AAOA welcomes guest bloggers to share their perspectives on how to address prevention of misuse and abuse of prescription opioids. Desmond Watt, PA-C, is a virtual medical director for One Medical, based in Chicago, Illinois. He is the co-founder and president of PAs in Virtual Medicine and Telemedicine (PAVMT), a special interest group of the American Academy of PAs (AAPA). His medical experience includes internal medicine, men’s health, cardiovascular health, hypertension and sports-related conditions. Desmond earned his master’s in medical science from Midwestern University.
The COVID-19 pandemic has affected how healthcare is delivered across the country. One of the most significant changes is a widespread adoption of telemedicine. The inability to bring patients into the office setting has forced a rapid transition into the use of remote or virtual medical services.
Prior to the COVID-19 pandemic, healthcare providers had varied levels of telemedicine infrastructure in place. Remarkably, healthcare organizations have worked quickly to unveil new telemedicine platforms to sustain their routine patient care.
The shift to telemedicine has been a major change for both healthcare providers and for patients, and affects the way providers educate, monitor and counsel their patients. Virtual patient-provider conversations are particularly important when it comes to discussing the rights, risks and responsibilities associated with prescription opioids.
The Physician Assistant (PA) Foundation, an Allied Against Opioid Abuse (AAOA) national partner, is especially interested in how the use of telemedicine during this challenging time impacts patient care, particularly whether it presents barriers that impact PAs’ abilities to care for their patients. Fortunately, states around the nation have relaxed some restrictions related to opioid prescribing by way of telemedicine during the pandemic, granting PAs the opportunity to leverage best practices related to counseling patients about prescription opioids.
It is important to remember that telemedicine is medicine. While connecting with a patient via remote encounter may feel different, the actual logistics of providing care are similar to an office-based encounter. If anything, connecting with patients via telemedicine can be more personal, as often the prescriber may be in their home office and the patient in their home space. To me, connecting in this way is akin to a “modern-day house call,” and can allow for a deeply personal conversation.
Telemedicine can be effective for educating patients who have been prescribed opioids. The more personal platform, which places the patient in the comfort of their home, or a comfortable private space, provides PAs with an opportunity to employ the concepts presented through the Pledge to Pause, and to have very deliberate discussions about risks and responsibilities of prescription opioid misuse.
When in-person medical visits are prohibited, telemedicine allows healthcare providers to continue to evaluate a patient’s treatment progress and determine when or if there should be a change in their prescribed medications. In evaluating a patient virtually, they can adjust dosage or change medication and deliver guidance on safe use as well as alternative pain relief strategies. Ultimately, expanding the use of telemedicine services may in fact increase access to services for patients using prescription opioids as well as enable the time and environment necessary for difficult conversations.
Provider communication to patients about safe storage and proper disposal of prescription opioids takes on new meaning during this time, with more individuals staying “safer at home.” When routines change and family members of all ages are in the home consistently, it’s important to remember to lock opioids away and to immediately dispose of unused quantities if no longer required.
Communication between healthcare providers and use of state-based prescription drug monitoring programs also are critical to successfully delivering care virtually for patients using prescription opioids. By connecting with different providers, PAs have insights into the patient’s entire history and can discuss how prescription opioids may impact other aspects of the patient’s care plan. This integration also reduces costs to the system, while improving patient outcomes and overall quality of care.
Moving forward, I anticipate strong continued growth in the popularity and utilization of telemedicine across the healthcare space. We know from research that patients are highly satisfied with telemedicine, and with the right processes and considerations in place, they can quickly become comfortable with the platform. Work is underway to address barriers to telemedicine accessibility, from expanding high-speed internet access to offering language interpretation services for patients.
The pandemic has demonstrated that telemedicine is an important tool in expanding access to healthcare. PAs are embracing the opportunity and are well-suited to play an active role in reducing the misuse and abuse of prescription opioids among patients and their families.