A model for the delivery of opioid agonist therapy with buprenorphine, in which nurses working with physicians play a central role in the evaluation and monitoring of patients
Recognizing the barriers to Office-Based Opioid Treatment with Buprenorphine (OBOT-B), in 2003, a multidisciplinary team at Boston Medical Center (BMC) created the Massachusetts Collaborative Care Model to increase access to treatment. The goal of this state OBOT-B program was to incorporate the model into primary care in community health centers, providing treatment to marginalized individuals including the homeless, under-insured, uninsured, ethnic and racial minorities and those with co-occurring physical or mental health disorders. The model consists of four treatment stages: 1) screening and assessment of the patient’s appropriateness for office-based treatment; 2) medication induction under a Nurse Care Manager’s direct supervision; 3) stabilization; and 4) maintenance.
The Nurse Care Manager (NCM) is central to the OBOT-B Collaborative Care Model. The NCM is usually the initial contact for patients seeking OBOT-B treatment and acts as the primary liaison between the patient and the physician throughout the treatment process. With the NCM as the first point of contact, patients have access to the OBOT-B team for questions, issues or support during induction and as needed throughout treatment. During treatment stabilization, patients are followed closely with weekly or more frequent visits as well as telephone communication to provide support and education, assure adherence, and address other concerns the patient may have. The frequency of follow-up visits with the NCM usually decreases but can increase based on the patient’s needs.
This model for treating opioid dependence mirrors the model for treating other chronic diseases in that management is individualized and includes OBOT-B clinical contacts and referrals to specialized care based on patient need. More information on implementing this program can be found in this presentation.
This model increased the number of healthcare professionals that could prescribe buprenorphine by 375%.