The VOICE of UPMC Shadyside Winter 2022–2023

Grant for Addiction Care Thrives at the Family Health Center

Inspiring and Supporting Innovation and Initiating New Programs at UPMC Shadyside

Dr. Alan Finkelstein loves Family Medicine — “the diversity, the opportunity to interact closely with patients through both joyous and difficult stages of their lives.” His special interest in cross-cultural health has led him to care for people in the Apache and Navajo Nations, Ecuador, India, and Bethel, Alaska, about 400 miles west of Anchorage. “You could get in and out of Bethel only by plane or canoe,” he remembers.  

But since 2001, he has stayed home in Pittsburgh to care for patients and teach Family Medicine residents at the UPMC Shadyside Family Health Center, which experiences about 35,000 visits a year from people in all walks of life. As the opioid epidemic worsened locally, statewide, and nationally in the 20-teens, Dr. Finkelstein and his like-minded colleagues decided that the Family Health Center “had to be the place on the Shadyside campus where patients could seek addiction care.” 

This dedicated team included, especially, Lindsay Nakaishi, MD, MPH; Lisa Schlar, MD; Scott Brown, DO; Stephanie Ballard, PharmD, BCPS, BCACP; Stefany Munsch, MSW, LSW; and Phil Phelps, LCSW, BCD, along with support from Family Medicine residents, other faculty members, and office staff. 

They turned to the Shadyside Hospital Foundation for help. With combined funding from the Foundation and the Staunton Farms Foundation, the Substance Use Recovery Clinic to treat substance use disorders at the Family Health Center started in 2019.  

Although COVID-19 briefly slowed its takeoff, the program now enables the Family Health Center to “effectively manage opioid and alcohol use disorders in a primary care setting,” Dr. Finkelstein says. “Patients feel well supported by having all their chronic diseases treated within one health site.” 

As added benefits, the Family Health Center can now begin medications for opiate and alcohol use when their patients are admitted to Shadyside Hospital and can directly connect them to continuing outpatient care. A direct referral system also targets Emergency Department patients who have a substance use disorder and need a primary care physician. 

“By welcoming these community members into our practice, we can not only treat their substance use disorders but also connect them to services they may not currently be receiving, such as preventative care, sexually transmitted disease screenings and treatment, hypertension management, women’s health care, HIV treatment and prevention, and mood disorders and Hepatitis C treatment,” Dr. Finkelstein says. 

“We are really proud that the Family Health Center is becoming part of the broader solution to the addiction crisis, which touches so many lives,” he adds. “We have so far been able to train more than 30 Family Medicine residents — who will be family physicians in our communities — in caring for patients who have substance use disorders.” 

Whole-person care

“I believe that teaching Family Medicine residents how to diagnose, evaluate, and treat substance use disorders is a giant opportunity for us to improve in primary care,” says Dr. Scott Brown. “Patients with addiction can have other health concerns, and they need somebody who knows how to help them pull it all together. This kind of whole-person care leads to a better understanding that every patient’s health is rooted outside of the four walls of our office,” Dr. Brown says. 

While medications such as Suboxone are pivotal in treating opioid use disorders, medication is actually only one part of the journey. “Once we have folks who are into a degree of recovery,” says Dr. Brown, “our goal is to ‘graduate’ them to primary care providers who can understand all of their chronic conditions — alongside substance use disorder — in the context of their ongoing care.

“My vision is that every primary care provider here will be as comfortable with the acute stabilization and management and the ongoing maintenance of these patients as they are with treating other chronic diseases,” Dr. Brown says, “so that there will be no need to silo or segment anyone’s care.”

They let us know we’ve changed their lives” 

Crucial to the success of the program is Katherine Swords, LSW, a psychiatric social worker who supports patients engaged in the Recovery Clinic, maintains the Recovery Clinic and patient registry, identifies and engages new patients, and helps connect patients to mental health services and other community resources, including transportation and housing assistance. 

Her position was originally funded by the Shadyside Hospital Foundation and the Staunton Farms Foundation — with the hope that the Recovery Clinic could become self-sustaining. That has happened. 

“Working with substance use patients is something that I fell in love with early in my career,” Ms. Swords says. “I saw how a lot of providers were uncomfortable treating those patients. And I just sort of recognized that these were people who needed somebody on their side to help them advocate for fair treatment.”

What Ms. Swords especially likes at the Family Health Center is the opportunity to follow patients and provide them with support throughout their recovery journey. 

“Our goal is to save lives and help our patients have a better quality of life,” she says. “Whether that means reducing their substance use or stopping completely, we’re here to support their goals, even help them figure out what their goals are. Many of our patients are very thankful for that, and they let us know that we’ve helped in changing their lives. And at the end of the day, I think that’s the greatest thing.” 

“We are grateful that the Shadyside Hospital Foundation was so forward-thinking in helping us launch this,” says Dr. Brown. “We feel really proud of what we’ve done. Some of these patients have come a long way with us. We could not have done it alone.” 

“It’s the kind of success story you always hope for,” says Dr. Finkelstein.