Enhancing Primary Care Capacity for Evidence-Based and Community-Oriented Opioid Agonist Therapy in Indigenous Contexts in Alberta (COATICA 2018 - 2021)

Enhancing primary care capacity for Indigenous-focused opioid agonist therapy through educational outreach & community-oriented models of care. 

Lindsay Crowshoe, MD 

Associate Professor

Dept. of Family Medicine

University of Calgary

Rita Henderson, PhD 

Models of Care Scientist

Dept. of Family Medicine

University of Calgary

Robert L. Tanguay, MD

Provincial Medical Lead, ODP Training 

Alberta Health Services

Medical Director, Transitional Outpatient Pain Program for Spine (TOPPS)

Adapting a telehealth model for Opioid Agonist Therapy (OAT) delivery, specifically Buprenorphine Naloxone, within Indigenous primary care settings in Alberta is a provincially-focused initiative that is guided by 5 over-arching objectives: 

Objectives

1. Improve social and health outcomes for opioid dependent Indigenous persons through greater access to Suboxone(C) treatment in urban and rural communities; 

2. Enhance access by Indigenous patients in communities to appropriate and high quality initiation and maintenance of Suboxone through primary care; 

3. Expand provider networks for Indigenous-focused OAT by strengthening inter-professional and primary-care/specialist provider connections; 

4. Overcome current dispensation barriers to OAT for marginalized patient due to geographic, social, and economic isolation from physician and pharmacy resources 

5. Develop and promote policies enabling telehealth-based physician & pharmacy services to indigenous & remote communities

Objectives

1. Improve social and health outcomes for opioid dependent Indigenous persons through greater access to Suboxone(C) treatment in urban and rural communities; 

2. Enhance access by Indigenous patients in communities to appropriate and high quality initiation and maintenance of Suboxone through primary care; 

3. Expand provider networks for Indigenous-focused OAT by strengthening inter-professional and primary-care/specialist provider connections; 

4. Overcome current dispensation barriers to OAT for marginalized patient due to geographic, social, and economic isolation from physician and pharmacy resources 

5. Develop and promote policies enabling telehealth-based physician & pharmacy services to indigenous & remote communities

See our Guiding Principles Here

Over 3 years (June 2018-March 2021), stakeholder healthcare providers currently working in OAT and/or primary care will come together to collaborate for Indigenous-focused care. In 3 phases, their input will help adapt, pilot and evaluate the network: 

Model Implementation Strategy

Phase 1Needs Assessment/Planning: Conduct interviews & sequential focus groups with stakeholders (i.e., opioid dependent patients/non-patients, diverse providers, community leaders); work with service partners to develop data sharing & use agreements for development of impact evaluation plan; 

 

Phase 2Implementation: Recruit general practitioner & specialist service providers who will provide telehealth OAT service to Indigenous clientele as part of the model; offer enhanced training of these physicians and their teams (i.e., nurses, staff); implement model; 

 

Phase 3Evaluation: Collect & analyse patient/provider-reported outcomes via surveys & administrative data. Conduct patient chart audit in pilot sites; mobilize formative & summative analysis with health systems policy- & decision-makers, to further scale up model throughout primary care settings in Alberta within existing infrastructure and available resources.