July 20, 2021
New Acute Ambulatory Opioid Prescribing Guidelines
From a Passion to Serve, to Best Practices
Doctor Kathryn Duevel recognized five years ago that there was a big opioid prescribing problem. “We didn’t have a policy or approach. I wondered what we could do to make sure we were following best practices here. So I started to develop a toolkit for prescribing within the clinic,” explained Dr. Duevel.
That sense of service and bias for action may have been why Dr. Cindy Firkins-Smith asked Dr. Duevel to return to practice in Willmar. Dr. Duevel had been an OB physician for 20 years before the effects of a birth defect, Arnold Chiari malformation, forced her to reinvent herself.
“I had surgery when I was in residency and thought I wouldn’t be able to practice,” said Dr. Duevel, “but it was 20-some years before the deterioration started again, making me unable to do the physical parts of the surgeries and deliveries. I had been interested in policy for a long time so I pursued that.”
In fact, Dr. Duevel was in the Health Care Delivery Science Masters program at Dartmouth College when she left practice. When Dr. Smith called her to come home to Willmar, Dr. Duevel had completed her Masters and was working in policy for the state of Minnesota.
According to Dr. Duevel, the toolkit she developed for prescribing opioids “opened the door to seeing that we offered little to no help in our clinic for patients who developed addictions — either through our prescribing or other routes — and what a huge need there was. And I got to thinking about it and I missed being able to care for patients. I thought, well, I could do that. That doesn’t require physical skills. It’s talking, relationships and knowledge skills. I still have those!’’
Close to Home
Dr. Duevel describes the incredible good fortune to attract partners within Carris who have developed the outpatient Addiction Medicine Program with her. St. Cloud offers a full-service program, too. Said Dr. Duevel, “We’re providing local access to help patients using chronic opioids and people with substance use disorders (addiction). We did it first in Redwood Falls and now in Willmar. We kept hearing these stories, the tragedies that patients and their families were experiencing. Our mission is to help people with substance use disorders and to prevent disease and death. And we can do better.”
Our mission is to help people who are undergoing these kinds of strains in their lives, to prevent disease. And we can do better.
Dr. Kathryn Duevel
Helping Physicians Do Better
Together with other colleagues on the Acute Ambulatory Opioid Prescribing committee (part of the Controlled Substance Stewardship Committee), Dr. Duevel has spearheaded the new Ambulatory Opioid Prescribing Guidelines for the system. “I don’t expect everybody to be as passionate as I am about managing how we prescribe and offer addiction care to our patients. Everyone has their own passion,” says Dr. Duevel, “I just want to make sure my partners know the best practices, because no one intends to put patients at risk. I want them to have the advantages of what we know and provide them with additional resources they may need.”
Information is a primary need. The Minnesota Department of Human Services (DHS) introduced opioid prescribing sentinel measures under the Opioid Prescribing Improvement Program (OPIP). CentraCare and Carris will adopt similar measures as part of tracking results of the Opioid Prescribing Guidelines. DHS is tracking opioid prescription by physician and alerting doctors when they do not meet the state thresholds. CentraCare’s Dr. Lynn McFarling and the IS team is working on making the data available to Clinical Partners so that physicians can see if they need to change their practices before the state requires them to participate in a mandatory improvement program.
“It’s just crushing if you find that you’ve done something that may have contributed to someone’s illness,” says Dr. Duevel. “So an important motivation for the new Opioid Prescribing Guidelines is to help frontline physicians who are in the trenches. They may have a person in front of them with an acute injury. In that moment, we need to help them make a quick decision and a safe decision about what to prescribe.”
Starfish
Dr. Duevel regards the Addiction Services practice at Carris as “one of the most rewarding practices I’ve ever had. It’s hard to compete with delivering a baby. I mean, there’s not much better than that! But this is another vulnerable population that is incredibly rewarding to treat.
“It’s not an easy population to care for, but to have just one patient come in and say, ‘You know, I’m so tired of being judged. And I don’t get judged here.’ That makes my whole week. They’re worried about being judged or kicked to the curb. How awful is that?” asks Dr. Duevel.
They’re worried about being judged or kicked to the curb. How awful is that?
DR. KATHRYN DUEVEL
She knows she can’t fix all the stressors in people’s lives that caused them to turn to drugs and alcohol to self-medicate, but she feels she can influence prescribing decisions that contribute to patients inadvertently becoming addicted by taking medicine and not understanding the risk. And by helping physicians understand the impact their decisions have on the risks for those patients. “It’s like the old starfish story. I can’t save them all,” says Dr. Duevel, “but I can save this one. And this one. One starfish at a time. That’s what we’re doing.”
Dr. Duevel is amazing! I’m so appreciative and proud of your work on this important issue so our clinics and clinicians have the tools they need to keep people as safe as possible.
Besides being a wonderful physician (OB/GYN and now in practice improvement), she was also part of a three person “team” who set goals (after attending Blandin Leadership training) to improve the community of Willmar. One: bring a YMCA to Willmar (check) and two: bring girls hockey and cross country ski teams to the Willmar school district (check). All are flourishing and are essential parts of the community.
Because of my understanding of some of the system issues related to opioid addiction through our organization and Dr. Duevel’s work, I was able to explain to someone at my dog’s veterinariary clinic why they have to give their own birth date for opioid medication for their dog – to track and prevent drug seekers from getting opioids through other channels. 🙂
Thank you thank you thank you!!!
Such a wonderful and inspirational story of compassion and expertise. Thank you Dr. Duevel for all you are doing for these patients to prevent and treat opioid addiction.
The gratitude I have for Dr. Kathryn Duevel and her commitment to others goes beyond words. This woman embodies service and moral compass.