This profile was written by Jackie Zubrzycki of the Colorado Health Institute, a third-party evaluator of the Colorado Health Access Fund. Pictured in the cover photo: Tonya Cook and Ryan Jackman
For people who live in Western Colorado, a primary care doctor can be hours away from home. When patients are struggling with a drug-related problem, a qualified provider can be even farther away.
At St. Mary’s Hospital in Grand Junction, Tonya Cook, a pharmacist, and Ryan Jackman, an addiction medicine physician, have launched a telemedicine program called PATH (Providing Access to TeleHealth) with the support of the Colorado Health Access Fund. PATH allows Dr. Jackman and Dr. Cook to consult with patients and doctors in 12 clinics throughout Western Colorado in order to assist them with concerns involving substance use disorders and complex medication regimens.
Cook and Jackman offer providers two major services: Chart reviews, in which they review patients’ histories with the provider and suggest possible treatment options, and “co-visits,” during which they consult with patients and providers together.
Many patients are dealing with chronic pain, which presents a challenge for providers and patients. Often, Cook said, “they’re dependent but not necessarily addicted to opioids.”
The American Academy of Family Physicians has advised family doctors that alternative treatments for pain are preferable to opioids. While the Centers for Disease Control (CDC) and groups like the AAFP have provided guidelines, “there aren’t always practical recommendations for getting from point A to point B. Providers are wanting someone to help them navigate this overlap of treating pain and addiction.” said Jackman.
|Tonya Cook, a doctorate-level pharmacist, left, and Ryan Jackman, a board-certified addiction medicine specialist, right, test out a telehealth system they use to consult with primary care clinics throughout the region that have less specialized knowledge about how to deal with complex situations or addiction.
Using video conferencing, Cook and Jackman help doctors identify whether patients have a disorder and offer recommendations about how to manage pain other than with opioids.
At many clinics, providers are not prepared to treat opioid use order. That led Cook and Jackman to organize four buprenorphine waiver trainings in Western Colorado, which providers from PATH sites have attended. These trainings help providers learn how to prescribe a medication commonly used to wean patients off of opioids. While they were not an initial part of PATH’s planned programming, they have directly increased the number of buprenorphine prescribers in Western Colorado.
PATH has also given providers the opportunity to discuss complex medication regimens. Cook described one situation in which she spoke with a 45-year-old patient who was taking 45 medications for multiple conditions including chronic headaches. Dr. Cook reviewed the woman’s chart and history to determine which medications were necessary, and then met with the patient and provider who had requested help. She shared with the patient her concern that her headaches were actually being made worse by her medication regimen. After the co-visit the patient agreed to decrease some medications and stop others. At a follow-up co-visit, the patient reported her headaches were better.
The PATH approach has had both pros and cons. The telemedicine approach allows for relatively simple set up due to ease of access to equipment like a speakerphone and a laptop. However, the technology is not foolproof. At times wireless internet is episodic in a clinic, or the microphone doesn’t allow for ideal sound in a crowded room. Scheduling can also present a challenge — no-shows are relatively common.
But the PATH team said they had been able to improve their services over time. Family practices have developed workflows and approaches gleaned from each other’s experiences.
SCL Health and St. Mary’s are exploring ways to continue the telemedicine program. The question now is “how do we sustain a program that’s very popular, that’s made great changes for patients’ overall care, and that insurance isn’t paying for at this time?” Jackman said.