anxious , and unable to reach their providers to get care .
“ I really felt before like I was ‘ in-theknow ’ on access to care ,” she reflected . “ I thought , ‘ you know , I get it . I ’ ve worked a lot of these little towns . People would come into the ER in the evenings and say , ‘ I don ’ t have any health insurance , so I ’ ve got to come here to get care , I ’ m sorry .’ I really thought I had a handle on that … that I was on the front lines , educated . Now , I don ’ t think anybody really understands the barriers to care and things like that until they witness what we ’ ve witnessed over the last couple of years .”
A case in point , Dr . Martin shared a call she received from one of the largest providers of substance-abuse disorders and recovery services that had closed just a few months into the pandemic . The organization had an extensive outpatient practice caring for hundreds of patients on medication-assisted treatment ( MAT ) for addiction . “ We had an economic crisis , a pandemic , and now , one of the only stabilizing forces in these people ’ s lives was taken away from them suddenly through no fault of their own ,” said Dr . Martin . “ There are few MAT providers in the state because it requires special licensing . When we got the call , my nurse practitioners and I ( all DEA-certified ) decided we didn ’ t want people to be without this care . We knew that if they didn ’ t get this care , they would have overdoses and end up in the ER – or dead . I say that because we realized that most of these patients , were told if they need help with COVID , addiction , or psychiatric issues , or need your diabetic drugs , they should just go do a telemedicine visit with your doctor .’
“ Generally , these patients don ’ t have internet access , and if they do , many don ’ t have a stable connection or access to a computer . Most don ’ t have smart phones either because they cost $ 1,000 .”
WORKING COVID VACCINES INTO PROVIDED CARE
With patients unable to come to them , Dr . Martin and her team began traveling around the state . “ I went to ERs in Stuttgart , Monticello , Malvern , Arkadelphia , and Dardanelle . We would fill in shifts and would let people know , ‘ Hey , I ’ ll be in your area on Saturday , so I can see you after my shift . I can help you with your medical needs .’”
River Valley started mobile units and began to care for people who didn ’ t have access to their regular providers . In building a relationship with new patients , the subject of COVID would come up . When asked if they had been vaccinated , many patients were hesitant . “ Many of them felt they had already been abandoned by places closing or weren ’ t trusting of vaccinations . We built a relationship with them as providers , and they began to know we would go above and beyond to treat them . In our clinic , we really try to meet the patient where they are – whether it ’ s their location , their access-to-care issues , understanding their mental health needs , their need for help with substance-use disorders , etc . We don ’ t use the word addiction anymore , and we don ’ t judge . We try to help them facilitate insurance or connect with providers in the area . Over time , many who were resistant to vaccinations or regular health visits began to trust . They started asking , ‘ Can you also be my primary care doctor ?’ or ‘ I ’ ll take the vaccination if you think it ’ s okay , doc .’ So ,
“ Part of the interesting thing about our practice is that we were all working as emergency care providers , but each of our medical providers is also board certified in family practice ,” said Dr . Martin . “ So , we ’ ve always been able to see both sides of the coin as far as inpatient and outpatient care .”
-Kristin Martin , DO , MS , FAAFP with that , it ’ s been an unconventional practice , but it ’ s been some of the most rewarding work I ’ ve done in medicine ,” said Dr . Martin .
A LITTLE HELP
To provide vaccinations , testing , and supplies , the clinic needed additional resources . “ Our practice typically does not generate a lot of money when we ’ re driving all over the place ,” said Dr . Martin , who reached out to the Society for help associated with the mobile technology needed to go to high-risk populations . Dr . Martin said , “ When we help care for patients in substance-usedisorder inpatient treatment centers , a good portion come in off the streets or from sleeping on somebody ’ s couch . While they ’ re in our facility for 30 days , we ’ re able to get them vaccinated and check for other health problems , and they participate .”
While the clinic initially set out to bridge the gap in addiction medicine and mental health services , it has ultimately provided additional , but vital , care in other areas of health . “ As a result , we ’ re moving away from strictly emergency medicine and setting up stand-alone clinics as well as bases for our work ,” explained Dr . Martin . “ The clinic in Russellville will have walk-in and primary care , addiction medicine , mental health providers , and peer recovery support specialists . We ’ re also building a community center in the back where we can do Narcan training , public education , trauma-informed care courses , and 12-step meetings .”
Essentially , River Valley Wellness is working toward being a one-stop shop , where patients can come in for everything they need – from a simple blood-pressure check to diabetic medications to addiction issues . And now , thanks in part to the AMS “ Our Fight Is Against COVID ” minigrant , patients will be able to receive vaccinations and boosters while they ’ re there . “ There ’ s no stigma when you walk in our door ,” said Dr . Martin . “ Our motto there is ‘ Where recovery and wellness come full circle .’ No matter what you ’ re recovering from , we want to be a clinic that offers holistic care .” ■
SPRING 2022 | VOLUME 118 | NUMBER 9 175