June 24, 2014 Meeting of CMPC – Notes by Kim Tjaden, M.D.

Here are Kim’s notes from our June 24, 2014 Central Minnesota Prescribing Coalition meeting:

Stearns Benton Medical Society Circle of Health
Bringing our Community Together – Solutions to the Opioid Crisis
June 24, 2014

What is the problem?
Oncology: Am I treating with right amount?
Peds: Babies/children with addicted parents
Lack of access to alternative therapies
Pharmacist: worry about risk/liability
Cultural issue – want to numb pain, expect no pain
Pharmaceutical companies profit, pharma marketing
Patients are isolated, reach out to physicians for instant relief
Shame of opioid use
As pain begins to debilitate, patient seeks to numb it
Patients want an easy, quick fix (why spend months in rehab when you can get an instant fix?)
Breakdown in communication within healthcare cultures
Doing the right thing takes more time – tough decisions, proper taking care of pain, comorbidities
Programmed to take a pill for everything, society, TV ads
Society expects zero pain, anxiety, concentrating – not reasonable or achievable
Nature vs nurture – environment
Patient excuses
Educate patients about disease/condition
Easy to prescribe (comfort)
Expect drugs
Expect relief
Acute vs. chronic
Need comprenehsive approach to pain treatment with policy to minimize opioid use
Does diagnosis warrant opioids
No objective study/test to diagnose pain perception or response to pain meds
Not utilizing resources
Discerning patients actual pain
Role of addiction
Are opioids appropriate care for chronic pain?
No comprehensive clinic
Not enough specialists in addiction and pain
Proliferation of opiate product
Transient pop d/t available (social/welfare services)
Multiple layers of meds
Poor scientific understanding of pain (causes, courses, recovery)
Too easy to prescribe and move along
Satisfaction driven interaction
Under utilization of adjunctive treatments (PT/OT/Muscle massage, Tai Chi, Qigong meditation, Pain Rehab Mayo Model)
No consistent boundaries/limits for opiate use
Insurance coverage
Behavioral Health component
Abuse/overuse – no standard way to address issue
Alternative methods (need for)
Pain is a perception, not a vital sign (need for additional resources to treat multiple problems)
Peoples need for perfection – societal pressure
Patients being ill-educated on effect/long term effects of pain meds
Over utilization to treat
Medical resources are being depleted on recurrent patients

How do we as a community address this?
Consistent standards city-wide
Support for providers (policies related to satisfaction surveys), multi-disciplinary approach
Change expectations/readjust culture (related to pain)
Prescribe fewer meds
Specific steps before prescribing meds
Keep eye on quantity and length of time of prescription, follow up on patient
Minimize amounts prescribed
All providers need commitment to use resources – specifically PMP
Provider could check box on Rx to show that PMP has been checked
PMP could come up on computer to alert doctor of drug utilization
Address patient satisfaction forms (look at pain level issue)
Guidelines, safe and effective, educational materials, adjunct (PT, psych, referrals and expectations)
Provider education
“Short term” occasional use not “bad”
Pain not a “vital sign”
Opioid “consent” forms with ceiling doses, especially if combined with other meds, risks benefits and drug alternatives and occasional drug screens
Early exposure
Up-to-Date on prescribing
Poly pharmacy
Poly physician
Transfer of care between facilities
Documentation in HER
Start implementing similar policies in the area
Education is key
Comprehensive taper plans
Better communication between providers
Record sharing
Community wide guidelines and follow them
Not using opioids for chronic non-cancer pain
Use system supported contract between provider, prescriber, patient
1degree care and episodic care (document accurately dose changes, esp. increase
Public education of prolem and solutions, multimedia
System speed to process best practice needs to be greater than “just prescribe and move along”
Consistency – Pain meds, benzos, stimulants
Standardized system in the community – USE IT!
Educate – community, clinicians
Policy change

What does it look like?
Change culture: pain is a part of life, there are no instant fixes
Public health education/marketing
Provider education
Adopt a policy for support (saves physician from complaints, standardizes)
Patient must signed informed consent to receive narcotics
Educate patients about narcotics
Money, costs, insurance company refusal restrictions
Comprehensive pain clinics (VA has one)
Insurance paying for adjunct therapies
Protocol documenting step therapy, diagnosis, pain contracts
Case management, follow up with primary care vs ER
Comprehensive Chronic Pain Coalition with guidelines-alternatives, goals, education (MD, RN, RPh, patient Psychologist)
Having services (addiction, rehab, pain specialist) readily available
Services to address family systems (whole family)
Universal policy for entire community
Identify other treatment modalities
Establish common goal among all involved
Multi-disciplinary team – multi organization
Integrated approach
Leader who works well with teams
Treatment of addiction part of program
Common policy among Health Partners, CentraCare, St. Cloud Med Group, Ortho, ER, Urgent Care, Walk-in clinics
Collaboration between healthcare facilities/pharmacies
Public education – focusing on what and why we are doing, what we are doing
Reiterating the importance of monitoring – we are helping not hurting
Providers would have protection against customer satisfaction surveys/compaints
Participation of Health Insurances

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