Office-Based Opioid Treatment: What You Need to Know: Trends in Behavioral He...Epstein Becker Green
Presented by David Shillcutt (Associate, Epstein Becker Green) and Kristina Sherry (Attorney, Nelson Hardiman) on April 4, 2019.
Office-based opioid treatment providers are on the front lines of the response to the opioid epidemic, but recent developments in federal and state legislation have significant implications for provider business models and service delivery strategies.
This webinar will examine provider capacity issues for medication assisted treatment, the opportunities and challenges of telemedicine for addiction services, and the expansion of innovative service delivery networks including the “Hub and Spoke” system and related models.
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/office-based-opioid-treatment-what-you-need-to-know-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Office-Based Opioid Treatment: What You Need to Know: Trends in Behavioral He...Epstein Becker Green
Presented by David Shillcutt (Associate, Epstein Becker Green) and Kristina Sherry (Attorney, Nelson Hardiman) on April 4, 2019.
Office-based opioid treatment providers are on the front lines of the response to the opioid epidemic, but recent developments in federal and state legislation have significant implications for provider business models and service delivery strategies.
This webinar will examine provider capacity issues for medication assisted treatment, the opportunities and challenges of telemedicine for addiction services, and the expansion of innovative service delivery networks including the “Hub and Spoke” system and related models.
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/office-based-opioid-treatment-what-you-need-to-know-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Presentation Objectives:
1) Define SBIRT and identify components of this evidence-based intervention for identifying, reducing, & preventing problematic use, abuse & dependence on alcohol & illicit drugs
2) Learn how to use the all the components of the SBIRT app, including, but not limited to the screening, brief interventions & referral to treatment features included in this app
3) Recognize the critical need for more research related to occupational therapy intervention and SBIRT, as well as potential obstacles to implementation of SBIRT in treatment settings & resources for continuing education on this topic.
Presentation Objectives:
1) Define SBIRT and identify components of this evidence-based intervention for identifying, reducing, & preventing problematic use, abuse & dependence on alcohol & illicit drugs
2) Learn how to use the all the components of the SBIRT app, including, but not limited to the screening, brief interventions & referral to treatment features included in this app
3) Recognize the critical need for more research related to occupational therapy intervention and SBIRT, as well as potential obstacles to implementation of SBIRT in treatment settings & resources for continuing education on this topic.
Primary Care Behavioral Health Consultation ServicesMichael Terry
presentation at APNA 2011 Conference in Anaheim CA. Looks at development of a consultation service, the ed/training required and an example of a curricula to address this at the DNP level.
Blazing New Trails: Shifting the Focus on Alcohol and Drugsnashp
Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Authors: Barbara Cimaglio, Sally Fogerty, BSN, M.Ed., John C. Higgins-Biddle, Ph.D.
Characteristics and Outcomes of Adult Opiate Users in Abstinence-Based Resid...Siobhan Morse
Prior research in this population suggests that, overall, opiate and non-opiate addicted users have different issues and ought to be treated differently for their addiction—and that young and older adult opiate users present at treatment with different issues. This study investigated what significant differences in treatment motivation, length and outcome, if any, exist between opiate and non-opiate users and further investigates young adult (18-25 years of age) and older adult (26 and older) opiate users and the impact of any differences. Data for this study was drawn from 1972 individuals who entered voluntary, private, residential drug treatment and rehab. Study measures included the Addiction Severity Index (ASI), the Treatment Service Review (TSR), and the University of Rhode Island Change Assessment (URICA). Interviews were conducted at program intake and six-months post-discharge. Implications for addiction treatment providers and planners are discussed.
Systematic Use of STroke Averting INterventions (SUSTAIN) TrialUCLA CTSI
This study, which is also funded by the American Heart Association, will assess whether lifestyle group clinics, care managers and support from community health workers may reduce the risk of a second stroke in socioeconomically disadvantaged minority patients.
Biomedical Informatics project for implementing a state wide screening program for narcotic seeking patients. Project defined from abstract to specific implementation and measurement criteria.
The Healthcare Team as the Healthcare Provider: A Different View of the Patie...guesta14581
Presentation to the Ohio State Society of Medical Assistant's annual convention about the Patient Centered Medical Home and the role of the medical assistant
SLC CME- Evidence based medicine 07/27/2007cddirks
Saint Luke's Care, a quality improvement organization within Saint Luke's Health System, presents a CME presentation by Dr. Brent Beasley on Evidence Based Medical Care.
The Ohio AFP's presentation 2013 SLC presentation on their communications & advocacy campaign surrounding the Medicare Medicaid primary care parity payment that won them the Leadership in State Government Advocacy award.
Virginia AFP's lobbyist Hunter Jamerson's presentation from the 2013 SLC on the unique Medicaid reform approach being followed in the state of Virginia.
Connect for Colorado's Lindy Hinman's 2013 SLC presentation on health insurance marketplaces and what the Connect for Colorado organization has done to get their state insurance marketplace up and running.
