Mercy Hospital Lebanon

RURAL COMMUNITIES OPIOID RESPONSE PROGRAM-OVERDOSE RESPONSE - MERCY HOSPITAL LEBANON WILL LEAD THE PROPOSED HRSA RCORP-OVERDOSE RESPONSE PROJECT ALONG WITH FOUR RURAL, CRITICAL ACCESS HOSPITALS (MERCY HOSPITAL AURORA, MERCY HOSPITAL CASSVILLE, MERCY ST. FRANCIS HOSPITAL, AND MERCY HOSPITAL CARTHAGE) IN 16 COUNTIES IN RURAL MISSOURI (BARRY, DALLAS, DOUGLAS, HOWELL, JASPER, LACLEDE, LAWRENCE, PHELPS, POLK, PULASKI, SHANNON, STONE, TANEY, TEXAS, WEBSTER, AND WRIGHT). ALL COUNTIES ARE FULLY RURAL EXCEPT JASPER, WHERE SERVICES SUPPORTED BY THIS AWARD WILL ONLY BE DELIVERED IN HRSA-DESIGNATED RURAL CENSUS TRACTS. THE PROJECT WILL PROVIDE IMMEDIATE ACCESS TO EVIDENCE-BASED CARE FOR RURAL PATIENTS PRESENTING IN THE EMERGENCY DEPARTMENTS AT THESE FIVE HOSPITALS FOR OPIOID USE DISORDER (OUD) AND CREATE BRIDGE CLINICS THAT CAN BE ACCESSED BY PATIENTS TO MEET SHORT-TERM NEEDS TO REDUCE AND PREVENT THE RISK OF OVERDOSES IN RURAL AREAS. THE OBJECTIVES INCLUDE ESTABLISHING AND/OR EXPANDING OUD PREVENTION, HARM REDUCTION, TREATMENT, AND RECOVERY SERVICES IN THE TARGET RURAL SERVICE AREA BY INITIATING MEDICATION-ASSISTED TREATMENT (MAT) WHERE APPROPRIATE THROUGH AN INITIAL DOSE PRIOR TO PATIENT DISCHARGE WHEN PRESENTING AT THE EMERGENCY DEPARTMENT; ESTABLISHING THE FIVE HOSPITALS AS BRIDGE CLINICS THAT WILL PROVIDE A THREE-DAY BRIDGE PRESCRIPTION OF MAT, TERTIARY PREVENTION SUPPLIES, AND CONNECTIONS WITH RELEVANT COMMUNITY SUPPORTS SUCH AS PEER-RECOVERY MEETINGS; PROVIDING DIRECT REFERRALS TO MERCY’S VIRTUAL SUBSTANCE USE RECOVERY PROGRAM (VSURP) WHO WILL REACH OUT TO PATIENTS WITHIN 24-72 HOURS AND BEGIN CARE IMMEDIATELY TO ASSURE THERE IS NO GAP IN TREATMENT FROM THE BRIDGE CLINIC; AND PROVIDING CLINICAL TRAINING AND SUPPORT TO OVERCOME STIGMA, INCREASE BUY-IN, AND EDUCATE PROVIDERS ON THE USE OF THE NEW OUD SERVICES AND RESOURCES TO BE IMPLEMENTED. VSURP WILL PROVIDE A VIRTUAL FOLLOW-UP VISIT VIA A TELEHEALTH CONSULT WITH AN ADDICTION MEDICINE PROFESSIONAL TO BEGIN A LONGER-TERM TREATMENT REGIMEN WITH A COMBINATION OF COUNSELING, MAT, AND CONNECTION WITH A SOCIAL WORKER TO ADDRESS ANY SOCIAL DETERMINANTS OF HEALTH. VSURP IS CURRENTLY SUCCESSFULLY BRINGING THESE SERVICES TO OTHER LOCATIONS WITHIN MERCY AND SEEKS TO EXPAND INTO THE RURAL PARTS OF MISSOURI TARGETED IN THIS APPLICATION. OUD RESOURCES IN THE TARGETED REGION ARE EXTREMELY LIMITED, SO THE PROPOSED PROJECT WILL FILL THIS GAP BY ESTABLISHING FIVE NEW BRIDGE CLINICS AND PROVIDING TREATMENT ACCESS VIA TELEHEALTH. THE NEEDS TO BE ADDRESSED BY THE PROPOSED PROJECT ARE THE LACK OF OUD AND BRIDGE SERVICES AVAILABLE IN THE TARGET RURAL AREAS (TO BE ADDRESSED BY ESTABLISHING BRIDGE CLINICS IN THE FIVE RURAL HOSPITALS AND PROVIDING ACCESS TO CARE VIA VSURP); OVERCOMING STIGMA FROM CLINICAL STAFF AND FRUSTRATION FROM A LACK OF AVAILABLE REFERRAL SERVICES (ADDRESSED BY CLINICAL TRAINING AND SUPPORT, BRIDGE CLINICS, AND VSURP); THE LACK OF PROVIDER EDUCATION ON MAT INDUCTION IN THE EMERGENCY DEPARTMENT (ADDRESSED BY CLINICAL TRAINING AND SUPPORT AND VSURP); THE LACK OF AFFORDABLE ACCESS TO NALOXONE (ADDRESSED BY PROVIDING THIS TERTIARY PREVENTION ITEM IN “TAKE-HOME PACKS” FOR BRIDGE CLINIC PATIENTS); AND THE LACK OF ACCESS TO ADDICTION MEDICINE PROFESSIONALS IN THE RURAL AREAS (ADDRESSED BY SCREENING AND ACCESS TO TREATMENT AS WELL AS THROUGH SERVICES FROM VSURP VIA TELEHEALTH). THE PROPOSED SERVICES INCLUDE TIER 1, PREVENTION #1—TERTIARY PREVENTION (1.1); TIER 1, TREATMENT #3—SCREENING AND CONNECTION TO TREATMENT (1.3); TIER 1, TREATMENT #4—BRIDGE CLINICS (1.4); AND TIER 2, CAPACITY BUILDING—CLINICAL TRAINING AND SUPPORT (2.CB). THE POPULATION GROUP TO BE SERVED IS ADULTS AGES 18 AND OLDER IN 16 COUNTIES IN RURAL MISSOURI THAT EXPERIENCE ECONOMIC DISTRESS AND LOWER MEDIAN HOUSEHOLD INCOMES AND HAVE HIGH RATES OF POOR PHYSICAL AND MENTAL HEALTH DAYS, UNINSURED AND MEDICAID RATES, SUBSTANCE USE DISORDER PREVALENCE, OVERDOSE MORTALITY, AND DEATHS OF DESPAIR, WHICH CAN BE INDICATIVE OF POOR MENTAL HEALTH AND CAN RESULT IN OR LEAD TO SUBSTANCE USE.