KS Rx and Opioid Advisory Committee Meeting Minutes

Transcription

1 KS Rx and Opioid Advisory Committee Meeting Minutes :00 pm - 2:30 pm Attendees Karen Bramen Reyne Kenton Ryan Lester Chrissy Mayer Ericka Welsh Rosanne Rutkowski Amanda Bridges Sharon Kearse Aaron Dunkel Sam Glennon Stefanie Baines Rian Souders Lisa Chaney Allison Degroff Kim Templeton Sarah Fischer Fan Xiong Adrienne Hearrell Greg Lakin Sosunmolu Shoyinka Daniel Warren Andy Brown Nick Clasen Jodi Jackson Betsy Knappen Mary Beth Warren Verlin Janzen Lori Moriarty Krista Machado Partner Updates Topeka Public Library- Marvin Auditorium 101 B Kansas Hospital Association (KHA) Kansas Board of Pharmacy (KBOP/KTRACS) DCCCA Kansas Healthcare Collaborative (KHC) Kansas Foundation for Medical Care (KFMC) Kansas Department for Aging and Disability Services (KDADS) Kansas Pharmacists Association (KPha) Kansas Pharmacists Association (KPha) KU Poison Control Center (PCC) KU Poison Control Center Greenbush Kansas Medical Society (KMS) Kansas Board of Healing Arts (BOHA) Board of Pharmacy/KDHE Sunflower Health Plans/Centene University of Kansas School of Medicine- Wichita Kansas Department for Aging and Disability Services (KDADS) US Department of Health & Human Services (HHS) Shawnee Mission Medical Center/Children s Mercy Shawnee Mission Medical Center/Children s Mercy University of Kansas Medical Center (KUMC) Hutchison Clinic DCCCA DCCCA KHA and KMS have developed a Joint Opioids Committee and Karen Bramen will serve as a liaison between groups. Garden City/Finney County is planning to have a Rx Summit for providers in the area sometime in March. Karen and Krista are assisting with planning. KTRACS provider report cards have begun KTRACS/Electronic Health Record (EHR) integration in progress 28 pharmacies, 23 hospitals, 4 clinics (Reyne will send update, more have signed up recently). Mock Project ECHO webinar on Opioid Addiction took place, the first of 2 8-week series will start in February, 30 signed up already and there is space for 100. Contact Daniel Warren or projectecho@kumc.edu for more information Flyer: Fan reported that in looking at preliminary opioid prescribing data from 2017 the rate appears to have decreased from 2016.

2 Kansas Perinatal Quality Collaborative is being reconvened and will focus on quality improvement in clinical settings. The first project they will be working on is the implementation of the Vermont Oxford Network (VON) to educate and provide resources to providers on Neonatal Abstinence Syndrome. Law Enforcement Sub-Committee Priorities Increase utilization of evidence-based OUD practices for justice-involved populations to decrease overdoses, facilitate recovery and reduce recidivism. Objectives: 1. Improve addiction care in the Criminal Justice System 2. Increase awareness and utilization of Naloxone within LE agencies 3. Provide educational opportunities for Law Enforcement 1. Improve addiction care in the Criminal Justice System Utilize Law Enforcement interaction as opportunity to refer to treatment o Increase awareness of KS SUD Treatment Referral number o Develop a list of state level and regional resources/services with a blank space for customize local resources Recommend that KS develop a reinstatement policy for procedure for Medicaid benefits to increase ability of offenders to access needed services upon release. Increase utilization of medication assisted treatment (MAT) among justice-involved populations (KS Department of Corrections Action Plan from National Governors Association Learning Lab for best practices for treatment of addiction in justice system) Support diversion programs that facilitate connections to needed services o Continue to support current programs o Seek additional funding opportunities to expand programs 2. Increase awareness and utilization of Naloxone within LE agencies Secure cost reduction for Law Enforcement/First Responders -Kansas Bureau of Investigation (KBI) working on contract for KS Raise awareness of Naloxone legislation and liability waiver to combat misconceptions associated with Naloxone. o Promote benefits of using Naloxone, if not for public administration but to carry at least for officers and canines that may be at risk of exposure Utilize KBI s policy as a template for local law enforcement agencies to implement necessary policy and agreement with local medical providers to provide oversight, in compliance with state statute. 3. Provide educational opportunities for Law Enforcement KDHE has a contract with (Kansas Law Enforcement Training Center) KLETC to develop virtual training and in person opportunities for Law Enforcement. Materials are being developed in coordination with KBI and the US Attorney s office for the District of Kansas (USAKS). Signs/symptoms of OD, drug impairment, how to investigate scene, how to recognize substances, etc. Officer and canine safety; evidence packaging, handling, submission, courtroom evidence safety, field testing, protective gear, etc. Counterfeit drug recognition Naloxone training- administration, benefits, storage, policy, statute requirements, etc. Treatment Referral resources Data -hotspots and trends