AAFP Government Relations Director Kevin Burke's 2013 SLC presentation on AAFP's Federal Priorities and the status of AAFP supported legislation at the federal level.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Rich.aafp slc 2013
1. Community Care of North Carolina
Community and Practice Based Interventions
to Lessen Opioid Abuse and Opioid Overdoses
2. Credentials
Robert L “Chuck” Rich, Jr., MD
Medical Director for Community Care of the
Lower Cape Fear, Medicaid network
Practicing MD in rural Bladen County, NC.
AAFP Commission member, Health of the Public
and Science
Chairperson AAFP workgroup re Opioids and
Pain Management
No industry connections or sponsorships
3. Problem:
Utilization of highly addictive opioid
medications has risen 160% in last 10 years
NC death rate for unintentional poisonings is
11.4 per 100,000 citizens
22nd in the
country
1140 such deaths occurring in 2011
Deaths by motor vehicle accidents and
unintentional poisonings are almost equal in
NC.
4. Solution:
A model of intervention in the chronic pain cycle based
on a successful integrated care pilot in Wilkes County,
NC, called Project Lazarus (PL)
PL decreased unintentional overdose deaths in Wilkes County
by 69% from 2009 – 2011
Community Care of NC, supported by a $2.6 million
grant from The Trust (Kate B Reynolds) and matching
funds from the Office of Rural Health, is expanding the
PL approach statewide through 3 interrelated initiatives:
Community-Based Coalitions
The Clinical Process
Program Outcome Goals
5. The Kate B. Reynolds Trust
1.3 Million Dollars
NC Foundation for Advanced Health Programs
NC Office of Rural Health
Pass Through
2.6 Million Dollars – Matched
CCNC
Governor’s
Institute
UNC
IPRC
Project
Lazarus
14 CCNC
Networks
Pfizer
$
$
$
$
$
6. PL Initiative –
Community-Based Coalitions
Community-based Coalitions:
Broaden awareness of extent and seriousness of
unintentional poisonings and chronic pain issues
Support community involvement in prevention and
early intervention
Comprised of broad range of community partners
Law Enforcement
Public Health
Schools
Hospitals
Faith-Based Organizations
8. PL Initiative –
The Clinical Process
The Clinical Process:
Focuses on medical assessment and treatment of
chronic pain
Provides education on assessment criteria for
pain, safe opioid prescribing, use of CCNC’s
Provider Portal, and registration and use of the
Controlled Substance Reporting System (CSRS)
information
9. Target Audience
Prescribers:
Primary Care Physicians, Emergency Medicine, DOs, PAs,
NPs, Pain Management, Orthopedists, Dentists
Dispensers:
Pharmacists
Behavioral Health:
CCNC Network Psychiatrists
Community Psychiatrists
Addiction Medicine Physicians
Prescribers of Methadone/Buprenorphine (Suboxone)
LME/MCO Medical Directors
SA/MH Clinical Directors
10. Topics
Overview of Chronic Pain and Pathophysiology
Risk Assessment
Treatment Planning/Written Agreements
Legislative Changes: CSRS, Naloxone, Good Samaritan Laws
Documentation
Role of Pharmacists
Monitoring for aberrant use
Diagnosing Addiction
Intervening for Misuse and Addiction
Referring to Behavioral Health Specialists
Case Studies
11. Clinical Trainings
40 trainings over next 2 years
20 trainings will offer 3 prescribed credits of CME AMA
Category 1 (CME trainings)
20 trainings will offer the same content and agenda but will
not be eligible for CME credit (Pfizer-sponsored, non-CME
trainings)
Each network will receive at least 1 CME training and 1 Pfizersponsored, non-CME training
CPI Coordinators will assist in determining which
geographical locations within the network would most
benefit from CME vs. Pfizer-sponsored, non-CME training
12. A Guide to Rational
Opioid Prescribing
Agenda Evening Meeting:
5:30 - 6:00 Registration, Pre-Evaluation, and Dinner
6:00 - 6:10 Introduction to Seminar Objectives
6:10 - 6:30 Nature of Pain/Role of Opioids
6:30 - 7:00 Risk Stratification and Initiating Treatment
7:00 - 7:30 Case discussion 1: Getting started
7:30 - 7:45 Break – Sign up for the CSRS
7:45 - 8:15 Monitoring, Intervening & When to Stop
8:15 - 8:45 Case discussion 2: Monitoring/Adapting Treatment Plan
8:45 - 9:00 Wrap up/Next steps
*Turn in Post-Evaluation and get CME Certificate*
13. PL Initiative –
The Clinical Process
The Clinical Process:
Makes use of toolkits with decision support and
other tools developed for:
Primary Care Physicians
Emergency Department Physicians
Care Managers
14. Toolkit Contents
Universal Precaution for
Prescribing & Algorithm for
Assessing and Managing Pain
Pain Treatment Agreement and
Informed Consent
Prescriber and Patient Education
Materials
Screening Forms and Brief
Intervention – list of Community
Resources
Format for Progress Notes
Naloxone Prescribing
Medication Flow Sheet
Controlled Substance Reporting
Personal Care Plan
System (CSRS) Application
Local Community Resources
15. Medical Director Leadership
Created educational
Advises Care Managers and
