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The Lehigh Valley Health Network (LVHN) used an to expand treatment for opioid use disorders in Pennsylvania. As a result, primary care physicians are now using medication-assisted treatment to care for their patients with opioid use disorders.  This new practice has been a success; as of fall 2021, 75 percent of patients who initiated treatment have returned in the following calendar month to continue treatment. With addiction treatment, this number of returning patients represents a major improvement, as most patients traditionally end treatment quickly.

With eight hospitals and numerous health centers, physician practices, rehabilitation locations, and other outpatient locations, LVHN serves patients in seven eastern Pennsylvania counties. LVHN used ����APPresources to integrate treatment for opioid use disorder into primary care practice.

“In one visit, a patient can get his diabetes and blood pressure medications, plus his medication for opioid use disorder, without feeling the judgement of going to an addiction specialist,” noted Gillian A. Beauchamp, M.D., LVHN emergency physician. “When you’re sitting in a primary care waiting room, nobody knows why you’re there, so you don’t feel the stigma you might in another setting of care.”

With a background in toxicology, Dr. Beauchamp came to LVHN in 2016 interested in implementing a program that would help people struggling with opioids get treatment with medication, which has a proven track record. Two colleagues helped her develop and expand the program. One colleague knew about AHRQ’s work and connected the team with the resources available from AHRQ.

The LVHN team collaborated with the Pennsylvania Department of Human Services, the Pennsylvania Department of Drug and Alcohol Programs, and the Graduate School of Public Health and the Program Evaluation and Research Unit at the University of Pittsburgh through an ����APPinitiative: the Rural Access to Medication Assisted Treatment in Pennsylvania project (Project RAMP).

Project RAMP incorporated universal screening for substance use disorders in outpatient clinics and medications for opioid use disorder in primary care practices. LVHN committed to improve screening, prevention, and treatment, and to increase access to medication through implementation across many LVHN primary care clinics.

Beginning in 2018, Dr. Beauchamp and a multidisciplinary team of colleagues set up emergency department, inpatient, and primary care-based resources to support patients with opioid use disorders and to provide medication treatment. After implementing initial acute care treatment—including withdrawal management, initiation of medication, and referral for ongoing care—the team began to train primary care physicians to continue this care in the outpatient setting.

Starting with just four primary care physicians, the program expanded to 10, and as of spring 2021 had 25 participating primary care providers in urban, suburban, and rural Pennsylvania. These are mostly family doctors in the Lehigh Valley area. Two practices are in isolated locations where they provide nearly all local medical services.

“At the beginning, because they were unfamiliar with addiction treatment, the primary care doctors were uneasy taking on this care. Now that they’ve become more experienced, they’re quite comfortable providing it,” Dr. Beauchamp said.

The training has been able to reach many physicians through webinars with monthly training and discussions using , a structure for virtual knowledge-sharing that brings specialty care to rural and underserved communities. LVHN also has monthly meetings for questions and discussion.

The LVHN team found AHRQ’s data assistance valuable. “Figuring out how to collect data and pull reports is something we could not have done on our own,” Dr. Beauchamp said.

As of 2021, the program has been designated by the State as a Center of Excellence, recognizing its leadership, best practices, research, support, and training. LVHN’s Center of Excellence brings together community-based care management with emergency care and case workers, all of whom help patients connect with primary care providers for all their care.

About 100 patients a month are transferred from emergency departments and inpatient hospital units to maintenance care. Many of these patients now engage with primary care providers who integrate medication for addiction treatment into their overall primary care. In April 2021, 80 patients in 12 sites were receiving treatment from more than 20 providers.

“While opioid overdose rates have gotten worse due to COVID, we are getting more people into treatment,” Dr. Beauchamp noted. “We’re seeing three to eight more patients each month over previous months. And, with such a high-risk population, our 40 percent rate of patients returning month after month for their treatment is a very good return rate.”

Approximately 72 percent of LVHN’s patients in this program have remained in treatment after 120 days; 65 percent remain after 180 days. Nationally, 20 to 30 percent of patients usually remain in treatment by 120 to 180 days.