Mentoring, Education, and Clinical Tools for Addiction: Primary Care–Hospital Integration (META:PHI) is a collaborative project to create new care pathways for addiction. Originally funded by ARTIC and implemented in seven sites in Ontario, META:PHI is now being rolled out in Toronto with the support of the Toronto Central LHIN.
The purpose of META:PHI is to integrate addiction care provided by the emergency department, hospital units, addiction medicine specialists, family doctors, and community programs, allowing patients to move smoothly between these services. Clinical education, tools, and ongoing support are provided to health care professionals working in these settings to ensure that patients are receiving the best possible care.
In the META:PHI model, patients presenting to any health care setting (emergency department, hospital, primary care) with an alcohol- or opioid-related condition receive highly effective, evidence-based treatment, and upon discharge are referred to a rapid access addiction medicine (RAAM) clinic, which they can attend without a booked appointment or formal referral note. RAAM clinics also accept self-referrals, as well as referrals from withdrawal management, community services, and the criminal justice system.
At the RAAM clinic, an addiction physician immediately provides counselling, prescribes appropriate addiction medications (such as buprenorphine, naltrexone, or acamprosate), and connects patients to community treatment programs. Once patients are stabilized, they are referred back to primary care for long-term follow-up; the addiction physician provides ongoing support by being available to family physicians for re-assessments, consultations, and advice about addiction care. In this model, addiction specialists, hospital staff, family doctors, and community service agents work together to provide seamless and accessible care to patients with substance use disorders.
The result is a fully integrated system in which patients receive evidence-based care at every step.
With the support of the Adopting Research to Improve Care program (a joint initiative of CAHO and HQO), the META:PHI care pathway has been successfully rolled out in London, Newmarket, Ottawa, Owen Sound, Sarnia, St. Catharines, and Sudbury. Currently, the META:PHI team is working with the Toronto Central Local Health Integration Network to spread the care pathway throughout Toronto.
Dr. Meldon Kahan MD CCFP FRCPC is currently an Associate Professor in the Department of Family Medicine at the University of Toronto, and Medical Director of the Substance Use Service at Women's College Hospital. Over the years he has written a number of peer-reviewed articles, guidelines, and educational publications on addiction-related topics. His goal for META:PHI is to expand best practices and create integrated care pathways for the management of addictions. His main interests are primary care and addiction, methadone and buprenorphine treatment, medical marijuana, and medical education in addiction).
Clinical Education Lead
Irene Njoroge RN BScN MPH(C) is the Advanced Practice Nurse for the Substance Use Service at Women’s College Hospital. Irene was the Addiction Nurse Clinician at St. Joseph’s Health Centre Toronto for five years, and has been involved in several addiction-related research and practice initiatives. Her interests include working with marginalized populations to build resiliency; advocacy/creating awareness to reduce stigma around mental illness and addiction; and building capacity in addiction treatment and support within the health professional community).
Kate Hardy MSW RSW has been working in the Substance Use Service at Women's College Hospital since 2013. She is the primary administrator for META:PHI and oversees all aspects of program implementation. She has a particular interest in criminal justice and mental health.).
Sarah Clarke PhD has been involved with various research projects since 2006, and joined the Substance Use Service at Women's College Hospital in 2013. She is overseeing the evaluation of META:PHI and also provides additional administrative support to the site teams).
Clinical Team, Women's College Hospital
Meldon Kahan MD CCFP FRCPC
Medical Director, Substance Use Service
Irene Njoroge APN
RAAM Clinic Nurse, Substance Use Service
Emergency Department Tools
Alcohol intoxication: Assessment, referral, and minimum criteria for reporting to the Ministry of Transportation
Alcohol withdrawal: Clinical features, baseline investigations in the ED, assessment, management, complications of withdrawal, co-occurring conditions, delirium tremens
Alcohol-related presentations: Depression, trauma, cirrhosis, problems in elderly drinkers
Opioid overdose prevention: Patient advice, providing take-home naloxone to at-risk patients
Opioid withdrawal: Clinical features, treatment, Clinical Opioid Withdrawal Scale (COWS), sample buprenorphine/naloxone prescription
Opioid-related presentations: Overdose, opioid use disorders, infections, medical or surgical problems, prescriptions, drug seeking, depression, acute pain in patients on methadone or buprenorphine/naloxone
Opioid-dependent inpatient management: Opioid use disorders in patients admitted to the hospital with medical or surgical problem, managing infections in opioid users
Clinical Institute Withdrawal Assessment for Alcohol scale: For emergency department assessment of alcohol withdrawal (5 minutes)
Sweating Hallucinations Orientation Tremor scale: For emergency department assessment of alcohol withdrawal (1-2 minutes)
Clinical Opioid Withdrawal scale: For emergency department assessment of opioid withdrawal
Primary Care Tools
Exceptional Access Program form (fillable PDF): For coverage of naltrexone and acamprosate
Exceptional Access Program naltrexone template (Word document): Naltrexone application with drug information and diagnosis completed
Exceptional Access Program acamprosate template (Word document): Acamprosate application with drug information and diagnosis completed
These guides should be given to patients that have been diagnosed with an alcohol use disorder or an opioid use disorder. They provide information about the causes of addiction, outline treatment options, and offer some suggestions for dealing with cravings in early recovery.Opioid Use Disorders: A Guide for Patients
META:PHI Google Group
The META:PHI Google group is an e-mail forum for health care providers across Ontario to discuss addiction-related clinical issues, policies, and recent articles. E-mail: Sarah Clarke to join the list.
These e-modules provide a concise overview of managing addictions for health care providers. The primary care provider and ED physician e-module series have been accredited by the University of Toronto.
November 10, 2016 - META:PHI has helped 49 people in Sarnia since March (Sarnia Observer)
September 23, 2016 - Pilot program expedites care for addicts (Northern Ontario Medical Journal)
July 3, 2016 - Ministries' turf war stalls distribution of opioid antidote to Ontario prisons (The Globe and Mail)
May 13, 2016 - Understanding and Addressing the Complexities of Addiction (Huffington Post)
April 28, 2016 - WCH's substance use service keeps patients closer to home (Toronto Star)
April 13, 2016 - Hospital visits for opioid overdose in Ontario spike by 72 per cent over past decade (The Globe and Mail)
March 9, 2016 - Bluewater Health officially launches META:PHI program (Sarnia Observer)
January 6, 2016 - Addiction management clinic up and running (Owen Sound Sun Times)
June 15, 2016 - Facing Fentanyl (TVO)