Edwin Chapman, MD, a District of Columbia internist, understands that innovation is not just a buzzword conjuring up advancements such as stem cell research or cancer-curing treatments. Innovation may also include using telephones and video to help vulnerable patients during the COVID-19 pandemic.
The growing use and coverage of telehealth, once thought mostly as a tool to grow patient access in rural areas, has expanded Dr. Chapmans ability to continue to care for hundreds of patients with a substance-use disorder (SUD) in the nations capital.
When I started treating patients with buprenorphine 20 years ago, I was being sent patients by parole officers and was asked to treat their addiction, but these patients also needed mental health services, primary care and psychiatry, Dr. Chapman said. Treating only the addiction wasnt going to completely rehabilitate themyou have to treat everything.
What his patients needed was an integrated care modeland, for Dr. Chapman, integrating meant updating. He digitized his patients records and then equipped every exam room with a microphone and a webcam to transition to telemedicine.
His patients could come to one office while having multiple consultations with social workers, primary care physicians and psychiatrists. This approach offered one-stop shopping instead of what might have morphed into multiple bus rides and hours worth of childcare.
Telemedicine was originally only seen as something appropriate for a rural practiceas a way to help patients who might not have a physician nearby, Dr. Chapman said. But the socioeconomic reality for many is that, even when a medical office is close, there are childcare costs, time off work, plus multiple bus and train fares to contend with. Telemedicine is useful in bridging those gaps, too.
The in-office consults gave his patients access to a whole host of specialists and services while allowing Dr. Chapman to not just treat his patients SUDs, but also their chronic conditions such as diabetes, hepatitis C, HIV, hypertension and cancer.
Telehealth has helped one of my long-term patients for at least 15 years now, he said. This model has helped him to stabilize his life.
That patient, who asked to just be referred to as Bill, credits his honest relationship with Dr. Chapman for turning his life around.
My life was using drugs, I destroyed my marriage, and it wasnt until my second, or third time trying medication with Dr. Chapmans help that I was able to start feeling better, he said. The people who know me say I look good, but I still have ups and downs. Dr. Chapman helps me prioritize my feelings and emotionsI wish there were more Dr. Chapmans out there.
Bill is one of about 260 patients Dr. Chapman sees.
Treatment is about benefits that reverberate across the entire community, said Dr. Chapman. Beyond the health care savings of keeping patients with chronic conditions and comorbidities out of hospitals, theres a reduction in criminal activities and homelessness. Its helping my patients get back on their feet, find housing and jobs.
Its an economic model that shifts money from just housing these patients in jails, to providing them with the social services that allow them to regain control over their lives, he added. Bill has been with me for 15 years. He hasnt been incarcerated or gone back to the emergency room. He got his life back, and in doing so, we have decreased reliance on medical services.
For too long in the African American community, incarceration was seen as treatment. But thats never worked. We have to change the model because medical treatment provides widespread social benefits and economic savings.
Dr. Chapman helped expand professional education and reduce provider stigma regarding telemedicine by producing some Project ECHO (Extension for Community Healthcare Outcomes)sessions with the Urban Health Initiative at Howard University, where Dr. Chapman is as an adjunct assistant professor in the behavioral health and psychiatry department and where a fellowship program in addiction medicine was recently initiated.
Besides wider use and acceptance of telemedicine, Dr. Chapman said his patients would be helped if several overly strict regulatory structures that hamper SUD treatment, exacerbate health risks and impose harmful barriers to care would be removed.
Specifically, he would also like to see:
Increasing the use of telemedicine removed 10 years of challenges, Dr. Chapman said. We still have a long way to go to remove the stigma of opioid-use disorder, help those who are homeless and get more people trained to provide treatment for opioid-use disorder in urban areas like mineand we need to do it soon.
Learn more about what the AMA is doing toend the opioid epidemic.
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