Shirley L. Beale, CRNP, is certified in family medicine and works full-time with Penn Medicine Lancaster General Health Addiction Medicine. She splits her week between three different offices, seeing up to 20 patients a day. She conducts patients’ initial assessment, starts and monitors their treatment, and connects them to community-based support systems.
“It’s a lot for families to go through, let alone the patient,” she says of substance use disorders. “I want to help support them and ensure they’re treated with dignity throughout the treatment process.”
Beale works within a hub-and-spoke, value-based-care addiction medicine model that was implemented several years ago at Lancaster General Health Primary Care. The impetus was a community health needs assessment that confirmed what had already become clear: The behavioral health and opioid crises were overwhelming the health system.
Training Lancaster General Physicians to Treat Substance Use Disorders
Lancaster General Health Primary Care quickly identified 20 to 30 physicians who had the capacity to see more patients – often under short notice – and assessed their interest in sub-specializing in addiction medicine. The practice then provided them with the necessary training.
Now, the other primary care physicians in the network can refer their patients with a substance use disorder to these select subspecialists.
“Traditionally, family medicine physicians administered methadone and suboxone, usually hand-in-hand with psychiatrists who specialize in addiction medicine,” says Jonathan T. Kinley, DO, managing physician at Lancaster General Health Family Medicine Quentin. “But now there are just too many people with addiction issues for psychiatry to be able to manage them alone.”
Since primary care is often a patient’s first point of contact with the health system, it was a natural place to redesign the care model.
“Addiction is part of what can be a very normal set of problems suffered by a number of our different patients,” says Dr. Kinley, who is board-certified in family medicine and addiction medicine. “As such, the addiction medicine service is just one branch of subspecialty care in the larger Penn Medicine family that seeks to help treat the problem.”
By having designated subspecialists such as Dr. Kinley throughout the network, he says it’s alleviated the burden of “crash-managing” patients for the other primary care physicians.
“I think the approach provides a more realistic structure for how we can help our patients with addiction,” Dr. Kinley says. “Having separate people working on addiction medicine as emergency care, addiction care as inpatient care, or treating acute medical issues from addiction, as well as treating the addiction itself and, to some extent, the psychiatric ramifications of that addiction, is only going to help provide a more thorough service than could be provided by family medicine physicians alone.”
Beale says she sees patients, every day, in different stages of recovery. Some are at the beginning of their recovery and may be continuing to use substances while in treatment. Others may be experiencing withdrawal symptoms. And still, others are receiving suboxone from a non-medical source, but knowing how well the medication works, they’re looking to be connected to a registered medical suboxone provider.
“We see patients move forward in their recovery journey, while we may see others intermittently or only once,” she explains. “But every day, we are making treatment and support easily accessible to our patients, and for that, they are thankful.”
Beale believes this addiction medicine model has had a meaningful impact on the communities served by Penn Medicine Lancaster General Health. But she worries about the corners of those communities for which access to care remains a challenge. And she realizes that even more providers are needed to meet a demand that continues to escalate.
As part of an ongoing effort to meet that rising tide, John C. Wood, MD, MBA, FAAFP, Executive Medical Director of Primary Care and Population Health for Penn Medicine Lancaster General Health, says that new providers who are certified in addiction medicine will immediately have the opportunity to divide their time between family medicine and one of the designated addiction medicine offices.
“This is very important work,” Beale says. “It’s changing lives.”