VA HEALTH CARE SYSTEM, DETROIT
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1 VA HEALTH CARE SYSTEM, DETROIT INNOVATIVE APPROCH TO FIGHT OPIOID EPIDEMIC COMPLIMENTARY AND ALTERNATIVE MODALITIES BASSAM BATARSE, MD. MEDICAL ACUPUNCTURIST
2 VA HEALTH CARE SYSTEM 144 Hospitals 1221 OP Centers 8.97 Millions Registered ( 2015) 20.4 Millions Total Veterans ( 2016) $200 Billions Budget
3 CHRONIC PAIN IN VA HCS Chronic Pain Prevalence 30% in Non VA Population 55% in Veterans ( 60% in Female Veterans)
4 CHRONIC PAIN IN VA HCS Veterans' pain is more often severe and complex, and often associated with psychiatric and medical comorbidities
5 OPIOID USE IN VA HCS Prevalence: 2012 (VA Peak) 21.2% (Compared to 14.5 % Non VA)
6 OPIOID USE IN DETROIT VA QTR Detroit VAMC 24.8 % (6874 Veterans) VA Nationally 16.2% # 2, Highest in the Nation
7 OPIOID USE IN VA HCS - DETROIT Higher Doses 2.2% (150 veterans) over 400 mg MEDD ( compared to 0.3% VA national rate) The highest dose prescribed 3460 mg MEDD
8 OPIOID SAFETY INITIATIVE BOARD (LATE 2014) ( To curb the use of opioids in general and to reduce doses to safe levels) Multidisciplinary Group Weekly Reviewed all those Veterans on 200mg MEDD or more ( over 500) Sent tailored letters with recommendations to prescribers Re-Reviewed in 6 months for compliance Created a Multidisciplinary Pain Clinic to support opioid prescribers Quantitative UDS (Ameritox) And Introduced CAMs
9 CIM Acupuncture Auricular Acupuncture (BFA and NADA) Yoga Chiropractor Care Aroma Therapy Healing Touch Biofeedback Others ( reiki, Tai Chi, Music therapy,.)
10 providers providers ACUPUNCTURE 80 Hrs a week pain area ED/FT, CLC, MH, PC,, Ortho Surgery, OR, Research
11 ACUPUNCTURE Most Common Indications: Chronic Pain ( spine, joints, fibromyalgia, HA, etc.) PTSD / Anxiety Nausea and vomiting ( Oncology) Paralysis of CVAs Acute pain in the ED/FT ( strains and sprains, sciatica, Migraine and Managing withdrawal symptoms
12 AURICULAR ACUPUNCTURE
13 AURICULAR ACUPUNCTURE Battlefield Acupuncture ( BFA) National Acupuncture Detoxification Agency (NADA) Other treatment protocols ( Anxiety, Depression, PTSD etc.
14 BATTLEFIELD ACUPUNCTURE Limited auricular AP protocol 5 semi permanent needles Quick, safe and effective 85% pain control Inexpensive ( $2-5 in supplies / 2 minutes ) 4 hours training for HC providers
15 BATTLEFIELD ACUPUNCTURE JDD VA MC Over 150 providers are trained Two, daily walk-in clinics Volunteers providers walk-in visits a day BFA in all areas ED/FT, CLC,PC, Specialty clinics ( Ortho and RO), MH, Pain Clinics Train family members
16 Video
17 NADA PROTOCOL JDD VA MC Several MH providers are trained in NADA In IOP Detox and rehab Helps reduce reliance on benzos minutes group visits NADA protocol is also used in ED for management of acute withdrawals.
18 NADA PROTOCOL Certification in NADA takes a one day training MH providers, Psychologists, SW and any one dealing with SUD can be trained and certified Can be used in both inpatient and outpatient basis
19 OTHER EAR PROTOCOLS
20 ACUPUNCTURE & BFA IN OR 3 anesthesiologists and 3 CRNs BFA used for Pre and Post Op pain Research : Somatic Acupuncture and BFA in THA and TKA peri-op management to reduce opioids used
21 FY 2014 FY 2015 FY 2016 FY 2017 YOGA IND YOGAEVAL YOGA GRP TOTAL YOGA
22 PAIN SCORE
23 RESULTS Opiod Utilization VISN Level Report-Detroit VA Medical Center Year Qtr Patients on Opioids (C1-5) VA Patient Population Percentage: National QTR: , , % 16.2 QTR: , , % 15.7 QTR: , , % 15.6 QTR: , , % 15.5 QTR: , , % 14.6 QTR: , , % 14.1 QTR: , , % 13.9 QTR: , , % 13.6 QTR: , , % 13.2 QTR: , , % 12.9 QTR: , , % 12.4 QTR: , , % 12 QTR: , , % 11.6 QTR: , , % 11.1 QTR: , , % 10.6 QTR: , , % 10.2 QTR: , , % 9.6 QTR: , , % 9.2
24 TOTAL MEDD RELEASED
25 > 90 MEDD
26 OPIOIDS IN ED All ED staff are trained in BFA (3 in somatic acupuncture, as well) Used for Migraines Back pain Joint pains Chronic pancreatitis pain Others
27 NALOXONE Automatic dispensing by pharmacy >50mg MEDD Other known risks
28 NALOXONE FY2018 Detroit Naloxone Distribution Oct Nov Dec Jan Feb Mar
29 PDMP
30 ACUPUNCTURE COST PER SOMATIC AP VISIT (30-60 Minutes using 2 or more rooms) $ COST PER AURICULAR AP VISIT 5-15 Minutes ( Group settings) ~$50
31
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