Ridesharing removes major barrier to attendance in Cleveland IOP

A Cleveland hospital's intensive outpatient program (IOP) for patients with substance use disorders is taking advantage of the popularity and convenience of ridesharing services to overcome a common barrier to treatment engagement.

The program at Rosary Hall at St. Vincent Charity Medical Center has reduced appointment no-shows considerably, by ensuring that patients lacking access to reliable transportation can receive Uber rides to and from outpatient treatment. The facility's director of outpatient services suggests to Addiction Professional that the efficiency of these services should help convince treatment providers that they can do much better than offer bus passes to patients for whom transportation poses a barrier to consistent attendance.

“Imagine that it's Feb. 2 in Cleveland and it's 10 degrees, with a wind chill of minus 8,” says St. Vincent's Orlando S. Howard, LCDC-II. “You're on your way to the bus stop, and then the bus is late. Your mind is saying, 'It's too cold, I'm turning around.' Or you're approached on the way to the bus by drug dealers.”

Launched as a pilot effort in June 2017, at a time when the overall attendance rate at Rosary Hall's IOP sessions was 76%, the program has resulted in an increase to 90% session attendance for participants. The rides are free of charge to patients, with the effort mainly supported by grants that have included a $45,000 contribution from the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County.

Emphasizing convenience

Howard says that prior to the launch of the pilot effort, it had become clear to program leaders that transportation needs were posing the biggest barrier to consistent attendance at the IOP. Even many patients who owned a car didn't have what amounted to reliable transportation because they often couldn't afford the cost of basic upkeep or major repairs.

The hospital's director of external affairs heard about a children's hospital in the Northeast that was using ridesharing services to help families with transportation needs, and this gave rise to a plan to try something similar at St. Vincent.

Use of the HIPAA-compliant Circulation digital platform allows Rosary Hall to control the bookings of rides to and from its IOP site. Just like the typical Uber customer, the patient receives notification on his/her cellphone about when the ride is arriving and the name and vehicle of the driver. To maintain patient confidentiality, the driver knows nothing more about the rider than his/her name and destination (St. Vincent uses ridesharing services in a number of its hospital operations, not only in substance use services).

If a patient does not own a cellphone but resides in a sober home or certified recovery residence, a house manager or other staffer will receive the notification. If the ride is originating from the IOP and the patient doesn't have a cellphone, a program staffer receives the information and passes it along to the patient.

Rides generally can be booked only for transportation to and from the IOP, which is a five-week program requiring four visits to the treatment site each week. “They can't order it to go to the movies,” says Howard.

The ride service remains available as patients step down to less intensive outpatient care and counseling appointments.

Howard described one very rewarding occurrence in the program, in which a patient was able to use the service to travel to a first and second job interview at a company located a significant distance away. She was offered the job, and later said that if she had been forced to rely on another means of transportation, she probably never would have made it to the interviews on time and secured employment.