Sarah Hadfield, physician assistant, runs Bridgeway Recovery Services primary care in Salem (Rachel Alexander/Salem Reporter)
Even before she became a physician assistant, Sarah Hadfield spent more time attending medical appointments than most people.
While working at a residential treatment center for people with drug addictions and mental health problems, Hadfield was responsible for taking clients to medical appointments outside the facility. She said often, the doctor’s visits were too rushed and narrowly focused to help.
“There’s just not the time to delve into it and address the addiction,” she said. “I was sitting as a bystander in a lot of rooms, and then I’d leave and listen to my clients: ‘That was terrible, they didn’t hear a word I said.’”
Hadfield, 31, is at the forefront of a different approach to health care for people who abuse drugs or alcohol. Since 2015, she’s been the primary care provider at Bridgeway Recovery Services in Salem, helping patients manage their diabetes or heart conditions alongside their mental health and recovery.
Patients get referred to her through Bridgeway’s treatment programs, but can stay with her even after they graduate or complete treatment. She regularly takes medical rounds at Bridgeway’s detox center so she’s a familiar face to some new patients. Her appointments run longer than at many doctor’s offices so she has time to listen to people, she said.
Because her patients’ struggles with addiction aren’t a secret, Hadfield said she’s able to provide better care.
“Part of that is having that be an open conversation from the beginning,” she said.
That could mean knowing that someone with a history of injecting drugs is uncomfortable around needles, and thus unlikely to take prescribed insulin shots. Or understanding that a patient with a recent knee injury may need extra support because of their history with opioids.
“People who have had an opioid addiction sometimes still have an accident and need pain medication,” she said.
Hadfield studied chemistry and psychology in college and said she’s always been interested in the psychology of addiction.
She earned her physician assistant degree at Mercer University in Atlanta, then moved to Salem to be closer to family. Her experience in residential treatment made her want to improve the health care system for people with addictions.
She was also motivated by research showing that people with substance abuse and mental health problems die about a decade younger than the general population, but often from the same causes: heart disease, diabetes or hypertension.
“It was scary to see that,” Hadfield said. It showed her that too often, patients like the ones she sees now were forgoing regular doctor’s visits or not getting the support they needed to manage their health.
Her job at Bridgeway was created after the 2014 Medicaid expansion made many low-income Oregonians newly eligible for health insurance. In theory, that meant many more people could afford to see a doctor.
But Hadfield said Bridgeway found many of their regular clients weren’t actually seeking out care elsewhere, often because they felt shamed for their addictions or didn’t feel comfortable discussing them with medical professionals.
Bridgeway began offering primary care appointments as a pilot program and expanded it to a full-time offering by hiring Hadfield.
Now, the clinic has about 600 primary care patients who Hadfield sees and carries a state designation as “patient-centered primary care home.” That means Bridgeway is recognized as providing high quality care and making it easier for patients to get the help they need in one place, without resorting to the emergency room.
Bridgeway is unique in Oregon as the only addiction treatment provider carrying the primary care home designation, Oregon Health Authority spokeswoman Aria Seligmann said. The other 650 include doctor’s offices, clinics and some mental health treatment providers.
Seligmann said Bridgeway’s approach “provides additional access for people to seek treatment and allows for choice. Having primary care available within substance use treatment can help normalize treatment-seeking behavior.”
Hadfield said having her practice connected to Bridgeway also makes it easier for patients who have dropped out of treatment to come back.
Treatment programs require regular sessions and drop clients if they stop showing up. But a primary care practice has many patients who might come in once a year for a check-up.
If someone stops attending treatment at Bridgeway and wants to get back in two months later, Hadfield is able to see them and help them get connected. If patients relapse, she can talk to them about it.
“Nobody’s going to pass judgment or be mad,” she said.
Contact reporter Rachel Alexander: [email protected] or 503-575-1241.
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