February 22, 2023 by
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Ratchanu “Rae” Everett, FNP, is a nurse practitioner at the Mi’kmaq Nation Family Health Service clinic in Presque Isle, Maine, in a community hit hard by substance use and a state experiencing a record number of opioid overdose deaths. The clinic provides acute, wellness, and prevention services to a primarily tribal population of around 500 patients. A new clinician in a very rural area, Everett has to navigate the often-challenging process of finding treatments for patients dealing with both a substance use disorder and a chronic condition, but has limited expertise.
Now, for rural clinicians like Everett seeking consultation with addiction medicine specialists, the ‘doctor is in.’
Led by Stacey Sigmon, Ph.D., professor of psychiatry and a Vermont Center on Behavior and Health researcher, the University of Vermont’s Center on Rural Addiction (CORA) has launched a new free program – called Clinician Office Hours – to help providers access this expertise. While most of UVM CORA’s initiatives focus on rural Vermont, New Hampshire, Maine and Northern New York, this new program is available virtually to any health care provider in the U.S. located in an area designated as rural by the Health Resources & Services Administration. Everett took part in the pilot phase of the program in fall 2022.
“The mental health crisis has compounded the substance use disorder crisis, and made decision-making and treatment pathways more complex,” said Gail Rose, Ph.D., associate professor of psychiatry and director of UVM CORA’s Best Practices and Clinical and Translational Cores.
During the weekly one-hour consultation sessions, UVM specialists in prevention and treatment of SUDs, including Peter Jackson, M.D., and Brady Heward, M.D., both UVM assistant professors of psychiatry, can address a wide range of SUD treatment-related topics, such as opioids, alcohol, or tobacco. They can make recommendations based on the patient’s age and health status, and assist the rural provider with developing a treatment plan that includes evidence-based practice recommendations for medications, harm reduction, contingency management, and more.
“We have a lack of access to specialties, and distance is a factor, so [the program] is very important,” said Everett, who added that she has adapted many of the strategies she learned during Clinical Office Hours for use in her clinic.
The idea for the program was hatched following a review of needs assessment survey data collected by UVM CORA. This survey gathered direct input from practitioners in Vermont, New Hampshire, and Maine working with individuals with SUDs. In the survey, they indicated that consultation with "champion" providers (for example, experts who could provide mentoring/coaching regarding complex patients) is a much-needed resource, with 65 percent of rural practitioners across the three states designating this resource as “high priority.”
“We aim to help primary care providers improve their confidence and comfort level in providing the highest-quality, evidence-based care to individuals and families impacted by substance use disorders,” Jackson said.
To participate, rural providers register in advance of the weekly session and can provide information about the SUD-related issue they would like to discuss. Up to three providers can take part in the consultation, which takes place via Zoom.
Fortunately, Jackson and Heward have expertise in psychiatric treatment for both adults and children, so they can help providers and teams with questions about how to care for individuals and families impacted by mental health challenges. This is critically important given that many rural areas currently have greater challenges accessing mental health services than substance use treatment.
Everett is hopeful that she will be able to attend the additional consultation sessions in the future, despite her busy schedule managing multiple complex cases. Her goal is to offer her patients the full spectrum of care. She has held sessions for family members on monitoring patients with SUD for symptoms of withdrawal, and her clinic makes intranasal naloxone available so families can administer the life-saving medication in the case of an overdose before emergency medical services arrive.
Jackson noted that over the past couple of years, he and colleagues in the field have been seeing a rise in both mental health and substance use disorder needs.
“We’re going to see the climb in substance use disorders from the pandemic for a while,” he said. The good news, he added, is that the benefits of treatment – once it’s been provided -- “are always readily visible.”