Innovative healthcare providers and thought leaders are using telehealth technology to empower primary care physicians in remote parts of the United States with powerful leading-edge treatments aimed at turning the tide against the crisis of opioid addiction.
“A significant challenge of the opioid epidemic is the lack of treatment options for millions of Americans living in rural communities,” says David Meyers, M.D, director at the Agency for Healthcare Research and Quality (AHRQ). “We can expand access by engaging primary care practices—the places where most rural Americans receive care.”
AHRQ is working with several entities to help them take new approaches in the fight against opioids – a public health disaster that began in relatively isolated sections of rural America. One of the most exciting efforts is Project Echo, which uses a video conferencing modality to connect primary care physicians with specialists. The idea is to teach primary care physicians specialized services – such as how to handle opioid misuse and withdrawal – they wouldn’t otherwise feel capable of handling, says Miriam Komaromy, M.D., associate director of Project ECHO.
It’s about more than telemedicine, she stresses. “It’s not specialists providing care to patients over video or phone, it’s specialists mentoring primary care providers in a simultaneous video conferencing setting.” Typically, a dozen or more primary care physicians tune in to a weekly video conference to watch a lecture and ask questions of a specialist or group of interdisciplinary specialists.
For example, a primary care physician in a rural area might be struggling with a patient who’s been injecting heroin for years and is now diagnosed with Hepatitis C. The patient requires a specific treatment regimen and medication, but the primary care physician may have little or no experience handling such a case.
The physicians on the video conference discuss the patient’s situation, and the specialist uses it as a teaching opportunity, Komaromy says. “They cite evidence, they cite guidelines, and the primary care physicians participate” and learn from the discussion.
Over time, after a series of video conference sessions, the primary care physician becomes more comfortable handling patient needs in their locality. The video conferences include the full spectrum of interdisciplinary care, including nurse practitioners and counselors, Komaromy explains. “They can develop a team-based care plan.”
Primary care physicians benefit from the counsel of an invaluably ally. “They have expert advice and support” from the specialists, she says. “Somebody they can contact if they get into trouble and are struggling with the patient. Over time, by [working together] on cases again and again, [the primary care physician] can really raise their level of confidence and expertise.”
The overarching goal of the program is to “expand access to needed services to underserved populations,” Komaromy says. “In the case of the opioid epidemic, there’s a huge need to train more primary care providers to prescribe medications to treat addiction.”
A relatively new tool, Medication-Assisted Treatment (MAT), also offers new hope, Meyers adds. It begins with utilizing existing relationships between caregivers and patients. “Doctors and nurses in these practices are trusted members of the community, they need information and tools to provide effective care for patients with opioid addictions.”
MAT, an evidence-based therapy for assisting people with opioid addiction, involves using both medications and behavioral support to empower people to manage their addiction. “The trouble is that many primary care physicians find it difficult to introduce MAT into their practice.” Meyers says.
AHRQ is investing in a series of grants to discover how the healthcare delivery system can best support rural primary care practices in delivering MAT in their communities It’s also earmarking approximately $12 million over three years for this initiative, which was announced in July 2016.
AHRQ’s grant initiative has brought together innovative teams including State health departments, academic health centers, researchers, local community organizations, physicians, nurses, and patients to introduce MAT to hundreds of rural practices. For example, two areas of geographical focus are Muskogee County, Oklahoma, where more than 1,300 people are thought to be in need of treatment for opioid addiction, and Bent, Colorado, where the overdose death rate has increased from fewer than 10 to more than 20 per 100,000 since 2002.
Grantees are utilizing innovative technologies, including patient-controlled smart phone apps, and tele-mentoring to support rural primary care practices in Colorado, North Carolina, Pennsylvania and Oklahoma.
It’s too early in the cycle to gauge success, Meyers says. All four grantees are active in the field and have finished recruiting primary care practices and are now providing support, identifying barriers, and developing solutions. “AHRQ is preparing to widely disseminate what the grantees learn,” he says.
There’s little doubt a program helping practitioners better treat victims of opioids will have a positive ripple effect in remote regions of the United States, which have been the hardest hit by the opioid epidemic.