Posts Tagged treatment

Attention Primary Care Providers: Alcohol and Drug Conference is March 19-21

Attention Primary Care Providers: Alcohol and Drug Conference is March 19-21

 

See also: Are You Interested in Becoming a DATA-Waived Physician?

Alabama Department of Mental Health has partnered with the Alabama Department of Public Health on a grant to increase awareness of substance use disorders among primary care professionals. This grant will allow ADMH to pay the registration fee only for any of the following to attend the Alabama School of Alcohol and Other Drug Studies (ASADS):

  • MD
  • DO
  • PA
  • CRNP
  • CNM
  • RN

The Medical Foundation of Alabama designates this live activity for a maximum of 27 AMA PRA Category 1 Credit(s)™.

ASADS has been conducting conferences for over 43 years. Over the past couple of years, there has been a heavy emphasis in the community and at the state level to begin to develop a system of care that integrates primary care and substance abuse treatment. There are many great speakers at this year’s conference.

Dr. Alta DeRoo, M.D., FACOG, will present Medication Assisted Treatment (MAT) Waiver Training. This is required 8-hour training.

T4: Medication Assisted Treatment (MAT) Waiver Training

This course is designed for MDs, DOs, PAs and CRNPs who are interested in becoming a 2000 Data Waived physician. This class will be held from 8 a.m. – 5 p.m. to meet the 8-hour requirement.

Course Description:

This presentation is designed to train qualified physicians in dispensing or prescribing specifically approved Schedule III, IV and V narcotic medications for the treatment of opioid addiction in an office-based setting. The goal of this training is to acquire the knowledge and skills needed to provide optimal care to opioid use disorder patients by providing:

1) an overview of opioid use disorder,

2) the efficacy and safety of buprenorphine,

3) process of patient selection,

4) clinical use of buprenorphine,

5) nonpharmacological interventions,

6) medical psychiatric conditions in opioid use disorder patients, office procedures, and

7) special treatment population.

This eight-hour training, which will include eight separate modules and four case studies. Each of the speakers will be presenting for two hours. The remaining two hours are broken up over the four case studies. Designated by the DHHS, this training meets the eight-hour requirement and is designed for physicians to dispense buprenorphine in office practice for treatment of opioid use disorder. Participation in this training will provide physicians with a comprehensive overview of buprenorphine prescribing and its safe and effective use in an office-based setting. This training is designed for physicians and other primary care providers who are likely to treat opioid-dependent persons in their practice, such as those in family practice, general internal medicine, psychiatry, pediatrics, adolescent medicine specialists, and Opioid Treatment Programs.

Course Objectives:

After attending the course, a participant will be able to:

• review addiction treatment in office-based practices;

• discuss the pharmacological treatments of opioid use disorder;

• determine what medical record documentation must be followed;

• discuss the process of buprenorphine induction as well as stabilization and maintenance techniques;

• describe how to take a patient history and evaluation; and

• review safety concerns and drug interactions.

Dr. Merrill Norton, Ph.D., will be conducting a three-part series on The Pain of Pleasure: A Pharmacist’s Guide to Opioid Use Disorders for Prescribers and Other Healthcare Professionals.

Dr. Cardwell Nuckols, Ph.D.The Neurobiology of Addiction: The Addiction Process in Three Stages

Dr. Boyett, D.M.D., D.O., DFASAM, and Dr. Taylor, M.D., M.P.H., F.A.S.A.MThe Delivery of Office-Based Addiction Treatment (OBOT) in the 21st Century

ADMH can pay the registration fee only. To have your registration fee paid, complete the registration form and return it to Kathy House at kathy.house@mh.alabama.gov no later than Feb. 24.

REGISTRATION FORM           BROCHURE

See also: Are You Interested in Becoming a DATA-Waived Physician?

Posted in: Education

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Can I Get a Witness? Do You Use Chaperones in the Exam Room?

Can I Get a Witness? Do You Use Chaperones in the Exam Room?

In 2018, the world of sports was rocked with the revelation that Larry Nassar, a physician for USA Gymnastics, used medical examinations as a pretext to molest nearly three hundred female gymnasts over a twenty-year period. Many of these young athletes were abused while their parents were in the examination room. News coverage of the scandal caused many physicians to reexamine the professional safeguards that exist to protect a patient during one of his or her most intimate and vulnerable experiences, the physical examination.

In fact, the medical community addressed this concern long before the Larry Nassar scandal brought the issue into the public consciousness. The American Medical Association promotes the use of chaperones to provide a comfortable and considerate atmosphere for the patient and physician to respect a patient’s dignity.  Am. Med. Ass’n Code of Med. Ethics, Op. 1.2.4 (1998). While Alabama has yet to act legislatively to require the use of chaperones during a physical examination, many states have. For instance, Georgia’s Composite Medical Board defines “unprofessional conduct” to include “conducting a physical examination of the breast and/or genitalia of a patient of the opposite sex without a chaperone present.” Ga. Comp. R. & Regs. 360-3-.02(12). While adopting a chaperone policy in your practice is not yet obligatory in Alabama, there are many reasons why doing so is in the physician’s best interest.

