key: cord-0743823-sh5x4lyq
authors: Whitfield, Martha M.; Wohlberg, Jeri B.; Whitaker, Katie
title: Letter to the Editor
date: 2020-04-27
journal: J Nurse Pract
DOI: 10.1016/j.nurpra.2020.04.024
sha: 136d1192154ba9e407b7beb2c508528396edbca8
doc_id: 743823
cord_uid: sh5x4lyq

nan

to their primary care services. We are also providers at a Federally Qualified Health Center and would like to offer an alternative view of MAT treatment initiation from the perspective of a clinic with a well-established MAT practice. While every MAT practice can experience the occasional bump in the road, we would not want Dr. Vonderhaar's experience to act as a deterrent to any NPs considering adding this vital service. As the current COVID-19 epidemic continues to unfold, we are already seeing an increase in the need for mental health and social services of all types and anticipate this will extend to MAT.

Our providers (five family nurse practitioners and three physicians) are all waivered to prescribe MAT. We have a growing panel of over 70 MAT patients and are unanimous in considering our MAT work one of the most rewarding aspects of our practice. We are fortunate to have support from a MAT nurse, a psychiatric mental health NP, a licensed clinical social worker, and other care coordination staff, and to have developed a clinic culture that treats MAT no differently than any other chronic disease.

In Vermont we also practice within the Hub and Spoke system (Brooklyn, 2018; Brooklyn & Sigmon, 2017) . This allows for a tiered approach to care, with patients who require more frequent visits being seen in an intensive outpatient treatment (IOP) program at one of the hub facilities. Patients in sustained or more stable recovery can be seen in an office-based outpatient (OBOT) setting such as the one offered by our clinic. A statewide learning collaborative brings providers, mental health clinicians, nurses and others together to learn and review cases (Nordtrom et al., 2016) .

Our intake process is thorough and includes discussion with staff at hub facilities and with the patient. This allows us to be clear about what we can reasonably manage within our outpatient setting. Many of our MAT patients are already seen for primary care services, and it is a requirement of our clinic that any patient who wishes to be seen for MAT services also enroll for primary care. Some of our primary care patients are also seen at a hub for their MAT prescriptions, with the goal of eventually transferring all of their care to our office. We do occasionally see patients for a direct induction with suboxone -often these are patients who are long-standing primary care clients, are already known to us, and are considered stable enough for outpatient treatment. A patient such as the one described by Dr. Vonderhaar would usually be referred to the hub for IOP service with daily visits.

Dr. Vonderhaar's commentary highlights the need for a range of MAT services. Collaboration with pharmacies, a clear process for urine drug screens, and consultation with experienced providers as needed are important. When a patient is discharged from the hospital with medical issues such as congestive heart failure, a recent myocardial infarction, poorly controlled diabetes, or worsening chronic kidney disease we work to prioritize their care. We consider housing, food insecurity, and access to home health if needed. We take it one step at a time, tap into our resources, and bring them back for frequent visits. Providing MAT requires a similar process.

As NPs we are charged with taking care of individuals, families and communities. MAT should be part of that care. We encourage our NP colleagues to become MAT prescribers for the rewards it offers both patients and providers.

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