Transitions of Care

As substance-use disorders increase across the nation, helping patients progress safely through recovery after a medical procedure is critical. With our transitions of care initiative, we strive to educate providers on the importance of screening for substance-use disorders, communicating with patients and caregivers, and providing appropriate referrals to treatment or educational interventions.

What we are doing:

Developing and sharing acute care provider education to promote the importance of substance-use screening with a specific focus on polysubstance use (opioids, benzodiazepines, alcohol). We will develop provider-facing tools to support the implementation of substance use screening.

Assessing provider stigma associated with substance-use disorders among healthcare providers. We will implement a baseline assessment of stigma prevalence among healthcare provider partners and collaborators.

Advancing provider-facing referral to treatment and educational intervention resources to include local treatment option tools/resources for coordination of care with community resources and substance-use disorder (SUD) treatment providers. We will collaborate with existing partners and experts to compile and/or develop tools to support improved utilization of existing SUD treatment resources and effective patient education strategies.

Jump to: Screening

Screening

Among surgical patients who developed new persistent opioid use, surgeons provided the majority of opioid prescriptions during the first three months after surgery. By nine to twelve months after surgery, however, the majority of opioid prescriptions were provided by primary care physicians.¹ Enhanced care coordination between surgeons and primary care physicians can allow earlier identification of patients at risk for new persistent opioid use to prevent misuse and dependence.²

Why screen for risk?

Screening for opioid use and substance use disorder before surgery can identify patients at risk for adverse opioid-related outcomes.³ Early identification presents an opportunity to coordinate care, tailor pain management, and ensure clear communication across the healthcare team.⁴

How to screen for risk?

The Tobacco, Alcohol, Prescription medications and other Substances (TAPS) questionnaire is a validated way to screen patients for risk before surgery.^5,6 TAPS asks patients about use of tobacco, alcohol, drugs, and prescription misuse in the past year. Responses generate a risk score, which can help providers understand more about their patient and assist in deciding care plans.

Next Steps:

Risk scores are a starting point for a clinician to have a conversation with a patient about use of substances before surgery. Risk scores are one data point to consider among other characteristics in the context of a patient’s care.

This toolkit for risky substance use screening for surgical care provides context for a) how to score risky substance use based on the TAPS, b) templates for communication to physicians and other surgical providers, and c) actions, links, and resources for next steps. Each template has language and resources specific to each category of risky substance use determined by the TAPS.

References

1. Klueh, M.P., Hu, H.M., Howard, R.A. et al. Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naïve Patients in the USA: a Retrospective Review. J GEN INTERN MED 33, 1685–1691 (2018). https://doi.org/10.1007/s11606-018-4463-1

2. Vu, J. V., Cron, D. C., Lee, J. S., Gunaseelan, V., Lagisetty, P., Wixson, M., Englesbe, M. J., Brummett, C. M., & Waljee, J. F. (2020). Classifying Preoperative Opioid Use for Surgical Care. Annals of surgery, 271(6), 1080–1086. https://doi.org/10.1097/SLA.0000000000003109

3. Kaye, A. D., Jones, M. R., Kaye, A. M., Ripoll, J. G., Galan, V., Beakley, B. D., Calixto, F., Bolden, J. L., Urman, R. D., & Manchikanti, L. (2017). Prescription Opioid Abuse in Chronic Pain: An Updated Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse: Part 1. Pain physician, 20(2S), S93–S109.

4. Vu JV, Cron DC, Lee JS, et al. Classifying Preoperative Opioid Use for Surgical Care. Ann Surg. 2020;271(6):1080-1086. doi:10.1097/SLA.0000000000003109

5. Gryczynski, J., McNeely, J., Wu, LT. et al. Validation of the TAPS-1: A Four-Item Screening Tool to Identify Unhealthy Substance Use in Primary Care. J GEN INTERN MED 32, 990–996 (2017). https://doi.org/10.1007/s11606-017-4079-x

6. Li-Tzy Wu, Jennifer McNeely, Geetha A. Subramaniam, Gaurav Sharma, Paul VanVeldhuisen, Robert P. Schwartz, Design of the NIDA clinical trials network validation study of tobacco, alcohol, prescription medications, and substance use/misuse (TAPS) tool, Contemporary Clinical Trials, Volume 50, 2016, Pages 90-97, ISSN 1551-7144, https://doi.org/10.1016/j.cct.2016.07.013.

Transitions of Care Pathway Buildouts

This guide is comprised of email templates with resources for surgeons and PAs to care for patients who scored positive in one or more category of the TAPS screening questionnaire.

Medication for Opioid Use Disorder Referral Resources

This one-page guide provides information on where to find ‘Medication for Opioid Use Disorder Referral Resources’ in the following Michigan counties: Genesee, Grand Traverse, Ingham, Kent, Washtenaw and Wayne.