My name Mike Moates, MD. I am a primary care internist at the Birmingham Alabama VA. Along with Dr. Sherry Cox, we developed a practice that brings together evidence based clinical care modes of care using a Whole Health Approach for Reducing Opioid Reliance within Shared Medical Appointments (SMAs). Over the past four years, our interdisciplinary team has been developing, refining, and training Primary Care teams locally and beyond regarding our innovative model of clinical care for Veterans reliant on opioids.
Our approach grew out of the necessity
As: 150+ Americans a day die from opioid overdoses and particularly alarming, is the fact that Veterans are twice as likely to die from opioid overdose as the average American.
Three groups of 30 Patients attended a series of Shared Medical appointments and were provided extensive education on opioid safety at each of 10 -90 min sessions and instructed on the use of traditional medical modalities and Integrative modalities such as tai chi, yoga and acupuncture.
• Constituents of the Shared Medical Appointments (SMAs)
• Education and Promoting opioid safety in Veterans on chronic opioids
• Introducing concepts of self-care and whole health, safety education, and goal setting
• Providing training for Patient Aligned Care Teams (PACTs) to deliver comprehensive, patient-centered care
• "Mini-Residency" Training Program training multiple teams across the VA
Over the 4 years since this project was initiated with~ 90 patient's, 20% of patients have been able to be tapered off opioids…. 80% of patients have been able to make reductions ranging from 10-75% of their morphine equivalent daily dose. 5% of the patients were converted to buprenorphine.
These results were achieved by equipping patients to manage their pain using non-opioid conventional options as well as complementary and integrative modalities. When surveyed, 100% of the patient's provided favorable reviews of the program. Other significant outcomes included improved access for patients to the health care team and improved staff engagement.
As part of the scale and spread of this program, in 2018 we developed a 3 day mini residency training program for Primary Care teams to deliver this mode of care in their respective clinics. To date we have trained 16 different teams from VAs both within and outside our VISN.
In 2019 this project was selected for Gold Status through the VAs Diffusion of Excellence Shark Tank competition and was awarded to the Boston VA.
In June 2020 as a response to the COVID19 Pandemic, we redesigned the WHOpSafe SMA to be virtual using the VVC platform so patients could continue to meet in groups but from the safety of their homes.
Our first VVC SMA brought back Alumni from our previous SMA groups averaging 6 patient's per week for two 10 week sessioms.
Clients were able to reconnect with our health care team in a safe format and establish new health goals or continue programs that were initiated previously.
In August 2020, we trained the 3 PACTs from the Boston in a virtual "MiniResidency" on how to implement the Whole Health Opioid Safety SMA using a virtual format. To date two of those PACTs have successfully launched virtual SMAs.
Going forward, we believe that the Whole Health Opioid Safety Shared Medical Appointment is one model of care that will help many patients reduce their opioid reliance in a safe and cost-effective manner. Spread of this practice will be facilitated with support from our key stakeholders (including BVHCS, Diff. of Ex., OPCC