Fixing the need for a fix: Treating 20,000 addicts in rural America

Fixing the need for a fix: Treating 20,000 addicts in rural America
Fixing the need for a fix: Treating 20,000 addicts in rural America

RMCHCS Community Worker Service Program members, (left to right), rear, Jason King, Leander Bitsie, Loren Mescale, RMCHCS CEO David Conejo and crew manager Bill Camorata; front, Nathan Begay, Francina Smith

David Conejo

David Conejo


The statistics are terrifying: According to the National Institute on Alcohol Abuse and Alcoholism, alcohol poisoning kills six people every day. More than 15 million people struggle with an alcohol use disorder in the United States, but less than eight percent receive treatment. Meanwhile heroin, fentanyl, and other synthetic drug addictions have surpassed alcoholism.

Almost 72,000 Americans died last year from drug overdoses, which is a record high, according to new preliminary estimates from the Centers for Disease Control and Prevention — a death toll higher than car crashes, and gun deaths.

Treating addiction is not a simple process. Ninety-day detox programs may only work well with thousands of beds, staff, and other resources, and behavioral treatment is a time-consuming process requiring individual diagnosis that is largely driven by trial-and-error guesswork.

Many technology-based health care solutions are available, but behavioral health has not benefited from innovation as much as physical health, despite being inextricably linked. Electronic health records (EHR) have been focused on the physical side of medical recording, leaving the behavioral side with little support.

While interoperability remains a major challenge in the health care industry, collaboration between physical and behavioral health care providers is also behind the curve. Behavioral health services (BHS) operate and are updated based on paper records, creating challenges around efficiency, communication, and the ability to scale treatment operations.

If a patient requiring behavioral care receives treatment at an urgent care facility, that data doesn’t get back to the patient’s primary care provider. In fact, the primary care provider only learns of the visit if the patient decides to tell them.

Providers addicted to records and files

Unlike physical care, behavioral treatments tend to be more subjective and require more time to monitor and record positive outcomes. Behavioral treatment depends more on data analytics from patients to determine the best approach for engagements. There are also additional categories required for BHS, such as chemical dependency, treatment plan, social service data, training programrelated data, and mental health assessments.

Historically, clinicians have evaluated a person’s mental state by examining movement patterns, mood states, social interactions, behaviors or activities at different times of day, vocal tone, speed, word choices, facial expressions, and biometric and heath measures. When assessing an individual’s symptomatology, large quantities of behavioral data provide vital information for researchers to increase their understanding of mental illness and well-being, develop better interventions and health outcomes, and potentially predict who may be at risk of developing behavioral health problems.

Before a substance abuse patient can check in to a behavioral health center, they need to be examined both physically and mentally. An intake coordinator starts that process; then the patient sees a nurse, followed by a counselor. In a typical BHS treatment center, admission is followed by treatment, which includes assigning a treatment counselor, a nurse for withdrawal, a case manager, and a training program coordinator. There is also a program for job training and an aftercare phase that includes monitoring, tracking, and reporting the patient’s progress. This phase is cumbersome due to the lack of an electronic recording system for behavioral health, as most records are stored as PDFs in EHR systems.

In addition to these limitations, there is a lack of support to track patient outcomes. Behavioral treatment centers may have operational differences, such as the number of treatment phases and the ability to track, monitor, and anticipate recidivism. Differing manual processes and types of documentation at treatment centers may slow support as well.

These compounded problems make the system seem almost designed to be slow and cumbersome. If the parameters of treatment can’t adapt to the surge in addicts, the only other approach is through the treatment process.

Treating 22,000 addicts

One of the nation’s epicenters of addiction is Gallup, N.M., where 22,000 addicts await a behavioral health care fix. The unemployment rate in the city is roughly twice the national average, and like other small cities and rural towns across the country, Gallup has a shortage of mental and behavioral health care providers.

To treat Gallup’s 22,000 addicts, providers implemented behavioral health service software, which monitors and tracks patients’ behavioral health. The preventive app monitors the health care needs of those suffering from addiction, dementia, and other behavioral health diseases with reports derived from specific criteria devised by providers to develop the most effective diagnosis. These reports also enable health care institutions to optimize efficiencies and facilitate patient care planning. This app enables hospitals to break through the barriers of traditional behavioral health care and monitor and track addicts in real time. Mobile devices generate topic-based reports that can quickly be compiled.

Successful treatment plans need to be based on accurate, identifiable data. Providers need to identify, track, and manage behavioral health by symptoms, ethnicity, substance abuse, and other points of data to create care categories that can integrate with a hospital’s EHR systems. This capability enables hospitals and clinics to identify patient symptom commonalities and leverage those findings, facilitating treatment and avoiding resource-consuming individual research. These types of reports can even be used for grant applications.

Collaboration among care providers and patients based on shared information is critical for successful treatment outcomes. The current paper-record approach limits such collaboration and the overall efficiency of the BHS treatment center operation. Embracing technology is the key.

Your chance to learn about rural opioid crisis solutions directly from those on the ground in New Mexico, and more from family physicians, nurses, physician assistants, and other practitioners from across the globe is at the 16th WONCA World Rural Health Conference co-hosted by NRHA Oct. 12-15 in Albuquerque, N.M. The deadline for our biggest discounts on registration is Aug. 30.