Welcome to the AMNet Collaborative. This newsletter will share updates, new learning opportunities, available resources, and provider stories.

AMNet Publications

The visibility of AMNet is increasing among research and clinical audiences through publications. Two publications describing the AMNet partnership and selection of AMNet assessment tools and quality measures can be found using the links below:

• Addiction Medicine Practice-Based Research Network (AMNet): Building Partnerships Psychiatric Services, April 2021
• Medicine Practice-Based Research Network (AMNet): Assessment Tools and Quality Measures Substance Abuse and Rehabilitation, June 2021

In addition, we request you to share the publications with your colleagues, and we hope you will encourage them to join AMNet.

Patient Engagement Tools and Techniques

We have heard from clinicians that it has been helpful to provide their patients with an introduction letter about the patient-reported outcome measures (PROMs) they are being asked to complete. This letter has been helpful in explaining PsychPRO, the PROMs and what patients can expect. View our sample letter here: Introducing AMNet and What to Expect to Your Patients (.pdf)

PsychPRO Tips and Updates

• If you or your patients receive an error when logging in to the PsychPRO Portal, please click on 'I forgot my password' to reset.
• If you are experiencing any issues with the PsychPRO Portal, please try to send a screenshot of the error message to [email protected].

PROM in Focus: Brief Addiction Monitor (BAM)

BAM is a 17-item questionnaire assessing alcohol and drug use, sleep disturbance, quality of life, drug and alcohol craving, and recovery over the past 30 days. This is a monitoring instrument that is appropriate for periodic re-administration. We recommend assigning the BAM on all patients with SUDs at their initial visit. It should be re-assigned monthly.

The BAM generates 3 scores (risk score, protective score, and use score). The risk score ranges from 0-180, with a higher score associated with greater risk. The protective score ranges from 0-180, with a higher score associated with greater protection. The use score ranges from 0-90, with a higher score associated with greateruse.

Clinicians are strongly encouraged to attend to the item-level data because they have direct implications for treatment planning. They identify specific areas of need or resources for the patient’s recovery. Treatment seeks to maximize the Protective to Risk ratio in an effort to initiate and maintain abstinence.

Ref: Cacciola, J. S., Alterman, A. I., Dephilippis, D., et al. (2013). Development and initial evaluation of the Brief Addiction Monitor (BAM). Journal of substance abuse treatment, 44(3), 256–263. doi:10.1016/j.jsat.2012.07.013

Data Collection Update

Overview

Since October 2020, 84 clinicians have joined AMNet, of which 16 are using the PsychPRO Patient and Clinician portals at this time. Some clinicians already have a workflow to capture PROMs in their EHRs or another electronic system like a kiosk, so their data are not yet represented here. These data will be helpful for all participants since the patient engagement and other challenges with MBC exist across most systems and processes for collecting these types of data.

Among these 16 clinicians who use the PsychPRO portals, 427 patients have been registered into the system. That's an average of 27 patients per clinician. 3,500 PROMS have been assigned to these 427 patients for baseline and repeated appointments, with the BAM and PHQ-2+1 being the most frequently assigned PROMs (Fig 1). However, as shown in Fig 2, only 18.5% of PROMS are fully completed, and another 35.3% are partially completed.

Fig 1: PROMs Assigned to Patients

Fig 2: PROM Completion Status

The proportions of partially completed and not started PROMs in Fig 2 indicate that patients face barriers to engaging with the MBC process and/or PsychPRO portal. It is essential to add that while this is an expected obstacle during the initial stages of implementation (e.g., patients may not be used to filling in surveys as part of their care), we would like to work with you to facilitate patient engagement and increase completion of the PROMs. If you do not use the PsychPRO portal and find it challenging to engage your patients in your MBC processes, we can also help; just let us know.

Please contact us at [email protected] at your earliest convenience to understand how best to support your practice. We understand the impacts of COVID-19 and that your patients are your priority, so let us know what will work for you. Below, we showcase one of our AMNet participants, Dr. Nickolas Hanna, who has had success in engaging his patients in MBC, resulting in a high rate of PROM completion among his patients.

Showcase AMNet's Top Performer: Dr. Nickolas Hanna

Nicholas Hanna, M.D., is a board-certified addiction and family medicine physician. His practice is located in Middleton, WI. He has been in practice since 2017. Dr. Hanna joined AMNet in October 2020 and, since then, has systematically implemented MBC in his practice, specifically using the BAM and TEA assessment tools.

Given his experience in joining AMNet and successfully using the AMNet tools in his practice, Dr. Hanna graciously agreed to participate in the first AMNet collaborative, where he talked about the practical aspects of MBC. Please see the recording of the webinar here: AMNet Collaborative: Using AMNet Assessment Tools and Engaging Patients in Measurement-based Care.

AMNet team: How do you find participating in AMNet?

Dr. Hanna: Participating in AMNET has been a great asset to my practice in Addiction Medicine. It allows me to track my patients' recovery objectively. It also helps me address specific concerns my patients have as it relates to their substance use.

AMNet team: What strategy have you used to get and keep your patients engaged?

Dr. Hanna: It is very helpful when I thank the patients for completing the survey. I think that it keeps them engaged when I review their answers with them during the visit and address any specific concerns they may have.

AMNet Team: What advice would you give to your peers who are interested in joining AMNet?

Dr. Hanna: My advice to peers who are interested in joining AMNET is to follow through on sending the questionnaires monthly. And use the patient answers to help guide the treatment plan.

Suggestions for Future Learning Collaborative Topics

If there is a topic you would like us to cover in our forthcoming webinars, please write to Sejal Patel at [email protected] with your suggestion.