Best Practice of the Month

Clinic Process Improvements to Reduce Barriers to Initiating MOUD

If a patient calls the clinic and requests MOUD, do the individuals answering the phone know how to schedule this visit?

• Evaluate this by calling at a few different days/times and asking about scheduling a visit for MOUD.
• Make available written information on scheduling for MOUD visits to individuals answering phones and retraining employed if challenges are identified.

What is the average wait time from point of MOUD request to visit being scheduled?

• This can be tested by calling several times over the course of a month to determine average wait time. Alternatively, electronic scheduling systems can be queried, but calling the clinic and requesting an appointment can help leadership better understand the patient experience.

• While same day or next business day access is ideal, it may not be feasible for all clinics. Identifying an internal goal (for example, visit scheduled within 3 business days of request) that can be intermittently monitored helps with internal quality improvement processes.

Are walk-in visits allowed for same-day MOUD assessment and initiation?

• Allowing walk-in visits or blocking several appointments for use as same-day slots increases access for individuals requesting MOUD and can reduce risk of no-shows. Similarly, some clinics use urgent care slots to assist patients requesting same-day MOUD access.

If a patient arrives late for an appointment, are they still able to be seen that day?

• While there will be a limit to the number of patients arriving late who can be seen by a single clinician in one day, there are also ways that clinic schedules can be built to allow for maximum support and flexibility. For example, holding slots later in the clinic session as “same day” appointments can allow patients who arrive late to be seen later in the clinic session.
• Another approach includes using integrated behavioral health team members to help with the historical data collection to allow for abbreviated medical clinician visits.

If a patient does not present for the MOUD intake appointment, what is the clinic outreach or follow up?

• If a new patient does not present for the intake appointment, is there a team member assigned to follow up in an attempt to re-engage the patient in MOUD services?
• Are there documented processes for how outreach attempts are documented in the medical record?

Does the clinic have a community advisory board or other defined processes to engage patients in MOUD delivery system design?

• One of the best ways to identify barriers to care and improve intake processes is through feedback collected from individuals who are actively engaged in services. Community advisory boards, focus groups, and patient surveys can all be helpful ways to collect feedback.

Clinics offering MOUD services should continually re-assess registration and intake workflows to minimize barriers to initiation of care. Adapting these systems typically requires input and buy-in from multiple stakeholders, including patients and clinic staff