Rx for Drug-Seeking - PowerPoint Presentation

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Rx for Drug-Seeking Patients in the ED

The Monterey County Prescribe Safe Initiative

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AIM:

Be the

Catalyst

for Change in your

CommunityOBJECTIVES:Why change is importantHow we made change in Monterey CountyHow to pitch the story in your communityProvide practical tools and resources to get started

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Tools and Resources

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www.chomp.org/for-healthcare-professionals/prescribe-safe

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Opiate use in the

U.S.

80% of the world’s prescription opiate supply

99%

of the world’s hydrocodone supplyFrom 1997 to 2007, the milligram per person use of prescription opioids in the U.S. increased from 74 milligrams to 369 milligrams, an increase of 402% (enough to supply every American adult with 5mg of hydrocodone every 4 hours for a month)

Scope of the Problem

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7 Million

Americans use prescription drugs recreationally annually (2.3% of the

U.S. population)

50 Million

Americans have used recreationally at least once during their lifetime (16.1% of the U.S. population)

Scope of the Problem

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Scope of the Problem

Increased adverse

medication events related to prescription drug misuse

Estimated

> 700,000 ED visits per year related to prescription drug misuse aloneApproximately 10% of all patients on chronic opiates account for

40% of all overdoses

Usually on

high daily doses

Getting drugs from

multiple prescribers

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Scope of the Problem

Death

from opiate overdoses have

increased 300% since the 1990sWe lose more years of productive life in the US to prescription drug overdose than motor vehicle accidents

Prescription drug related deaths exceed motor vehicle-related deaths in

29 states

and

Monterey

County

Prescription drug related deaths now outnumber those from heroin and cocaine combined

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Scope of the Problem

Gateway:

Nearly

1/3

of people aged 12 and over who used drugs for the first time in 2009 began

by using a prescription

medications non-medically

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Street

Value

www.streetrx.com

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Selling drugs for consideration (sex, addicted physicians)

Medicine cabinet parties

Prescription fraudInsurance fraudMRI forgery black market

DIVERSION

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An Experiment

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An Experiment (circ. 2005)

Frequent Users of the ED Group (FUG)

The Team:

ED

physicians ED nurseAdministration Addictionology Hospitalist

Pain management

physician

Psychiatrist

Behavioral

h

ealth nurse

S

ocial worker

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EDRVP

Emergency Department

Recurrent Visitors Program

2013

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EDRVP

Purpose

Adequately

meet the needs and improve the overall care of patients recurrently seeking care in the ED for chronic medical problems,

including, but certainly not limited to, opiate or benzodiazepine addiction 

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Change Concept

Apply

care management concepts:

Identify

and engage recurrent visitorsRemove barriers to more appropriate care

Barriers to

self-management

Establish PCP

or referral to more appropriate specialist

Address

socioeconomic

barriers to care and refer to community resources

Engage

payer

in the process

Apply evidence-based and safe

standards of care

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Criteria

Frequency

≥ 4 visits in 1 month

≥ 6

visits in 3 months≥ 12 visits in 12 monthsUsing the ED as a PCP office for non-emergenciesChronic condition managementRepeat imaging and laboratory

Medication refillsSeeking pain medication refills

and/or +

CURES test

Abusive

or out of control behavior

Provider

or outside referral

Pharmacy

Insurance company

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Care Management Process

Screen

all referrals using criteria

Review

(prior 6 month chart review)Utilization patternsVisit reasonDiagnosticsPCPMedications refillsEngage patient, family, providers, insurance

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Care Management Process

Draft

Plan of Care (POC)

Advisory Council

review of POC (monthly meeting)Communication with PatientLetter to patient and providersPOC uploaded in electronic medical record (green dot)

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Tracking Board “Green Dot” Alert

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Advisory Council

ED Physician

Urgent Care Physician/Addictionologist

ED

DirectorCHI ED Transition Care Manager and Referral CoordinatorSocial WorkerClinical Specialist Behavioral Health ServicesHospitalist CoordinatorCCAH Care Management Supervisor

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Health Information Technology Enablers

High utilizer reports

Electronic referral processAuto-population of POC

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Monterey County Prescribe Safe Initiative

Launched in February 2014

Modeled after the San Diego Collaborative

Aim: Develop a broad-based coalition representing those interested in dealing with the epidemic of prescription drug abuse in Monterey County

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County-Wide EngagementSlide27

Monterey County Prescribe Safe Initiative Strategic Objectives

Establish county-wide ED Pain Medication Prescribing Guidelines

Develop resource tools to support ED efforts

Community physician education

“CURES Party”27Slide28

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CURES Report

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CHOMP

Results

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Resources

FUG:

Periodic Committee meeting0.2 FTE Assistant Director of ED

Annual Cost: $50,000

EDRVPAdvisory Council meeting0.5 FTE TCMAnnual Cost: $75,000

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Future

More

of the same for the CHOMP EDRVP

County-wide

EDRVP ProgramEngage local pharmaciesEngage local health plans

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Take Home Messages

A

national

e

pidemic with local implications (including your community)Exhaust the behavior – push in the same directionUse CURESCountywide medical community prescribing practices

Engage the neighborhoodDo it because it is the right thing to do AND there is a return on investment

You’re behind – catch up by visiting

our website

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Questions?Slide43

Thank you

Anthony

Chavis

, MD

831-644-7466Anthony.chavis@chomp.orgReb Close, MD831-625-4900Reb.close@gmail.com