SIOUX CITY -- A patient can receive a Pap smear, discuss her addiction and get treatment for depression all in one place at Jackson Recovery Centers' Family Health Care Clinic.
Rachel Wurth, an advanced registered nurse practitioner and assistant medical director, said Jackson Recovery Centers began offering outpatient medical services in 2012 through a partnership with Siouxland Community Health Center.
This past April, Jackson took the reins and established Jackson Family Health Care Clinic in existing space on the second floor of the drug treatment center's main office, 800 Fifth St.
As of December, Jackson's own providers had logged more than 1,147 medical visits at the clinic, which features two medical exam rooms, three provider offices, a detox room, nurses station, check-in area and small laboratory.
"Last week was our busiest week to date. We had 54 appointments where we saw patients," Wurth said.
Addiction is a chronic disease that affects a person's biological, psychological and social health. A report released by the U.S. Surgeon General in November warned that 1 in 7 people in the United States is expected to develop a substance use disorder at some point during their lifetime.
Wurth said the purpose of the clinic is to stabilize physical and psychological conditions, such as diabetes and depression, which can affect a patient's long-term recovery from addiction, and to meet new health care needs that arise as a result of addiction.
"This clinic isn't just for while they're in treatment, this is a lifelong primary care medical home," she said. "Even though they might be in recovery and they bridged out of our therapy services, they can still come and get their services here for the rest of their life."
Heidi Kammer-Hodge, vice president and chief operating officer for Jackson Recovery Centers, said integrating primary care services with addiction treatment services is a growing trend across the United States. But she said Jackson is ahead of the curve in providing these services locally and regionally.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), back-and-forth referrals between behavioral health and primary care offices result in up to 80 percent of patients with a substance abuse disorder not receiving care. In contrast, clinical trials have shown that integrated care can reduce costs and improve health outcomes for patients with substance abuse problems.
"We know that we can help people to live longer and healthier lives if we're able to truly deliver addiction, psychiatric and medical care," Kammer-Hodge said.
Breaking down barriers
Many patients enrolled in a drug treatment program don't have a primary care provider.
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Even if they do have one, Wurth said their needs may go unaddressed.
She said she recently saw a patient with a bad cold. If she had encountered the woman earlier on in her career at an urgent care, she would've just dealt with the woman's cold. Instead, she asked the woman how her recovery was going.
"She was in a full-blown relapse and needed some help. I don't think she would've sought out any of that on her own," she said.
Individuals with a substance abuse disorder may suffer from physical problems such as hepatitis, lung disease, cardiovascular disease and HIV/AIDS. Common mental health disorders include depression, anxiety and bipolar disorder.
Patients abusing drugs and alcohol are likely neglecting their systemic health and oral hygiene. Wurth said they may be malnourished and sleep deprived.
"Some of these people are so ill in their addictions that when they go to the doctor it has been for a specific purpose and that's to feed their addiction," Wurth said, referencing the prescription opioid epidemic. "They haven't been going and being honest about what's really going on with them."
SAMHSA says providing primary care to individuals with a substance abuse disorder enhances their chances of recovery. A 2005 study published in the medical journal Addiction found that two or more primary care visits in a six-month period improved abstinence by 50 percent.
Seven providers -- two medical doctors and five advanced registered nurse practitioners -- specializing in addiction offer primary medical services at Jackson Family Health Care Clinic to both patients and their family members. Patients are often introduced to the providers who staff the clinic after staying at one of Jackson's residential treatment centers.
Wurth said her patients include young children, whose health is compromised when their parents' addiction takes priority. These children fall behind on annual checkups and vaccinations.
Roughly 60 percent of Jackson's patients are covered by Medicaid or are Medicaid-eligible, while around 20 percent have commercial insurance coverage. A block grant from the Iowa Department of Public Health helps cover services for patients who don't have any form of coverage and can't afford to pay out of pocket.
Wurth said patients tell her they feel "safe" at the Family Health Care Clinic because they don't have to explain their addiction to a new doctor, who could unintentionally derail their long-term recovery.
Unaware of a patient's history of addiction, Wurth said a doctor could prescribe benzodiazepines, some of the most popular drugs prescribed for problems with sleep, stress and anxiety. Although these drugs have a calming effect, they are highly addictive.
"It isn't necessarily that the primary care provider is trying to purposely hurt them, they just aren't as educated on the disease of addiction, because it really has become a specialty field," she said.
Kammer-Hodge said the clinic is breaking down barriers surrounding both addiction and mental illness, which are often viewed by society as a choice or moral failing.
"It goes so far to reduce that stigma by really affirming what we've known for many, many years -- that addiction truly is a health care issue and it is an illness," she said.