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Mobile addiction care service to offer outreach to high-risk populations

School of Medicine student Lisa Chan to study community-based care to homeless

By Susan E.W. Spencer

UMass Medical School Communications

June 22, 2020
 
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Lisa Chan, SOM '23
 
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Kavita Babu, MD

A second-year UMass Medical School student will delve into the front lines of addiction care for hard-to-reach populations in Worcester, as part of an innovative mobile addiction services contract funded by the Massachusetts Department of Public Health.

Lisa Chan, School of Medicine Class of 2023, said she is undertaking the initiative for her multiyear capstone project after researching community access to opioid use disorder care while an undergraduate at Boston University.

“I used to think of medicine as being nonpartisan, but in the treatment of opioid use, we can really see how stigma and politics have an effect on it,” said Chan.

UMMS is a partner in the $350,000 annual contract, totaling $1.75 million over five years, awarded to UMass Memorial Medical Center, which is the lead agency and recipient of one of four contracts awarded statewide. Other partners are Worcester Department of Health and Human Services, Worcester Division of Public Health, AIDS Project Worcester and Eliot Community Health Services.

The number of opioid overdose-related deaths remains high in Worcester County, despite a downward trend in fatalities elsewhere in the state. Mass. DPH reported 266 overdose deaths in Worcester County in 2017; 283 in 2018; and 265 in 2019. Total overdose deaths statewide during that time were 2,050 in 2017; 2,031 in 2018; and 2,015 in 2019.

Worcester Emergency Medical Services reported 1,780 opioid-related calls in 2018, but many resuscitated individuals refused transport to the emergency department, according to Kavita Babu, MD, professor of emergency medicine and program director for the mobile addiction services contract.

Dr. Babu serves as Chan’s mentor for her capstone.

The program will operate a van—an RV donated by the Kraft Center for Community Health’s Community Care in Reach initiative—to provide addiction treatment to high-risk, largely homeless people in Worcester. Treatments include medications for opioid use disorder and naloxone, as well as primary care, screening for sexually transmitted infections, chronic disease management, psychiatric screening, and case management with referral to additional health care and social services.

“The beauty of this is that it’s pretty agile,” Babu said. “I think a lot of the focus will be with individuals who have unstable housing. But the mobile clinic approach lets us sort of continue to define the areas of greatest need.”

Providing community-based care to vulnerable populations has become even more important with the spread of COVID-19 this year, said Babu.

Clinical services will be led by Erik Garcia, MD, assistant professor of family medicine & community health, who was the primary physician overseeing the homeless shelter at the DCU field hospital during the height of the pandemic.

Babu said, “We’ve got the right people to develop those protocols and one of my goals is to help facilitate both prevention, masking, hand sanitizing and things like that, as well as routes into testing and treatment for any individuals we encounter who have symptoms of COVID-19.”

To gauge the impact in the wider community, mobile clinic staff will report metrics on services provided over time to DPH. Chan said she would like to extrapolate data from that set for further analyses, which she will develop as planning gets underway.

“I think that this is a unique opportunity because it shows you what diverse impacts you can have as a physician,” said Chan. “I mostly think of it as a clinical exposure, but I think that learning the components of research and how that can have a greater impact on health care, and reach more people, is really exciting to learn about.”

The contract’s planning phase begins in July and Babu expects the van to start making scheduled stops in the city in early 2021. Eventually, she would like to see mobile services provided outside of the city in Worcester County.

“I’m excited about the impact that we could have outside of our walls,” said Babu.