Editor’s note: This month, we are exploring the theme of “data and efficiency in science and medicine.” Here, Dr. Leslie Dye, Editor-in-Chief of Elsevier’s Point of Care Content, writes about using technology to get clinicians the information they need to diagnose and treat substance abuse.
As a medical toxicologist and emergency medicine physician, Dr. Leslie Dye has seen substance abuse up close. And it’s often not what you would think. While most of her patients are addicted to heroin, many start by taking prescription painkillers after an accident or surgery. They are often professionals and college students. And they usually don’t have obvious symptoms or medical exam findings one would see at a general visit.
This means that without a comprehensive knowledge of addiction, it can be hard to spot people at risk – even for doctors and nurses. Those with expertise in the field still need current information at the point of care – about the latest chemicals being added to street drugs, for example, or where to refer patients who may be suffering from addiction.
Meanwhile, the opioid crisis is reaching epidemic proportions. In the United States, where President Trump has declared the opioid crisis a national emergency, prescription opioids and heroin killed more than 33,000 people in 2015, according to the Centers for Disease Control and Prevention (CDC). Dr. Dye’s own state of Ohio is suing five pharma companies for “deceptive marketing,” claiming they have “fueled the opioid epidemic and devastated Ohio communities” by misleading doctors about the addiction risks of popular painkillers.
Still, there is no simple solution. While stricter guidelines for opioid prescribing are preventing patients from getting these drugs legitimately, those who have become addicted often turn to heroin, which is cheaper and more readily available. Dr. Dye sees many of those patients on her weekly shift at the Northland Intervention Center in Milford, Ohio.
For her, the solution comes in the form of knowledge and education: getting medical professionals the information they need to recognize patients at risk and the resources they need to act.
This is what drives her work as Editor-in-Chief of Elsevier’s Point of Care Content. Medical professionals access this content through decision tools that use sophisticated technology, enabling them to find relevant information while treating patients.
For upcoming medical content, including addiction topics in ClinicalKey, Dr. Dye’s team of 15 has been reviewing thousands of information sources, including articles in peer reviewed medical journals and books, synopses from Elsevier’s Evidence-Based Medicine Center and the latest recommendations and guidelines from societies and the government. Some of these guidelines come from organizations she has led; Dr. Dye is immediate past president of the American College of Medical Toxicology and current president of the Medical Toxicology Foundation.
Our content addresses (questions like): What are the symptoms of addiction or acute toxicity from multiple agents? How does a patient in withdrawal appear? What’s the best way to treat different types of addiction right at the bedside when seeing the patient? What resources are available for treatment, whether it be outpatient or in-patient?
Ideally, Dr. Dye said, early awareness will become a bigger part of treatment.
“I was on a panel with a woman who lost her son from a heroin overdose,” Dr. Dye recalled. “He was a full-time college student and ran his own company. He was a ‘good kid.’ Later, this mother and I met to discuss ideas for prevention, and we talked a lot about encouraging earlier recognition by the medical community of addiction.
“For example, when you take your child to the doctor for well-child checks, even a first-year check-up, part of the history needs to include any family history of addiction. Let’s address the potential problem early. So if that child gets a tooth pulled at age 13, we can talk about how to manage the pain and reduce the chance of chemical dependency.”
With more medical history entered in the electronic health record, decision support tools can offer more specific guidance; tools like ClinicalKey, for example, can integrate patient information with Elsevier’s own extensive resources.
This is just one way medical treatment is shifting its focus to the patient.
“Patient engagement is a huge piece of the puzzle,” Dr. Dye said, pointing out that it can include educational materials and home-care advice to patients and their families. Our nursing resources, including ClinicalKey for Nursing, also offer suggestions for talking with patients and caregivers.
Dr. Dye related a conversation her fellow panelist had with a nurse soon after losing her son: She was taking her daughter to have her wisdom teeth removed when she asked the nurse if the pain medication prescription could be submitted electronically. “The nurse replied, ‘No, we have to give you a prescription (in person); drug addicts ruined it for everyone else.’ This demonstrates the ignorance that persists.
“For addiction, I think the biggest problem is the stigma associated with chemical dependency,” Dr. Dye said. “I’m not sure any solution is going to work if people don’t recognize this as a disease. Many in the medical and lay community still believe addiction is a moral failing and not a disease.”
Elsevier’s Point of Care Solutions
- Clinical Practice – Integrates evidence-based content into patients’ electronic health records and order sets. Includes Care Planning and Professional Practice Services, Order Sets, Arezzo Pathways, and Stanson CDS and Analytics. Has concise information about recognizing and treating addiction for providers. Also has Information about recognizing and treating addiction for nurses, who are often in a front-line situation for recognizing signs of addiction.
- Patient Engagement – Information in easily consumed nuggets for patients, prescribed by clinicians during and after a patient’s hospital stay or clinic visit. Includes Information about recognizing and treating addiction for patients and their families.
- Drug Information – Provides data and drug information for all areas of healthcare. Includes Elsevier’s Gold Standard Drug Database and Clinical Pharmacology, which has monographs on medication for MAT (medically assisted treatment) and links to REMS programs for providers.
- Reference and Decision Support – Provides evidence-based medical, surgical, specialty, nursing and drug content to help health professionals make faster, smarter decisions and avoid errors. Includes ClinicalKey, Elsevier’s flagship clinical reference tool, accessible from a bedside computer or mobile app, for physicians and nurses.
Leslie Dye, MD
Dr. Leslie Dye serves as the Editor-in-Chief of Point of Care Content for Elsevier in addition to practicing addiction medicine at Northland Intervention Center in Milford, Ohio. She graduated from the University of Kansas School of Medicine and completed her residency in Emergency Medicine and her fellowship in Medical Toxicology and Hyperbaric Medicine at the University of Cincinnati. She was an Associate Professor in Emergency Medicine and Pharmacology/Toxicology at Wright State University until becoming the editor of Living Longer, a monthly health magazine in the Cincinnati Enquirer. Her publishing career continued as she served as managing editor for Innovations, the official journal of the International Society for Minimally Invasive Cardiac Surgery. She later served as Editor-in-Chief of the Journal of Medical Toxicology, the official journal of the American College of Medical Toxicology.
Prior to joining Elsevier and Northland, Dr. Dye was the training coordinator for Medisync Health Care Solutions in Cincinnati, where she trained physicians in medical coding and worked with multiple electronic health records. She has written numerous book chapters and published extensively in the scientific literature, as well as speaking nationally and internationally. She is President of the Medical Toxicology Foundation and immediate past President of the American College of Medical Toxicology. Dr. Dye is board certified in Emergency Medicine and Medical Toxicology.