Telehealth Partnership for Delivery of Opioid Substitute

Treatment

Breakout Session 6 | Care From A Distance

Presenters

Michael Melia is Health Services Administrator for Prince

Rupert and Haida Gwaii

Chris Melenberg is Team Leader for the Community

Interprofessional Team Northern Health

Dr. Alan Brookstone is the co-owner of Alliance Clinic with

Dr. Maire Durnin-Goodman and Dr. Jennifer Melamed and

is paid under the fee for service and sessional fee

reimbursement program.

• Approximately 7,000 staff

members

• Serve a population of 350,000,

spread out over ~ 2/3’s of BC

• 13% Aboriginal population

• 25 acute care facilities, 14 long-

term-care facilities, many public

health units and offices providing

specialized services

• 2013/2014 operating budget was

$737.5 million

• Organized into three Health

Service Delivery Areas: the

Northeast, the Northern Interior,

and the Northwest

Northern Health Overview

Prince Rupert - Local Health Area

This area has a rich heritage and is the

traditional territories of the Tsimshian

peoples. The present day population is

approximately 13,973 people.

Approximately 5,000 additional people flow

into the service catchment area from Haida

Gwaii and a number of remote coastal

villages.

Today it is estimated that:

90% + of the Prince Rupert LHA population

resides in the City of Prince Rupert.

41.2 % of the population are Aboriginal.

The Prince Rupert Local Health Area (LHA) is located on the

North-coast of BC approximately 1,507 km northwest of

Vancouver.

Source: BC Stats; National Household Survey and Census 2011.

http://www.bcstats.gov.bc.ca/StatisticsBySubject/Census/OpenData.asp

SNAPSHOT OF MMT SERVICES IN THE NORTH WEST HSDA - MARCH 2012 (Sources: Pharmacare, BC College of Pharmacy, & BC College of Physicians and Surgeons

COMMUNITY *

(*where Pharmacy is

located)

# of MMT

Clients

# of Physicians with

Methadone Exemption

# of Community

Pharmacies

Dispensing Methadone

Houston 1 0 1

Kitimat 7 1 2

Prince Rupert 6 0 2

Haida Gwaii 3 2 1

Smithers* 14 3 2

Terrace 16 1 2

*Smithers has a weekly clinic supported by MHAS

Attempts to Improve Access to MMT/OST

March 2012 – MMT Environmental Scan for Northern region

January 2014 – Presentation to the Medical Advisory

Committee in Prince Rupert

January 2014 – Working group formed to develop tele-

methadone services

November 2014 – Blog Post and Video released to raise

awareness of Methadone programs and service gaps in the

Northern Region

Northern Health and Alliance Clinic Partnership

Alliance Clinic requested psycho-social and telehealth

support for MMT client

Following this initial success funding obtained to support a

pilot project starting in April 2015

Site visit April 2015 by Dr. Brookstone with presentations

to doctors, pharmacists, and community stakeholders

First clinic June 2015

Alliance Clinic

10 physician full-service addiction clinic

in Surrey, BC established in 2010

Fully EMR-based

2 Full-time addiction counsellors

5 Support staff

Care for 500+ clients

Intake Timeline

Clinic process and typical days waiting

– Future QI for reducing wait times

Intake Process Typical Business Days Waiting to next

step

Referral (self or doctor) 1

Referral reviewed by team for booking 5-10

Intake by Mental Health Team 0-2

Alliance determines appropriateness for clinic 0-30

Client starts MMT seeing Alliance doctor Average days waiting - 25

What are we proud of?

Client Care for past 8 months:

Wrap Around Services

Alliance

GPs Public Health

Mental Health

Pharmacies Labs Community Services

Referral Outcomes since April 2015 Clients

Clients in the MMT program 23

Inappropriate referrals 8

Clients removed from program 2

Outstanding referral 1

Total Referrals 34

An Assumption

Offering OST in Prince Rupert will result

in increased crisis Intervention

– the reality:

2 clients removed from program

1 client hospitalized for detox

What was the single most significant lesson learned?

Relationships are key

– Trust is paramount

– Shared commitment to make it work

– Process is the back-up

Ongoing Challenges

Acceptance by local family physicians

4 clients without a family physician

Technology

– Overall Success, but ongoing issues

– Internet access, security requirements, EMR

access, lab reporting

Question to Audience?

Has anyone tried to implement OST

services in their community with remote

support (Telehealth/Telephone)?

Any lessons learned?

How can we further expand the

continuum of services for problematic

substance use?

Contact Information

Dr. Alan Brookstone 604-813-6729

alanbrookstone@gmail.com

Michael Melia: 250-622-6298

michael.melia@northernhealth.ca

Chris Melenberg: 250-622-6321

christopher.melenberg@northernhealth.ca