RHET CHLE Write-Ups
Karyn K Cecele, MD
Working with a rural county to address non-prescription opioid use
Background:
Jackson County is a rural county in West-Central Wisconsin that consists of farmland and forests with a scattering of six small towns and villages. The total population is 20,554. The county’s 2017-2019 Community Health Improvement Project (CHIP) identified non-prescription opioid use as a priority based on the 2016 Community Health Needs Assessment initiated by Black River Memorial Hospital, the County’s only hospital. Black River Memorial Hospital (BRMH), Jackson County Department of Health and Human Services (DHHS) and other local organizations formed the Community Health Improvement Network (CHIN), a group designed to address goals set forth in CHIP. A subgroup of CHIN focused on opioid use in the county. The group consisted of BRMH, DHHS and Together for Jackson County Kids, an organization that offers evidence-based training to families to reduce youth drug abuse and other problem behaviors, along with other local organizations. The group identified that a critical barrier to improving county-wide outcomes was a lack of access to medication-assisted treatment for patients with opioid use disorder. In 2018 SAMSHA showed rural Jackson County had no physicians with X-waivers allowing them to prescribe buprenorphine for the treatment of opioid use disorder.
Objectives:
The objective of my learning experience was to investigate ways of addressing opioid use disorder in a rural county, and to explore necessary components of providing MAT as a physician in a rural county without other X-waivered providers.
Methods:
I participated in CHIN meetings in person or by telephone when possible. In addition, I shared information with the group about incidence and prevalence of opioid use disorder in the county and best practices for addressing opioid use disorder. I also discussed the impact of opioid use with stakeholders including physicians, EMS, Drug Court, and social workers from both the hospital and Department of Health and Human Services.
Results:
On a community wide basis, there were no measurable consequences of my activities. Over the course of my participation, there was more familiarity with and interest in prescribing buprenorphine for MAT among local physicians. However, there are currently no active prescribers in Jackson County. The momentum of the CHIN group waivered over time and the group is no longer meeting regularly
Conclusions:
I learned a great deal about opioid use in general and about the impacts of opioid use in Jackson County in particular. In addition, I was able to observe the difficulty of maintaining momentum in a network of community organizations with representatives already burdened with heavy workloads. I also learned that there is hesitancy to treat opioid use disorder with MAT without multiple prescribers within a practice to prevent “overloading” an individual’s patient panel, and without an established organizational structure for addressing the complex needs of many patients with opioid use disorder.
Acknowledgments:
Jillian Landeck for excellent guidance on this project. Esteban Miller and MaryBeth White from Black River Memorial Hospital for welcoming me and allowing me to engage with the team.
Kelsey Schmidt, MD
Green County Mental Health Matters and Farmers’ Health
Background:
For my CHLE I worked with a county wide collaboration called “Mental Health Matters” to help address mental health disparities. The vision for this effort is that Green County residents will experience greater access to mental health services through an expansion of behavioral health prevention, intervention, and support services. The initial framework for the committee came from a community health needs assessment. Green County Human Services sees 2-3 patients whom have attempted suicide per week. Monroe Clinic Emergency Room saw 70 patients who intentionally overdosed or self-harmed in 2015. In addition to this coalition work, I also worked more specifically to address the hardships facing area farmers and the effects it has on their health. This work included partnerships with local experts in the field, SWCAP, UW Extension, and other medical trainees.
Objectives:
As part of this learning experience I was trying to network in my community and establish relationships with stakeholders around this topic. Mental Health Matter’s main goal was to establish a Mental Health Navigator position. Additionally I wanted to raise awareness about farmers’ health related topics and address the barriers to access.
Methods:
I met regularly with the Mental Health Matters team at monthly meetings. I completed related tasks in the interim. I also developed several lectures and an afternoon-long educational event pertaining to Farmers’ Health. Additionally, I attended the Southwestern Wisconsin Mental Health Matters Summit.
Results:
Several exciting outcomes developed from this work in addition to many networking experiences. First of all, a Mental Health Navigator position was developed in Green County. They now have a physical space in the Public Health Department Building and a part-time navigator position. I also gave several presentations pertaining to Farmers’ Health topics. In total there were about 40 attendees who gained knowledge and were able to better care for their patients who are farmers. Pertinent resources were shared with clinicians and distributed at the Family Medicine Clinics.
Conclusions:
Throughout residency I have really enjoyed getting to network in my own community and meet people who are excited about making changes to decrease mental health stigma and improve access to care. I have also enjoyed working on Farmers’ Health topics as it is a way to combine my family’s ties to agriculture with my profession. It has been fun to see how these two projects have overlapped. The challenge has been to stay engaged when on more time intensive rotations. I have recently had more invitations to work on Farmers’ Health projects and am excited to see what will come of those.
Acknowledgments:
Special thanks so the many collaborators I had on this project. These include the members of the Mental Health Matter Committee, members of the Rural Health Equity Pathway, Justin Sena, Dr. Jillian Landeck, Dr. Lou Sanner, Chris Frakes, Jackie McCarville, John Shutske, and Rebecca Steffes. Lastly I would like to thank my husband Tyler Schmidt and his parents for their support.