Charles D. Brackett, MD, MPH

Assistant Professor of Medicine, Geisel School of Medicine, Dartmouth; Associate Professor of The Dartmouth Institute, Geisel School of Medicine, Dartmouth

During and since medical school, Dr. Charles Brackett has been interested in health disparities and underserved populations and has felt that primary care is the most effective and efficient way to improve the health of individuals and populations. After his training at Cambridge Hospital, he pursued a GIM fellowship to improve his teaching skills and gain experience in research and public health. For his first job, he chose to work in a split position between a FQHC and Boston City Hospital serving the underserved. Since training, Dr. Brackett’s primary role has been clinician-educator with at least 25% of his time spent teaching students and residents in various settings, predominantly precepting residents in their primary care continuity clinic. In Boston, he was involved in shaping the Primary Care Track Ambulatory Curriculum, the Psychosocial Curriculum and the Race, Class and Culture Curriculum. Dr. Brackett spent a year in Rwanda (2014-15) with the Human Resource for Health project, which had the goal of doubling the throughput of medical students and residents. His role was entirely educational, including leading the Core Lecture Series: designing the curriculum and recruiting faculty to deliver 3 hours/week of content delivered to 4 sites through a web-based teleconference platform. Dr. Brackett is currently on the teaching team for General Internal Medicine, spending 2-3 half days/week teaching residents in their outpatient clinic and actively involved in their didactics and evaluation.

Dr. Brackett has a career-long interest in addressing behavioral health issues, especially opioid use disorders, in the primary care setting. In 1998-9, he received a Community Medicine Fellowship, during which he piloted a primary care-based opioid treatment program working with colleagues in behavioral health at South Boston Community Health Center. Dr. Brackett received one of the first waivers to prescribe buprenorphine in 2002 and has treated patients for opioid use disorder (OUD) in primary care ever since. Over the years, he has given over 30 talks to trainees and 7 regional or national presentations on alcohol and substance use disorders, in addition to talks on somatization and social determinants of health. After returning from Rwanda in 2015, he was hired by DHMC’s new “Knowledge Map” Unit to produce institutional consensus-based guidelines and decision support through their electronic health record (EHR). In this capacity, he was asked in 2016 to join Drs. Kraft and Torrey’s Substance Use and Mental Health Initiative (SUMHI) to work on the Behavioral Health Integration Project. After a year of planning, the project piloted the implementation of the Collaborative Care Model (CCM) of integration with the Nashua family medicine team. Around this time, Dr. Brackett also led a pilot of broadening Medication-Assisted Treatment of OUD using the CCM model in DHMC’s main resident teaching site (where I teach and practice). Their team is currently disseminating this model (CCM, including MAT of OUD) to all the DH primary care sites. To support this work, he led the creation of consensus guidelines with associated EHR tools (best practice advisories, smartsets, note templates…) on the topics of: Behavioral Health Integration, Depression, Anxiety, Unhealthy Alcohol and Drug Use, and Primary Care Based Treatment of OUD. Dr. Brackett led the group in selecting screening instruments for BH disorders and together we implemented pre-visit screening through the EHR patient portal and in-clinic tablets as part of our pilot. In 2018, Dr. Brackett was asked to head a new SUMHI project, the Opioid Addiction Treatment Collaborative, to promote the recognition and treatment of OUD in general medical settings. This focuses on initiating MAT with buprenorphine on the inpatient service and in the emergency department, with smooth transitions to ongoing treatment in DHMC’s specialty Addiction Treatment Program and/or primary care-based MAT.