First, the presence of a chaperone during a sensitive examination can help put the patient at ease. Patients who have had very few interactions with a physician may not yet fully trust the physician. Offering the patient a chaperone may ease any patient anxiety arising from unfamiliarity with the physician and helps demonstrate the physician’s respect for cultural or personal sensitivities.

Second, a chaperone may serve as a deterrent to improper patient behavior. The presence of a disinterested third party can help prevent false claims of sexual assault by the patient. In some cases, boundary violations may be initiated by patients. For example, patients may initiate boundary violations in order to gain an advantage over the physician. The manipulative patient may use the threat of a medical board complaint or a lawsuit to demand controlled substances or other special treatment. Thus, having a chaperone present can help protect the physician and other medical staff by discouraging abusive patient behavior.

Third, a chaperone serves as a witness to events occurring during the patient interaction. As a defendant in a malpractice suit, the physician will benefit from an additional witness to the physician-patient exchange. The chaperone can serve to corroborate the physician’s testimony, rendering the physician’s version of events more believable to a jury.

Before undertaking any sensitive examination or procedure, the physician should explain the specific components of the physical exam, and offer the patient the option of having a trained chaperone of the gender of the patient’s choice present. Document clearly in the patient’s chart whether the patient consented to the examination, and whether he or she elected to have a chaperone present. Write a note in the chart identifying all individuals present during the exam. Ideally, a practice should train at least one male and one female staff member to serve as a chaperone; however, patients often decline a chaperone when the physician and patient are of the same gender. As the Nassar scandal revealed, lay chaperones such as family members are not trained to observe the examination in a way that best protects the physician and the patient. Additionally, it may be awkward and uncomfortable for a patient to have a family member present during a physical exam. Thus, the presence of a trained, uninterested observer is the most effective means of ensuring a safe and respectful physical examination.

Occasionally, it will not be possible to accommodate a patient’s desire to have a chaperone present. If your practice does not have a chaperone available on the date of the examination, consider rescheduling the patient’s routine physical examination for a date when a chaperone will be available. If your practice lacks the capability to accommodate the patient’s chaperone request, discuss transferring the patient’s care to a physician better suited to make those accommodations.

Physician boundary violations portrayed in the media are increasing calls for mandatory use of chaperones. Rather than viewing this procedure as an unnecessary regulatory response to a few bad actors, physicians should embrace the protections provided by a chaperone policy. An effectively implemented chaperone policy helps physicians to become more responsive to patients’ sensitivities, ultimately strengthening the physician-patient relationship.

Article by William T. Ashley, III, JD, Risk Resource Advisor, ProAssurance. ProAssurance is an official partner of the Medical Association.

Posted in: Legal Watch

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CMS Announces New Medicaid Policy to Combat Opioid Crisis

CMS Announces New Medicaid Policy to Combat Opioid Crisis

Just a week after President Trump declared the opioid epidemic a public health emergency, the Centers for Medicare & Medicaid Services (CMS) announced a new policy to allow states to design demonstration projects that increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD). CMS’s new demonstration policy responds to the President’s directive and provides states with greater flexibility to design programs that improve access to high quality, clinically appropriate treatment.

Through this updated policy, states will be able to pay for a fuller continuum of care to treat SUD, including critical treatment in residential treatment facilities that Medicaid is unable to pay for without a waiver, according to a letter CMS sent to state Medicaid directors. Previously, states had been required to build out their entire delivery system for SUD treatment while also meeting rigid CMS standards before Medicaid demonstration approvals could be granted. The new policy will allow states to provide greater treatment options while improving their continuum of care over time.

According to a new study, nearly a quarter of patients on Medicaid filled a prescription for an opioid painkiller in 2015. Express Scripts, one of the largest pharmacy benefits manager of Medicaid drug benefits in the country, analyzed data on 1.8 million opioid prescriptions given to 3.1 million Medicaid enrollees in 14 states. It found that 6 percent of all Medicaid prescriptions were for opioids. Of those that acquired opioids, nearly one-third took the medications for more than 30 days.

Opioids also contributed notably to costs, accounting for 4.1 percent of plan costs overall. Medicaid enrollees are 10 times more likely to be drug addicts or substance abusers than the general population, according to the report.

In the letter, CMS said that state projects under its new program should aim to make notable improvements over the course of five years with goals to increase access, reduce overdose deaths, reduce use of the emergency department or inpatient care for drug addiction treatment and improve care coordination.

CMS also said that it will “ensure states take significant steps” to reduce opioid prescribing.

Posted in: Opioid

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Study: Many Still Sidestep End-Of-Life Care Planning

Study: Many Still Sidestep End-Of-Life Care Planning

Before being deployed overseas for the Iraq War in 2003, Army reservist Don Morrison filled out military forms that gave instructions about where to send his body and possessions if he were killed.