presentation for prescribers to
Quality Improvement Staff on
use with Toolkit distribution
“difficult” chronic pain
Conducting Lunch & Learns
with “Top 20” practices in
network with high chronic pain
patient volume and other
practices indicating interest in
chronic pain education
patients or practice-related
issues via “in person”
meetings, telephonic
consultation and use of CMIS
Presenting at CommunityCoalition stakeholder
meetings
16. Medical Director Presentation
Typically 1 hour long
Discussion of NC Medical Board guidelines
Review of current NC data
Review of provider toolkit contents including useful
forms, basic prescriber guidelines, CSRS, DMA “lockin” procedures
Summary with Q&A
17. Chronic Pain Patient
Care Management Activities
Provide support to patients identified by the ED
Referrals to PCP or specialty services
Provide care management to CPI Priority Flag patients:
Screenings and assessment
Medication reconciliation
Ensure all prescribers have a medication list
Referral to DMA narcotic lock in program if appropriate
Counsel patient on living with chronic pain
Assist with appropriate referrals to behavioral health
Educate patient and caregiver re: signs and symptoms of
overdose
18. Types of Practice Interventions
Identification of ED and Hospital Utilization
Recommending and/or Assisting with:
Timely follow-up PCP appointment post ED visit or hospital
admission, including home and practice visits
Pain assessment and behavioral health screenings
Narcotic Lock-In
Pain contract
Close collaboration with pain management specialist/clinic
and/or Psychiatrist/MCO providers as a TEAM effort
CSRS registration
Medication reconciliations and pharmacist consultations
19. PL Initiative –
Program Outcome Goals
Program Outcome Goals:
Measured through the Injury Prevention Research
Center and include:
Decreased mortality due to unintentional
poisonings
Decreased inappropriate ED utilization for pain
management
Decreased inappropriate ED utilization of
imaging with diagnosis of chronic pain
Increased use of Provider Portal and CSRS
20. CCLCF Chronic Pain Activities
Prior to Recent Funding
Identified 53 chronic pain patients to follow as a
cohort group
32 practices represented
Survey Tool created to capture static data at baseline
Practice and patient ID blinded
Included data snapshot of key utilization stats
Pharmacy section
Case Management section
Practice section
Identified Top 20 practices with most patient volume
associated with chronic pain
21. Cohort Data to Track
Sum of Inpatient Mental Health Admissions
Sum of Inpatient Non-Mental Health Admissions
Sum of Emergency Department Visits
Sum of Total Medicaid Cost
Average of Total Medicaid Cost
Sum of Total Medicaid Drug Cost
Average of Total Medicaid Drug Cost
Sum of # of Pharmacies (All Fills, Not Just Opioids)
Sum of # of Opioid Fills in Past Year
Sum of # of Benzo Fills in Past Year
Sum of # of Hypnotic Fills in Past Year
22. Cohort Data at Follow Up
Data Being Tracked
Percent of Change
Sum of Inpatient Mental Health Admissions
-14 %
Sum of Inpatient Non-Mental Health Admissions
Sum of ED Visits
0%
-30 %
Sum of Total Medicaid Cost
1%
Average of Total Medicaid Cost
1%
Sum of Total Medicaid Drug Cost
-12 %
Average of Total Medicaid Drug Cost
-12 %
Sum of Number of Pharmacies (All Fills)
-22 %
Sum of Number of Opioid Fills/Past Yr
-22 %
Sum of Number of Benzo Fills/Past Yr
- 8%
Sum of Number of Hypnotic Fills/Past Yr
33 %
23. Advocacy- Medical Boards
Often forgotten
2013 FSMB guidelines just released with
emphasis on proper screening, documentation,
treatment plans, monitoring
MB monitoring often preeminent in provider
thought process compared to legislation
Advocacy avenues include MD testimony re
proposed rules, membership on MBs, case
reviews
24. Advocacy- Legislatures
Everyone wants the problem solved- “we just
need more rules”
“Primary care MDs do not need to be prescribing
these meds”
PCPs handle the bulk of prescribing and do so
safely with guidelines
Advocacy / educational materials abundant
No need to reinvent the wheel
25. Advocacy- LegislaturesResources
AAFP “Prescription Drug Monitoring Report”
AAFP position paper from OAPMWG workgroup
National conference of State Legislatures report of
“Prevention of Prescription Drug Overdose and Abuse –
State Laws”- updated 07/2013
FSMB policy guidelines re opioid prescribing
State level workgroups and position papers
http://www.cdc.gov/homeandrecreationalsafety/Poisoning/laws/laws.html
www.projectlazarus.org
Pharma resources
26. Types of Laws- CDC Website
Laws requiring a physical examination before
prescribing
Laws requiring tamper- resistant prescription forms
Laws regulating pain clinics
Laws setting prescription drug limits
Laws prohibiting “doctor shopping”/ fraud
Laws requiring patient identification before
dispensing
Laws providing immunity from prosecution/ mitigation
at sentencing for individuals seeking assistance
during an overdose