Bringing Medical Care to the People

Jordana Latozas, RN, MSN, ACNP, was early in her career when the opioid epidemic was hitting back in 2010. In her area of southeast Michigan, these pain medications were having a great effect locally, just as it was throughout the nation. As she was witnessing the effects of the opioid epidemic, she began thinking of her long-term career aspirations and what type of medicine she wanted to practice. She decided to combine primary care with addition medicine.

The ongoing challenge she heard from her patients was the ability to get to the office for follow-up appointments. And for people who are dealing with substance abuse disorder this can be especially difficult. This patient population may also be dealing with a host of comorbidities and health issues such as hepatitis C (HCV) and the need for ongoing therapy and follow-up appointments.

As she begun to think about the lack of reliable transportation as a barrier to care, she thought about the idea of having a mobile clinic to go out into the communities and go to where people were. Her husband sells recreational vehicles (RV), so she was able to purchase one and get her clinic off the ground. Although there was some good fortune associated with establishing the clinic, their timing was not. They opened their doors in February of 2020, one month before the US shutdown due to COVID-19. However, she and her staff decided to pivot and offer COVID-19 testing services especially for those in need during those early days in the pandemic when homeless shelters were closed.

They were able to survive the COVID-19 epidemic, and today, Latozas serves as president and founder of the Recovery Mobile Clinic. They now have 2 RVs and 1 ambulance, which serve as clinics and she says the clinics are a combination of primary and urgent care needs.

“We're taking this into homeless shelters, transitional houses, community centers—anywhere where people are gathering that don't really have reliable health care access points,” said Latozas.

In working with patients who are dealing with substance abuse disorder and need to get into the continuum of care, how the messages are presented is another important aspect.

“We do a lot of counseling on self-harm prevention in general,” said Latozas. “The biggest trick that we do is getting people to screen. And the way we do that is by making it completely routine. So, we don't ask them, ‘do you want to be screened for STDs?’ We don't say to people with IVDAs [intravenous drug abuse] who have a higher risk of hepatitis C, ‘you should get screened.’ It's all of that stigmatizing language that they're very used to, and shut it right down when it happens. So, our staff is trained to say, ‘we would like to do a routine evaluation’…we're doing a very similar model that the pandemic taught us, which is STD screening, STD treatment, hepatitis C.”

Latozas says that by normalizing the things they want to screen for, patients don’t say no.

Overcoming Requirements and Beliefs

Screening is the first part of getting people into the continuum of care; the second part is overcoming previous requirements and beliefs to begin treatment. For people who are dealing with substance abuse disorder and may have HCV, there were former requirements for individuals to be clean for 6 months before receiving treatment, so many people had given up hope for hepatitis treatment.

“A lot of individuals stopped asking, because they haven't met the 6-month mark; they've written themselves off,” said Latozas. "The new rules that you can be [either] inactive, using, or even just in the beginning of your substance use recovery journey, and still receive treatment is immensely encouraging for them. And then it engages them to ask questions.”

Latozas says patients will then ask her about direct-acting antivirals and they can get a better understanding of therapies, which can lead to treatment and better outcomes.

“Around 90% of the patients that we see for hep C, we’re able to treat right out of the mobile clinic," said Latozas. “Because you are using medications like Mavyret and Epclusa, you use them for 8 to 12 week treatment regimens, most of the time they're able to start and complete treatment while they're still in an inpatient facility or in transitional housing. So, we're able to not only screen them, but get the meds ordered, delivered, and complete their treatment. And in most cases, even the follow ups before they leave their treatment facility.”

Educating Future Clinicians

In addition to counseling patients, Latozas says she and her team are also speaking with future clinicians and discuss adapting greater screening practices, which would lead to increased treatment initiation.

“On the provider side, we do a lot of education with nursing students and with NP students,” said Latozas. “We've even partnered with some medical schools with residency programs, and encourage primary care level providers to do the screening and in a large part, initiate treatments for those that aren't at a higher level of risk.”

Contagion spoke to Latozas recently about her clinic, overcoming care barriers, and treating people with substance abuse disorder.