Performance Improvement: The Opiate Use Challenge Iowa Healthcare Collaborative: 13 th Annual Conference Brian J. Isetts, RPh, PhD, BCPS August 16, 2016 100 E. Grand Ave., Ste. 360 Des Moines, IA 50309-1800 Office: 515.283.9330 Fax: 515.698.5130 www.ihconline.org Your Facilitator: Brian J. Isetts, RPh, PhD, BCPS Professor, University of Minnesota College of Pharmacy E-mail: isetts@umn.edu Brian is a practitioner, educator and researcher. He is a former Health Policy Fellow at the Centers for Medicare & Medicaid Services in the CMS Part D MTM Program and at the CMS Innovation Center. 2 Disclosures Brian Isetts has no conflicts of interest to report relative to this workshop. I am currently serving as a medication use quality improvement advisor under contract with the IHC. The views, opinions and reflections expressed are solely my own, and do not represent the official position of any institution, agency or organization. 1
Session Objectives Understand the vital role of communities Identify outcome strategies and measures Review evidence on the appropriate, effective and safe use of opiates Establish meaningful priorities to reduce adverse drug events and prevent addiction in individuals new to opiates while supporting recovery Session Agenda Big picture overview of opiate use Systems perspective of community solutions Overview of evidence and best practices Setting patient-specific goals of therapy, stepdown therapy and care plan responsibilities Solutions workshop with actionable improvement priorities This is Reality in Homes across America 2
Key Question to Run On How can your community come together to prevent addiction in individuals new to opiates; ensure the appropriate, effective and safe use of opiates; and support recovery? A Medication Use System we can Have and Deserve Aims of a Rational Medication Use System from the Patient s Perspective Patients routinely achieve their drug therapy treatment goals with zero tolerance for preventable medication harms Routinely: More than 90% of patients' treatment goals are being achieved Preventable: Between 44-60% of medication harms are preventable Comprehensive Team-based Medication Management All team members help set patient-specific drug therapy goals for each medical condition: Assessment of intended use, effectiveness, safety, and adherence across the care continuum When patient is not achieving goals of therapy there is more efficient and effective use of team members Coordination of care as we all work together to help patients achieve goals of therapy Patients/care-givers help the team understand medication needs in patient-centered health homes 9 3
A Big Picture Perspective of Opioid Use in America Where do we start? 14,000 Rx overdose deaths/year I.H.I. Systems Perspective Is Pain really the fifth vital sign The pain treatment pendulum Euphoria - CNS neurotransmitter milieu Predisposition and risks for addiction Medical & criminal treatment approaches A Systems Perspective for the Rational use of Opioids Engaging & aligning all sectors/stakeholders Everyone in the community has a role Resource rich/coordination poor teams Address multiple system components Frank discussions about opioid risks Re-train the medical community Treat addiction as a chronic disease 4
High Level Action Items Reduce the supply of opioids Patient-specific goals of therapy for pain Use of non-opioid therapies for pain Educational priorities on uses and risks Reframe treatment programs & stigmas Access to Medication-Assisted Treatment Naloxone in every home, cabin & car Community measures for hot spotting Best Practices in Pain Management (or don t send them home with #100 Vicodin) Opioid naïve or opioid tolerant person Goals of therapy 0-10 pain scale H-CAHPS Item #14 perverse incentive Care plan step down therapy Naloxone co-rx with high dose opioids Pain Contracts for long term use Prescription drug monitoring programs Community-wide Take Back Programs 5
Checklist for Prescribing Opioids Set realistic goals for pain and function Assess baseline pain and function Optimize non-opioid and non-drug therapies Engage persons & families in benefits/risks Evaluate risk of harm or misuse Establish care plan criteria for dose reduction Schedule follow-up and reassessment Naloxone: >20-50mg morphine equivalent/day Opioid Measurement Strategies Concurrence with Opioid Rx Guidelines % of patients with opioid goals of therapy % of patients with step-down care plans Rate of in-hospital naloxone use Rate of on-admission naloxone use No. of persons refocused through drug courts % of naloxone co-rx with long-acting opioids % of patients with pain contracts w/long-acting Strategies to Achieve Results in Iowa Celebrate success: In-hospital Naloxone rate Empower C-3 & accountable communities Team-based focus on opioid Rx and use Engage patients/families in our strategies Harm-minimization treatment perspective Meaningful Community-wide measures Patient-specific pain goals of therapy 6
Opioid Resources Closing the Gap Between Science and Medicine http://www.centeronaddiction.org/addiction-research/reports/addictionmedicine Guidelines for Cancer Pain Management http://jco.ascopubs.org/content/early/2016/07/19/jco.2016.68.5206.ful CDC Guidelines for Prescribing Opioids http://www.cdc.gov/drugoverdose/data/overdose.html CDC Checklist for Chronic Pain Prescribing http://stacks.cdc.gov/view/cdc/38025 I.H.I. 100 Million Healthier Lives Toolkit http://www.100mlives.org/approach-priorities/#opioid Breakout Session Open Forum Questions to Run On What pain management approaches have you found to work best? Turn to the person sitting next to you and share your reflections to this query. 2 minutes per person We will then go around the room so you can share the great ideas and observations from the person sitting next to you! Thank You Brian Isetts isetts@umn.edu 100 E. Grand Ave., Ste. 360 Des Moines, IA 50309-1800 Office: 515.283.9330 Fax: 515.698.5130 www.ihconline.org 7