In a rural state like Wyoming, state health care providers are no longer newcomers to utilizing telehealth to help bridge distances. But Cody Regional Health is experimenting using remote technology for an opioid treatment that is generally underutilized in the nation.
"There's like this massive TV that I show up on so everybody else, you know, is normal human size. And then I'm on the TV, where it shows me like from the shoulder up, so I'm like this giant in the room," described Krista Blough, a psychiatric mental health nurse practitioner at Cody Regional Health.
She's describing how she appears to patients during medication-assisted treatments (MAT) that is provided through telehealth.
"And so it's a little weird, but, but it's great. It's predictable, it's consistent, and I feel close with [patients]," said Blough. "And surprisingly, the patients report that they feel close with me as well."
A MAT program combines prescription medications used to treat opioid use disorder and group therapy. Many experts refers to it as the most effective way to treat opioid use disorder, but there have been barriers to the treatment becoming widely used.
"There are not enough providers. And there's some stigma around opioid use disorder," said Saira Haque, a senior health informaticist at RTI International, a nonprofit research and technical service company.
There's a stigma because MAT uses a controlled substance for its treatment. Nationally, there are only about 6,000 providers who have the waiver that allows them to prescribe the medication required for the treatment. In Wyoming, there are 85 prescribing providers.
And Haque said there's one more problem, "reimbursement for MAT is across the board."
But Krista Blough said the retention rate for patients that utilize the program show that it can be very successful
"Nationwide, with true MAT programs, relapse rates are less than 25 percent. And that's good, because when they relapse, they die," Blough said.
Cody Regional Health has seen similar numbers with its MAT program, which is good news because some patients were driving more than two hours weekly to get treatment. Dr. Brett Martin, a certified addiction practitioner at Cody Regional Health, said they decided to apply for a grant to make it easier on patients.
"With all of the opiate epidemic in the United States, the federal government has brought a lot of money to individual states. And when they did that, here in Wyoming, we applied for a grant," said Martin.
Cody's grant funding came through the Wyoming Department of Health and will last for two years. The grant helps with the covering treatment costs, and they used a lot of money to get the technology.
For Martin and Blough, there are definitely challenges to providing care remotely through a screen. For instance, it takes a while for patients to get comfortable with it. But Dr. Martin said it's the way of the future.
"We've had patients driving to us from Montana or southern Montana, from Thermopolis, from Worland, from the Basin and Greybull areas, coming driving to our program weekly," said Martin. "Which has a lot of barriers, weather, the cost of transportation, and so we've been able to take the treatment to their rural area and provide that to the patient for free."
And while there are still a few kinks to work out, like having to see the patient in person for the first consultation, the folks at Cody Regional Health believe this model is preferable than their patients driving hours every week.
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