Rapid-access clinics reduce emergency department visits in Ontario

A program designed to provide fast, high-quality treatment for those in Ontario with opioid and alcohol addictions has shown promising results in the form of fewer emergency room visits and hospitalizations.

The META:PHI initiative (Mentoring, Education and Clinical Tools for Addiction: Primary Care – Hospital Integration) has developed seven rapid-access addiction medicine (RAAM) clinics in the Canadian province with the goal of providing a smooth transition between emergency departments and primary care.

“Traditionally, accessing treatment for addictions in Ontario has been challenging, if not impossible, for patients who suffer from this disease,” Kate Hardy, project manager for Substance Use Service, Women’s College Hospital, the organization behind META:PHI, wrote in an email to Addiction Professional. “Our approach of offering both medication and psychosocial interventions from the first visit is unique, ensuring a holistic approach to addressing the patient’s substance use.”

RAAM clinics accept patients from any referral source, including self-referrals, and their operating hours range from daily to once a week, meaning that the typical wait time for a patient to be seen by an addiction physician once the patient has learned about the service is three days, Hardy said. In addition to addiction physicians, the clinics provide access to nurses and counselors, who are able to provide medication-assisted treatment and short-term therapy until the patient is stable and ready to be transferred back to primary care physicians, who are provided with materials to be prepared to take over the patient’s treatment plan. Medications used by the clinics in treatment include buprenorphine or methadone for opioid use disorders and naltrexone or acamprosate for alcohol use disorders.

Patients can remain engaged with a RAAM clinic as long as they and their providers feel it is helpful, and they may also be referred to other community services for matters such as housing assistance or long-term counselling.

“Our services are flexible, with no arbitrary, fixed number of appointments,” Hardy said. “We meet patients where they are at, and work with them to create a care plan that fits with their goals, be them abstinence, reduced use, safer use, etc., as we believe this will be what creates the best program engagement and ultimately the best health outcomes.”

Getting results

Clinicians at Health Sciences North in Sudbury, Ontario, measured the number of times patients supported through the RAAM clinics visited an emergency department 90 days before and after their first clinic visit and found a 63% drop in visits. The rapid-access clinic in Sarnia, Ontario, reduced emergency room visits by 45%.

Thus far, 861 patients have received treatment in the seven rapid-access clinics across the province. By early 2018, the clinics project they will treat 2,000 patients. RAAM clinics currently are being set up in Toronto, and by the fall of 2018, seven clinics will be operational in the city, covering most mornings and afternoons, Hardy said.