident in supporting this patient?
  • Could you and your team identify who, among your existing panel, is at risk of OUD?

Now is the time to actively identify and seek out patients like Katie. Look beyond your panel and connect with local ODT clinics to provide safe, consistent care for stable patients without a family physician.

Tools, support and resources are available to you and your team through the Primary Health Care Opioid Response Initiative (PHC ORI).

If Katie is not your patient, could she be?

Primary Health Care Opioid Response Initiative: Work in Progress

The opioid crisis in Alberta continues to affect communities across the province, and all health system partners have been actively working to address this crisis.

Since receiving the grant, the Primary Health Care Opioid Response Initiative (PHC ORI) partnership (ACFP, AMA, AHS aligned with AH) has been leading the primary care response. We have been working with Zone PCN committees and zone opioid working groups to design and implement activities that serve each community while meeting the 4 over arching goals:

  1. Access and Continuity: Improve access, continuity and care delivery within primary care settings for individuals using opioids.
  2. Decision Support, Knowledge Translation and Education: Implement relevant and practical evidence informed decision supports and knowledge translation tools, including mentorship, to better equip and educate primary care providers and teams, including clinics and PCNs, to support patients with addition, mental health and/or pain issues resulting in use of or risk of use of opioids and/or with Opioid Use Disorder.
  3. Enhanced Coordination of Care and System Integration: Enhance system integration and coordination of care between primary care practices and other service delivery partners for patients using opioids including those with Opioid Use Disorder.
  4. Population Health Planning: Using a population health based approach, develop and implement a service plan for the integrated delivery of opioid related care.

Responding to the Opioid Crisis in Your Practice

 

Read the full June eNews and President’s Message.

Patients at risk of opioid dependency are in your practice. Let me repeat this. Patients at risk of opioid dependency are in your practice. The good news is that we can manage those risks through basic chronic disease management approaches.

The reality is that we will have patients that require pharmacological interventions for their acute or chronic pain. It’s also likely that we’ll have patients that are using substances recreationally or due to substance use disorder, and that may put them at risk of mortality.

In primary care—as generalist providers of comprehensive and, often, complex care—we need to look to simple practice change and new partnerships to make huge impacts for our patients.

  1. Start with a conversation. We have trusted, long-term relationships with our patients and if we open the door to allow open and honest dialogue about where they are struggling, it can be the first steps into the prevention and management processes. It may, perhaps, be similar in nature to discussing smoking cessation with your patients where highlighting the benefits of quitting (rather than the dangers of continuing) is the most effective way to a solution that works for them.
  2. Partner with others in your clinic and community to create your care teams. It may take some time to build the relationships, education, and experience to create a functional care team that works but it will pay off in spades. Consider building “integrated care partnerships” with your patients and others in your community (even if you have to look to AHS or PCN resources outside of your practice) that have the needed expertise. That’s what they are there for.
  3. Build your capacity as a team. There are, and will continue to be many, opportunities in the coming years to build capacity in opioid management, including harm reduction, diagnosis, and treatment (such as opioid replacement therapy and prevention). Look for sessions—conferences, workshops, or online—that you and your team can participate in to gain skills and best practices.
  4. Bring in facilitators to help redesign your practice. Health care, including family medicine, is changing and we need to become increasingly agile to adapt to the changes, but you don’t have to do it alone. Your PCN and the AMA have an army of practice facilitators and change agents that are well-equipped to support your clinic in a rethink/redesign process.

Here at the ACFP, we are working with our partners—PEER, AMA, PCN Zone Committees, AHS (Provincial, Zone, and Community Programs), and Alberta Health—on the Primary Health Care Response to the Opioid Crisis. We want to make sure that we are providing the supports and resources that you need and are looking to you to let us know where your challenges are, where you’ve been successful in your own practice in responding to the crisis, and what we can do to help.

Call or email Terri Potter, our Executive Director, any time.

 

Opioid Response Grant Announced

Primary Health Care Opioid Response Initiative

Alberta has dedicated $56 million towards urgent actions to address the opioid crisis, including $30 million dedicated to recommendations made by the Minister’s Opioid Emergency Response Commission. Of the $30 million, $9.5 million provincial grant (over three years) has been established for primary health care. The grant will support increased access to services and provide training for primary care providers to offer treatment, medication, and care to patients and families affected by the opioid crisis.

The Alberta College of Family Physicians, Alberta Medical Association (AMA), and Alberta Health Services (AHS), have committed to work together with Alberta Health (AH) to lead this essential work for primary care.

The ACFP will be the secretariat for the grant and will work alongside with key stakeholders to ensure the response includes engagement and guidance from primary care physicians, their teams, and Primary Care Networks (PCNs), and their patients. The ACFP’s support and focus in the Opioid Crisis response began since in late 2016 when it struck the Opioid Crisis Response Task Force—it is with their dedication, determination, and also the commitment of the Board, that ACFP remains driven to support the needs of their members and patient communities.

Primary Health Care Opioid Response Objectives
As front-line primary care providers, family physicians are well positioned to understand the complexity and scope of the opioid crisis and, therefore, must contribute to the design and delivery of a response that is both swift and decisive, and that can be implemented with the flexibility to work with supports available in any community. The response includes:

  • Urgent Opioid Response: Addressing urgent needs of those in crisis through distribution of naloxone kits and provision of Opioid Agonist Therapy (OAT) within primary care settings;
  • Enhanced Provider Decision Support, Knowledge Translation and Education: Changing current practice within primary care clinics and PCNs to better care for individuals using opioids;
  • Enhanced Opioid Related Service Delivery through PCN Zone Committees Engagement, Planning, and Implementation: Developing new integrated service delivery models coordinated with partners including Alberta Health Services (AHS) addiction and mental health services and community services.

Watch for opportunities to respond to the opioid crisis within your clinic and PCN and take part in upcoming training and practice planning to improve support for your patients using opioids or with opioid use disorder.

More information is available in the Alberta Health press release on the Primary Care Opioid Response Initiative.