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Willmar health care initiative seeks to reduce toll of opioid epidemic

Erica Dischino / Tribune Dr. Ken Flowe shows a medication safety pamphlet to one of his co-workers at Rice Memorial Hospital in Willmar. At Rice Hospital, opioid management efforts have focused on the two areas that loom largest for hospitals: acute pain in the emergency room and post-surgery. 1 / 5
Erica Dischino / Tribune Dr. Ken Flowe, chief medical officer at Rice Memorial Hospital in Willmar, and an emergency physician, said physicians have embraced an opioid initiative launched this year locally that aims to provide better education for both prescribers and patients. 2 / 5
Dr. Kathryn Duevel, Affiliated Community Medical Centers, Willmar, Minnesota3 / 5
Erica Dischino / Tribune A set of guidelines for prescribing opioids for postoperative pain lies on Dr. Ken Flowe’s desk at Rice Memorial Hospital in Willmar. Doctors at the hospital and at Affiliated Community Medical Centers are working to reduce the toll from opioids, in part by considering alternative ways to manage acute or chronic pain.4 / 5
Dr. Ken Flowe, chief medical officer at Rice Memorial Hospital, Willmar, Minnesota.5 / 5

WILLMAR — Through a local initiative launched this past year, doctors at Affiliated Community Medical Centers and Rice Memorial Hospital in Willmar are working to reduce the toll from opioids at a key source: the prescription pad.

A toolkit developed by ACMC offers better guidance for doctors on prescribing opioids for chronic pain. Similar work is underway at Rice Hospital to provide alternatives to managing acute pain in the emergency room and post-surgery.

Now the next phases are gearing up: narrowing gaps in local access to treatment for addiction and complex chronic pain and educating the public about opioid use.

"We need to get ahead of all of this," said Dr. Kathryn Duevel, medical director for quality and innovation at ACMC. "Think of the families you can save and the tragedies you can prevent."

Like most states, Minnesota is battling the epidemic on the prescriber front with strategies such as education and prescription monitoring.

But the problem is complicated and many-faceted, and one of the critical challenges is how to stem the tide at the community level where doctors see patients every day in the clinic and the hospital, Duevel said.

"Most physicians want to do the right thing. They want to take care of people the best they can," she said. "Now we have a problem and we have to say, 'What can we do better? What can we do differently?'"

For ACMC and Rice, the opioid initiative represents an opportunity to help alter the curve of Minnesota's rising number of opioid overdoses and deaths.

"I would like to see some consistent decreases in deaths from opiates as well as fewer prescriptions in emergency rooms," said Dr. Ken Flowe, the chief medical officer at Rice Memorial Hospital and an emergency physician. "How do we find a middle ground and do what's right?"

One of Duevel's first tasks when she started her new position last year was to look at ACMC's opioid prescribing policy. A work group was convened this past year. Community partners were brought in to share their expertise.

The result was a new policy and clinician toolkit introduced this past May, that pull together best practices to guide doctors in prescribing opioids.

Duevel hopes it will reduce some of the barriers doctors face in providing the best care to this patient population.

Keeping up with the evolving state of knowledge on opioid management is one of the challenges for doctors, but the biggest issue is time, she said.

Appointments often simply aren't long enough to explore everything that may be going on with someone who has chronic pain or to discuss alternatives to opioids, Duevel said.

"We have all these different things to look at in deciding what to do with this person's chronic pain. That's a long conversation," she said.

The toolkit helps doctors be better prepared to have that conversation while also taking a whole-person approach to the patient in front of them, she said. "It gives them the right information at the right time. It helps them keep track that they're doing the right things."

At Rice Hospital, efforts have focused on the two areas that loom largest for hospitals: acute pain in the emergency room and post-surgery, where new prescriptions for opioids often originate.

Prescribing narcotics is no longer automatic, Flowe said. Patients might be offered something else for acute pain or, if they need a narcotic, they might be prescribed six to 10 pills instead of 30, he said.

"We're trying to take a more thoughtful approach," he said. "The key thing is alternatives."

Certified registered nurse anesthetists at Rice received advanced training this past year in administering nerve blocks for acute pain. Flowe hopes to bring their expertise into the ER this coming year.

He and Duevel said local doctors are embracing the opioid initiative.

"The most surprising non-challenge has been getting physician buy-in," Flowe said. "Physicians have been eager."

Duevel has been visiting the clinics in ACMC's network to help doctors implement the toolkit, and she said she's getting more requests for help. "It's steadily gaining traction," she said.

In recent months the initiative has started to broaden.

Limited local access to addiction therapy has been a barrier for helping people reduce dependence on opioids, Duevel said, noting that many patients have to travel 100 miles or farther to obtain a prescription for buprenorphine to treat their addiction.

Programs that offer alternatives such as biofeedback for chronic pain also are scarce in rural Minnesota.

Efforts are underway to expand the number of doctors in the region certified to prescribe buprenorphine.

A pilot program with Courage Kenny Rehabilitation Institute also was recently launched to provide alternatives for chronic pain management that are available locally. It's currently limited to one ACMC physician's patients, but Duevel expects it to grow.

With the merger Jan. 1 of ACMC and Rice Hospital into the new Carris Health organization, Duevel and Flowe believe their ability to tackle opioid use across the region will be enhanced. The to-do list for upcoming months includes public education and the forging of partnerships beyond the hospital and clinic.

"We're trying to make sure we cover the whole spectrum," Duevel said. "We're happy to work with anybody. We want this to be a regional program."

What gives the opioid epidemic so much emotional resonance is how its impact is felt by ordinary people, most of whom never expected they or someone close to them would become addicted to a drug prescribed for pain, Duevel and Flowe said.

"I would like to see our population educated and interested in the best practices physicians are offering so we don't have to talk about this as often," Duevel said. "Then maybe we can have it become a rare problem."

Anne Polta

Anne Polta covers health care, business/economic development and general assignment. Her HealthBeat blog can be found at http://healthbeat.areavoices.com. Follow her on Twitter at @AnnePolta.

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