1. Medication Assisted Treatment Adding a new medication into outpatient treatment

2. AIM (Plan) Baseline use of Vivitrol/Naltrexone was 0. Goals Increase the use of Vivitrol/Naltrexone Have 40% of all alcohol dependent patients on Vivitrol/Naltrexone Screen all new and current patients for MAT Develop seamless process for acquiring and delivering MAT in an outpatient setting

3. Change (Do) Educated staff on Vivitrol/Naltrexone Worked with Denver Health pharmacy to create procedures for receipt and storage of Vivitrol Developed screening tool for all new and current patients Developed agency protocol for delivery of Vivitrol → Physician now requires 1 week of oral naltrexone prior to 1 st injection of Vivitrol Asked DH pharmacy to add Vivitrol to formulary Started screening and dosing in February 2009 using Vivitrol donations from Alkermes

4. RESULTS (study) 102 patients screened between February and June 25 patients started on Vivitrol or Naltrexone Patients appear to like Vivitrol/Naltrexone with few reports of adverse reactions Referral sources have been informed of availability of MAT

5. NEXT STEPS (Act) Continue to educate clinical staff to increase screening and use of MAT Fine tune current processes for acquiring and delivering Vivitrol Expand to DH residential programs; integrate into other areas of hospital Follow through with P&T Committee to put Vivitrol on formulary Develop stable funding sources –Increase billing to commercial insurance, Medicaid –Acquire multiple funding sources for uninsured patients

6. IMPACT (Business Case, Lessons Learned) Referrals increased Culture change is hardest for staff!! Market to community Use change process to introduce other types of MAT (Buprenorphine)