Substance Abuse PICC Line Program

Program Description

Program Overview: SAPP is a hospital diversion program that allows for patients in hospitals who have a history of IV drug use and a current severe infection that requires antibiotics through a peripher ally inserted central catheter “PICC” line to come to this specialized unit for services. This PICC line is advanced into a large vein above the right side of the heart, usually used to administer long term antibiotic therapy especially in severe systemic infections such as endocarditis and osteomyelitis. IV Drug Users are at great risk for relapse and overdose leading towards perpetuating their addiction and even death due to their infection if not closely monitored. Instead of the patient sitting in an expensive hospital bed for 4 to 6 weeks they can come to SAPP and receive addiction treatment services where they are monitored 24/7, and they also receive medical and case management services relating to their condition for a fraction of the cost. The SAPP program provides a structured, drug-free environment in which individuals learn about the disease of addiction, engage in supportive counseling, receive home healthcare services on-site for their infusion supplies and education with maintaining a clean working PICC line.

Creativity

Enhancing integration of medical treatment facilities with substance abuse and mental health treatment providers through a high level of care coordination to reach the Triple Aim of Care i.e. better health through improved outcomes, manage or reduction in costs, and improvement in the patient experience. The reality of patients having indwelling intravenous access, is especially risky because of the likelihood that the line will be used to self-administer illicit drugs in unmonitored situations. Additionally, there is a very strong need for this population to be evaluated by an addiction medicine physician and following their need for medication management. Having a specialize unit/program allows for each of the challenges the client is experiencing (medical, addiction, mental health and social issues) to be addressed .

Leadership

Program leaders work closely to ensure the developed protocols are being followed and operating efficiently to treat and maintain a high level of client satisfaction experience. Treatment team members work continually with our primary referral source, Shands Hospital at the University of Florida, social work and nursing care teams to maintain positive working relationships. Our Executive Management Team members promote in SAPP through development activities in fundraising efforts, community engagements e.g. chamber of commerce. Also one to one communications with leadership in area community hospitals i.e. executive members and case management directors. Given the state of the nation with the Opioid epidemic PICC line places a group of patients, such as IV Drug Users (IVDU’s), at great risk for relapse and overdose leading towards perpetuating their addiction and even death due to their infection if not closely monitored. This a strong motivator for agencies to seriously consider implementing the program.

Sustainability

Financially this save hospitals significant dollars and provide a new/separate revenue stream to substance abuse treatment providers. This models savings are driven primarily from the community hospitals being saved from accruing expenses when having uninsured patients, or patients who have exhausted their medical insurance benefits, utilizing hospital bed space and medical care resources at the hospital. Also during this time at hospital clients are not able to receive any therapeutic treatment related to their substance abuse and mental health issues which can lead to ongoing IV us after discharge, recidivism in the hospitals and repeated costly medical procedures.

Replicability

This program can be duplicated by other agencies as it builds on a foundation of social work , clinical psychotherapy and care coordination techniques. The team consists of team members found in current staffing patterns of substance abuse provider agencies and hospitals. This allows an agency to start up a with current staff employed (and possibly with current bed space). This reduces overall startup costs. As patient count grows the revenue can offset or pay for expansion needs for staff positions and facilities.

Results/Outcomes

Medical stability leading to reduction in eminent subsequent medical procedures/surgeries. Reduction on drug seeking behaviors, replacing with pro social healthy activities, mending/enhancing family relations, obtaining or returning to gainful employment. Introduction and integration into recovery community while in treatment. Reduction in mental health symptoms. Reduction in aftercare utilization of emergency rooms. Linkage to and establishment of a medical home/primary care. Specific example: A patient come in with significant medical complexities and infections(and was early stage of pregnancy) while in pre contemplation stage of drug use. After SAPP program participation patient was able to transition/step down into a pre and post partum treatment unit to continue in treatment. Patient delivered a healthy baby and successfully graduated step down program with family supports in tact and engagement in the recovery community.