While the opioid crisis has reached every community, rural America has been hit particularly hard.
In October 2017, the Centers for Disease Control and Prevention (CDC) indicated that the rates of drug overdose deaths in rural areas are surpassing those in urban areas. This month’s estimates on opioid-related deaths show that this figure is only rising – a record 72,000 Americans lost their lives to drug overdoses in 2017 according to the CDC. The epidemic has indeed become one of the worst public health crises in recent history, surpassing the peak yearly death tolls from the height of the HIV epidemic in the 90s as reported by the New York Times.
Now more than ever, it is important for us to embrace telemedicine as a solution to address rural America’s care access challenges. As one moves further away from academic medical centers, the density of providers that are specially trained to manage addiction rapidly decreases. Researchers have long demonstrated telepsychiatry’s ability to secure positive clinical outcomes for a variety of mental illnesses, including panic disorders, depression, and post-traumatic stress disorder.1,2 Newly published research in the American Journal of Emergency Medicine shows that clinicians now see enormous benefit in expanding telepsychiatry services in the country’s emergency departments (ED) to address the increasing volume of ED mental health visits.3
As a force multiplier, telemedicine can help connect communities with the right care in two key ways. On the provider-to-patient front, individuals suffering from addiction can obtain greater access to a wider pool of trained specialists, such as a telepsychiatrist or social worker, which is an important supplement to the primary care physician (PCP). When I think back to my medical school training days in rural West Virginia, most of the PCPs needed to care for a large population with a variety of medical needs. Providing the high-touch treatment needed for patients suffering from mental health issues is very challenging under these circumstances.
On the physician-to-physician side, telemedicine can empower PCPs and healthcare professionals in rural communities with specialized knowledge. For example, there is now a surge in online educational programs for rurally based physicians who are interested in effective therapies targeted at curbing addiction, such as medication-assisted treatment (MAT). MAT, a combination of psychosocial and medication therapy, is considered one of the mostly highly effective therapies for opioid use disorder. However, many providers still lack the specialized training required to appropriately implement MAT for their patients. Fortunately, new initiatives such as the federally-funded Distance Learning and Telemedicine Grant (DLT) Program and the Extension for Community Health Outcomes (ECHO) programs are allocating millions of dollars to improve this type of physician-to-physician telemedicine.
Telemedicine also has the power to extend the reach of the entire care team, which has now expanded to an interdisciplinary group of professionals including nurse practitioners, pain specialists, telepsychiatrists, pharmacists and social workers. Together, these care professionals can increase the number of touchpoints with a patient and greatly reduce the likelihood of a relapse. But those touchpoints can only be made possible if care teams can access the patient, easily communicate with each other and securely share patient information.
While bleak, I hope that the CDC’s latest estimates further accelerate the progress we have started to see with virtual care solutions. We have the technology, the funding and cultural impetus to kill “death by zip code.” We must continue supporting the widespread adoption of telemedicine to connect those suffering in rural areas with physicians who are trained and willing to help. We cannot slow down – we owe that, at a minimum, to those 72,000 families.
1 Lauckner, C., & Whitten, P. (2016). The State and Sustainability of Telepsychiatry Programs. The Journal of Behavioral Health Services & Research, 43(2), 305–318. http://doi.org/10.1007/s11414-015-9461-z
2 Deslich, S., Stec, B., Tomblin, S., & Coustasse, A. (2013). Telepsychiatry in the 21st Century: Transforming Healthcare with Technology. Perspectives in Health Information Management / AHIMA, American Health Information Management Association, 10(Summer), 1f.
3 Heravian, Anisa et al. (2018) Mental health and telemedicine in the acute care setting: Applications of telepsychiatry in the ED. The American Journal of Emergency Medicine, Volume 36, Issue 6 , 1118 – 1119. https://doi.org/10.1016/j.ajem.2017.10.053