3 Medication disposal Building collaboration with local healthcare providers, hospitals, EMS, and treatment providers to monitor and alert for new threats and resources available. Suggestion: Recommend KS implement Good Samaritan Law This is partially included in the Naloxone legislation (HB 2217) protecting from liability if naloxone is administered in good faith We have protections for healthcare providers and anyone who provides emergency care or assistance to a person from civil liability. (Healthcare providers KSA a and nonhealthcare providers KS b) Recommend that KS implement a law that provides criminal immunity for an individual who seeks emergency services for themselves or someone else who may be experiencing an OD of life threatening medical emergency. For example, if they are in possession of an illegal substance they would not be criminally pursued that instance. Provider Education Sub-Committee Priorities Provide education and resources to healthcare providers to increase implementation of best practices associated with pain management, opioid prescribing, opioid misuse, and opioid use disorder. Objectives: 1. Provide and raise awareness of educational opportunities (virtual and in person) on evidencebased practices associated with OUD addiction, treatment, pain management, etc. 2. Provide resources and tools for clinical application 3. Recommend additional education requirements on MAT, Addiction, and Opioid prescribing to better equip healthcare professionals with the necessary tools to implement evidence-based practices 4. Develop and implement opioid prescribing policies and prior authorizations for Medicaid beneficiaries, managed care, and FFS along 5. Increase utilization of KTRACS for surveillance and intervention 1. Provide and raise awareness of educational opportunities (virtual and in person) on evidencebased practices associated with OUD addiction, treatment, pain management, etc. Disseminate information on upcoming events and resources for provider education. Current efforts associated with provider education include: o Kansas Partnerships for Pain Management o Kansas Foundation for Medical Care o Shawnee County Collaborative on Chronic Pain o DCCCA- Annual Opioid Conference o Project ECHO o Virtual resources such as PCSS-O and PCSS-MAT providing CME 2. Provide resources and tools for clinical application Develop toolkit and repository of resources for medical providers o Develop comprehensive toolkit o Develop separated lists of resources by topic area for website Including tools/resources by specialty and for other professions (PCPs, Pharmacists, Dentists, etc.

