Emerging Topics in Public Health Accreditation: Aligning Accreditation and Opioid Response Activities

October 30, 2018|10:34 a.m.| ASTHO Staff

Accreditation through the Public Health Accreditation Board (PHAB) serves as a framework to help health agencies respond to emerging public health issues by systematically examining their infrastructure, policies, and processes. With the opioid epidemic continuing to impact communities across the United States, preparation, coordination, and efficiency are crucial to a health agency’s ability to prepare for and respond to this public health crisis.

ASTHO’s opioid framework is a tool designed to help public health leaders respond holistically to the opioid epidemic, revealing opportunities for health agencies to align efforts with other public health priorities, such as accreditation, to enhance efficiency and reduce duplication of efforts amid limited resources. Accredited in 2016, the Oregon Health Authority (OHA) has been at the forefront of the opioid epidemic, leveraging accreditation-related activities to address the crisis—even before it was declared a national public health emergency in 2017.

Described below are four ways OHA has benefited from aligning its opioid and accreditation-related efforts:

Improved Monitoring and Surveillance Capabilities

Under PHAB’s Domain 1 requirement (assess population health and public health status), OHA used its state health assessment (SHA) to strengthen the agency’s capacity to track fatal and non-fatal opioid overdoses, identify high risk populations, and examine prescribing practices for opioids and other controlled substances in the state. “The collaborative, community-driven process of conducting a state health assessment provided an avenue for OHA to collect input on the impact of opioid misuse in the communities,” says Katrina Hedberg, OHA’s health officer and state epidemiologist.

OHA’s process for developing the SHA involved working closely with partners at the prescription drug monitoring program, hospitals, and medical examiners to obtain health outcome data related to drug misuse. To provide current data for program staff and external stakeholders to use, OHA’s public health division designed and implemented an interactive data dashboard showing deaths, hospitalizations, and prescribing patterns by county, age groups, and trends.

While the assessment helped OHA collect health outcome data on overdose morbidity and mortality, Oregon’s state health improvement plan (SHIP) lays out specific activities to address the crisis. OHA has included opioid and substance misuse prevention as one of seven priority areas in this plan, along with objectives and metrics to measure progress. These metrics make up a vital component of Oregon's infrastructure, allowing leadership to regularly track progress toward tackling the state’s opioid crisis.

Stronger Prevention and Education Strategies

OHA’s success demonstrates that states have several opportunities to expand and strengthen evidence-based prevention and education strategies through accreditation, including PHAB Domain 4 (engage with the community to identify and address health problems).

Throughout the process, OHA found several benefits to engaging its community around the opioid crisis, referring to it as a drug “syndemic,” or a model for conceptualizing the misuse of a variety of drugs where there are common causal factors that interact synergistically. Activities undertaken as part of the SHA encouraged OHA to proactively engage the community. OHA held community focus groups to capture the various nuances of the opioid crisis that are often difficult to gather through population-based surveys and administrative datasets. “This engagement helped OHA to better understand the misinformation and impact of opioid misuse among subgroups of the population, including tribal communities,” Hedberg explains.

Through conversations with American Indian and Alaska Native community members, OHA discovered that some tribal health practices did not align with the risk reduction strategies and evidence-based approaches to medication-assisted treatment promoted by the state. OHA also heard concerns about naloxone potentially enabling opioid misuse. OHA is working with tribal leaders to encourage integration of evidence-based treatment for opioid use disorder and to support culturally-appropriate prevention and education materials and policies.

Greater Oversight Concerning Access to Opioids

Health agencies can use guidance under PHAB Domain 5 (develop public health policies and plans) and Domain 6 (enforce public health laws) to reduce and manage access to opioids in their states. Agencies can utilize this structure by assessing current measures, proposing amendments, and providing assurance around public health statutes, policies, and regulations.

OHA’s strategies included implementing its prescription drug monitoring program and developing opioid prescribing guidelines for chronic pain, acute pain, pregnant women, and dental settings. These strategies were developed after assessing various data sources in Oregon, including data on mortality, prescribing, and drug misuse showing that many clinicians prescribed high amounts of opioids, resulting in many patients becoming chronic users, or with “leftover” (unused or expired) medications. This likely contributed to Oregon having one of the highest rates of non-medical prescription opioid use in the nation.

Better Access to Effective Treatment and Recovery Support

Accreditation requirements in PHAB Domain 7 (promote strategies to improve access to healthcare) and Domain 10 (contribute to and apply the evidence base of public health) provided additional opportunities for OHA to improve access to effective treatment and recovery support for opioid misuse. Informed by data collected in the SHA, Oregon identified improving access to care as a top priority in its SHIP. OHA also identified a variety of evidence-based strategies, including the Medicaid program’s efforts to prioritize evidence-based non-opioid pain management therapies for patients with chronic, non-cancer pain.

As illustrated by Oregon’s experience, public health accreditation can support several programmatic needs within a health agency, including action to address the opioid crisis. OHA’s top public health officials believe tackling something as large as a drug syndemic requires leadership across sectors, in addition to integrating prevention, intervention, and treatment resources that support a coordinated response across state and tribal health systems, government agencies, academic institutions, and communities. By leveraging existing resources and efforts related to accreditation, health departments can establish a solid infrastructure and greater capacity to better prepare for and respond to the opioid epidemic and other public health crises. The four areas described above offer a path for state and territorial health officials to carry out a comprehensive response to preventing drug misuse in their jurisdictions.

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