“I thought, wow, this is mortality right in your face,” Morrison, now 70, recalled.

With his attention keenly focused on how things might end badly, Morrison asked his lawyer to draw up an “advance directive” to describe what medical care he did and did not want if he were unable to make his own decisions.

One document, typically called a living will, spelled out Morrison’s preferences for life-sustaining medical treatment, such as ventilators and feeding tubes. The other, called a health care proxy or health care power of attorney, named a friend to make treatment decisions for him if he were to become incapacitated.

Not everyone is as motivated to tackle these issues. Even though advance directives have been promoted for nearly 50 years, only about a third of U.S. adults have them, according to a recent study.

People with chronic illnesses were only slightly more likely than healthy individuals to document their wishes.

For the analysis, published in the July issue of Health Affairs, researchers reviewed 150 studies published from 2011 to 2016 that reported on the proportion of adults who completed advance directives, focusing on living wills and health care power-of-attorney documents.

Of nearly 800,000 people on whom the studies reported, 36.7 percent completed some kind of advance directive. Of those, 29.3 percent completed living wills, 33.4 percent health care proxies and 32.2 percent were “undefined,” meaning the type of advance directive wasn’t specified or combined the two.

People older than 65 were significantly more likely to complete any type of advance directive than younger ones, 45.6 percent vs. 31.6 percent. But the difference between people who were healthy and those who were sick was much smaller, 32.7 percent compared with 38.2 percent.

The Medicare program began reimbursing physicians in January 2016 for counseling beneficiaries about advance-care planning.

This study doesn’t incorporate any data from those changes. Rather, it can serve as a benchmark to gauge improvement, said Dr. Katherine Courtright, an instructor of medicine in pulmonary and critical care at the University of Pennsylvania. She is the study’s senior author.

There are many reasons that people are reluctant to sign a living will. State forms vary, but they generally ask people to spell out what medical intervention they want under various circumstances.

“Many people don’t sign advance directives because they worry they’re not going to get any care if they say they don’t want [cardiopulmonary resuscitation],” said Courtright. “It becomes this very scary document that says, ‘Let me die.’”

Living wills also don’t account for the fact that people’s wishes may change over time, said Dr. Diane Meier, a geriatrician and the director of the New York-based Center to Advance Palliative Care.

“In some ways, the public’s lack of excitement about this is related to the reality that it’s very hard to make decisions about the kind of care you want in the future when you don’t know what that will be like,” Meier said.

Sometimes as patients age and develop medical problems they’re more willing to undergo treatments they might have rejected when they were younger and healthier, Meier said.

“People generally want to live as well as they can for as long as they can,” Meier said. If that means going on a ventilator for a few days in order to get over a bout of pneumonia, for example, many may want to do that.

But if their living will says they don’t want to be put on a ventilator, medical staff may feel bound to honor their wishes. Or not. Although living wills are legal documents, medical staff and family members or loved ones can reinterpret them.

“At the moment, I’m very healthy,” Morrison said. If he were to become ill or have a serious accident, he said, he’d want to weigh life-saving interventions against the quality of life he could expect afterward. “If it were an end-of-life scenario, I don’t want to be resuscitated,” he said.

If someone’s wishes change, the documents can be changed. There’s no need to involve a lawyer in creating or revising advance directives, but they generally must be witnessed and may have to be notarized.

Although living wills can be tricky, experts have no reservations about recommending that people have a health care proxy. Some even suggest, for example, that naming someone for that role should be a routine task that’s part of applying for a driver’s license.

“Treatment directives of any kind all assume we can anticipate the future with accuracy,” said Meier. “I think that’s an illusion. What needs to happen is a recognition that decisions need to be made in real time and in context.”

That’s where the health care proxy comes in. Just naming someone isn’t enough, though. To be effective, people need to have conversations with their proxy and other loved ones to talk about their values and what matters to them at the end of life.

They may tell their health care proxy that they want to die at home, for example, or that being mobile or able to communicate with their family is very important, said Jon Radulovic, a vice president at the National Hospice and Palliative Care Organization.

Some may opt to forgo painful interventions to extend their lives in favor of care that keeps them comfortable and maintains the best quality of life for the time that remains.

“The most important thing is to have the conversation with the people that you love around the kitchen table and to have it early,” said Ellen Goodman, a Pulitzer Prize-winning writer who founded The Conversation Project, which provides tools to help people have conversations about end-of-life issues.

Morrison said he’s talked with his health care proxy about his wishes. The conversation wasn’t difficult, he said. Rather than spell out precisely what he wants done under what circumstances, Morrison is leaving most of the decisions to his health care proxy, if he can’t make his own choices.

Morrison said he’s glad he’s put his wishes down on paper. “I think that’s very important to have,” he said. “It may not be a disease that I get, it may be a terrible accident. And that’s when [not knowing someone’s wishes] becomes a crisis.”

By Michelle Andrews | Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Posted in: Health

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