4 3. Recommend additional education requirements on MAT, Addiction, and Opioid prescribing to better equip healthcare professionals with the necessary tools to implement evidence-based practices Identify processes for outreach and implementation of this strategy Develop materials on KTRACS and CDC Guidelines aimed at students. 4. Develop and implement opioid prescribing policies and prior authorizations for Medicaid beneficiaries, managed care, and FFS along (KMAP-DUR Board, MCO pharmacists, KDHE) 5. Increase utilization of KTRACS for surveillance and intervention Identify/secure funding for KTRACS Implement provider report cards EHR integration Provider education on KTRACS Discussion: Add education on VON to one of the provider education objectives? ATTC-Pregnant Women- Education for prescribers occurring in the KC metro area Prevention Sub-Committee Priorities By 2022, reduce misuse of prescription drugs/opioids, and the use of illicit heroin, to reduce their associated negative health outcomes including dependence and fatal/non-fatal poisoning. Objectives: 1. Develop a collaborative, state website as an informational hub to increase public awareness and facilitate a coordinated response to prescription drug, and prescription/illicit opioid misuse, abuse, dependence, and overdose in Kansas. 2. Implement coordinated statewide health communication campaigns to raise awareness of prescription drug and prescription/illicit opioid misuse, abuse, dependence, and overdose 3. Promote safe use, storage, and disposal of prescription drugs, including opioids, to prevent misuse, and illicit acquisition and distribution. 4. Develop and disseminate education for the general public, parents, community members, and patients. 5. Increase the number of community coalitions addressing prescription drug, and prescription/illicit opioid misuse and abuse prevention activities. 6. Collect and analyze data to surveil prescription drug, and prescription/illicit opioid misuse and abuse, monitor controlled substance dispensation data, monitor morbidity and mortality related to prescription drugs and prescription/illicit opioids, and evaluate state plan interventions. (outcomes of interest decreased fatal/non-fatal poisonings) 1. Develop a collaborative, state website as an informational hub to increase public awareness and facilitate a coordinated response to prescription drug, and prescription/illicit opioid misuse, abuse, dependence, and overdose in Kansas. Using the statewide strategic plan, information from Kansas grant workplans, and other resources, develop KDHE's website: 2. Implement coordinated statewide health communication campaigns to raise awareness of prescription drug and prescription/illicit opioid misuse, abuse, dependence, and overdose CDC Rx Awareness Campaign It Matters KS Awareness Campaign

5 3. Promote safe use, storage, and disposal of prescription drugs, including opioids, to prevent misuse, and illicit acquisition and distribution. Provide educational opportunities and resources to various audiences (General public, patients, healthcare providers, students, parents, etc.) on the importance and ways to properly use, store, and dispose of prescription pain medication. Medication disposal programs/ Pharmacy medication disposal pilot projects Lock box programs / Promote the use of lock boxes to prevent unintended access to medication Promote community medication collection programs 1. DEA Take-Back Days 2. Drop Box locations 3. Toolkit on medication collection options (content developed with description of how to become a medication collection site) 4. DCCCA medication disposal request form 5. Poison Control Center 4. Develop and disseminate education for the general public, parents, community members, and patients. Virtual and in person educational opportunities Repository of resources by topic Social norms campaign and peer to peer learning about SUD/dangers of drugs Disseminate press releases and social media posts with relevant Kansas data 5. Increase the number of community coalitions addressing prescription drug, and prescription/illicit opioid misuse and abuse prevention activities. Develop repository of resources o Low/No cost strategies Media resources Operation Prevention EVERFI program DEA Drug take backs o Safe use, storage, disposal o Warning signs o DCCCA toolkits o Previous webinars o Upcoming webinars o Referral resources Provide training and technical assistance around prescription drug misuse prevention to community coalitions 6. Collect and analyze data to surveil prescription drug, and prescription/illicit opioid misuse and abuse, monitor controlled substance dispensation data, monitor morbidity and mortality related to prescription drugs and prescription/illicit opioids, and evaluate state plan interventions. (outcomes of interest decreased fatal/non-fatal poisonings)

