Bridging the Gap for Patients with Addiction
At CHA we specialize in the care of complex and under-served patients. We provide high quality, compassionate care in both the inpatient and outpatient settings. However, there is a large gap in services for our patients with addictions between the inpatient and outpatient levels of care. Treatment options are limited. Patients who are referred to a program that they really don't want to participate in are classified as "non-compliant" and are often readmitted to the hospital or ED because follow up care did not take place. Available interventions work for patients who are already engaged, but not for our patients who are precontemplative. An effective plan is co-produced with the patient and meets the patient where he or she is. A peer Recovery Coach program is being piloted at Everett Hospital. The Recovery Coaches work to engage precontemplative patients with addictions in the ED, inpatient Med/Surg and Psych units. The goal is to engage these patients through the power of shared experience, and for the Recovery Coach and patient to co-create a plan that leads to engagement in care. This fellowship project will utilize lessons learned from the Recovery Coach pilot to further explore the gaps and possible interventions in the continuum of care between inpatient and outpatient settings. Plans for fiscal and clinical sustainability will be explored and developed.