6 Data collection and analysis from the following sources: o Office of Vital Statistics- overdose mortality data, syndromic surveillance data, and hospital discharge o KTRACS dispensation o KDHE BHP Behavioral Risk Factor Surveillance System (BRFSS) with prescription drug related questions o National Survey on Drug Use and Health (NSDUH) o Youth Risk Behavior Survey (YRBS) o Kansas Communities that Care Student Survey (KCTC) o Kansa Behavioral Health Indicators Dashboard (KBHID) o Poison Control Center Neonatal Abstinence Syndrome (NAS) Sub-Committee Priorities Decrease the prevalence of NAS in Kansas Objectives; 1. Identify standard best practice for diagnosis coding and tracking the incidence of NAS 2. Establish a reporting process to assist in tracking cases of NAS and getting individuals connected with needed services. 3. Increase access of substance use treatment for pregnant women with OUD 4. Provide education on clinical resource, Vermont Oxford Network (VON), available to hospitals and providers in Kansas. 5. Connection/facilitate access to services for mom and baby 6. Increase education and awareness of prevention prior to pregnancy and universal standardized screenings to identify those at risk 1. Identify standard best practice for diagnosis coding and tracking the incidence of NAS 2. Establish a reporting process to assist in tracking cases of NAS and getting individuals connected with needed services. Determine best practices for reporting cases of NAS or those identified as at risk that enhances access to services and avoids consequences 3. Increase access of substance use treatment for pregnant women with OUD Identify treatment available in KS for pregnant women with OUD Develop a list of service providers in Kansas o Develop repository/maps of available treatment (by level) in Kansas 4. Provide education on clinical resource, Vermont Oxford Network (VON), available to hospitals and providers in Kansas. Establish Kansas Perinatal Quality Collaborative (KPQC) Identify champions in identified centers Begin engagement and enrollment for individuals to receive VON training Provide training and support for participants (webinars, workshops) 5. Connection/facilitate access to services for mom and baby 6. Increase education and awareness of prevention prior to pregnancy and universal standardized screenings to identify those at risk

7 Data Sub-Committee Priorities This sub-committee is working to identify all data sources and will assist in identifying data to measure progress within each sub-committee s objectives. The goal is to have one go to data person on each sub-committee and data objectives will fall under each sub-committee in which it relates rather than having separate objectives for data. Question: can we track the number of providers conducting SBIRT and receiving reimbursement? Number of individuals trained/qualified in SBIRT? Should we add an objective under one of the sub-committees about SBIRT Training? Treatment and Recovery Sub-Committee Priorities Expand access to treatment and recovery services Objectives: 1. Expand Medication Assisted Treatments (MAT) 2. Expand Peer Support Services 3. Workforce Development 4. Increase access to sober living 5. Increase access to detox/withdrawal/residential services 1. Expand Medication Assisted Treatments (MAT) Identify and develop an up to date list of providers in Kansas Increase number of MAT providers in identified areas Expand tele-health services o Be ready as a state for the telehealth changes that may result from the declaration of a public health emergency Promote the KS SUD treatment referral hotline Expand Peer Support Services Recommended Kansas move to Value-Based Payment Model Coverage for peer support services o Research reimbursement rates Recommend best practices of assigning peer support/mentor upon discharge from treatment programs to continue to assist with the recovery process 3. Workforce Development Increase education on effective, evidence-based practices for treatment Increase the number of LACs and other qualified treatment providers o Explore incentives for qualified addictions counselors, especially in rural KS o Treatment for co-occurring 4. Increase access to sober living Increase # of providers accepting OUD/MAT patients Develop an up to date list/map of providers accepting OUD/MAT patients 5. Increase access to detox/withdrawal/residential services Increase # of providers accepting OUD/MAT patients

8 Develop an up to date list/map of providers accepting OUD/MAT patients Discussion: In Kansas NP/PAs are limited in ability to provide MAT by the collaborating physician Question: Is about initial appointment for MAT required to be in person? the declaration appears to be eliminating this requirement and allowing telehealth to be provided on the initial visit. Nick Clasen from HHS will find out. Answer: You must have an in-person consultation with a medical professional who has a DEA license to receive MAT. In rural or resource-deficient areas, however, an individual could visit their non-data waived PA/NP (or MD) and teleconference a provider with a DATA waiver to receive MAT. So yes, you need an in-person consult but, if the medical professional in front of you doesn t have the credentials, they can bring someone else into the fray who has the ability to prescribe via telemedicine. Note - All federal and state telemedicine laws and regulations still apply and vary how this service is implemented. Workgroup Meeting Schedule (1:00-2:30) Agenda Description Location February 22nd, 2018 Planning Meeting Topeka Public Library - Marvin Auditorium 101B March 22nd, 2018 Committee Meeting Topeka Public Library - Marvin Auditorium 101B April 26th, 2018 May 24th, 2018 Speaker/Planning Meeting Committee Meeting Topeka Public Library Anton 202 Topeka Public Library - Marvin Auditorium 101B