Primary Care Practices:
You can’t pick up any form of media without hearing about the opioid crisis facing the nation. Did you know that…
- There were more overdoses in the state of Florida in 2017 from Xanax than from an opioid?
- There is an increase focus on the use and misuse of Gabapentin?
- Benzos are considered/mentioned as the new opioid for an epidemic?
- The FDA issued a warning against prescribing benzodiazepines with opioids in elderly?
- Almost 40% of the elderly experience polypharmacy?
- And, Medication Management is almost always one of the key solutions suggested to address these challenges?
In October 2015, First Coast published guidelines on Controlled Substance Monitoring using urine drug testing. In March 2016, the CDC published guidelines geared towards primary care physicians and their prescribing of controlled substances. In March 2018, Governor Scott joined many other states in signing legislation (HB 21) to address Florida Opioid Prescribing. And insurance companies are now requiring more documentation from the patient encounter to refill certain prescriptions.
At American Clinical Solutions, we have been educating on these exact formats for over 10 years. The importance of medication management – for those prescribed controlled substances, anti-depressants and anti-psychotics – is a key component to keeping physician’s practices and licenses up-to-date with regulations, legislation and guidelines for best practices and keeping patient’s safe, healthy and as independent as possible through medication management, medication reconciliation and medication reduction, all as appropriate.
We would welcome the opportunity to speak with your team about our services, to share educational documents created to keep our customers up-to-date and well-armed to make the best medication management decisions for their patients and to introduce our processes developed with our customers in mind to test, monitor, manage and educate your patients on controlled substance medications prescribed by your clinicians.
“Pain is the most common complaint for which individuals seek medical attention.” American Pain Society Definitions of Acute and Chronic Pain². Acute pain follows injury to the body and generally disappears when the bodily injury heals. It is often, but not always, associated with objective physical signs of autonomic nervous system activity. Chronic pain, in contrast to acute pain, rarely is accompanied by signs of sympathetic nervous system arousal. Lack of objective signs may prompt the inexperienced clinician to say the patient does not “look” like he or she is in pain.
Chronic nonmalignant pain can be defined as: unrelated to cancer (RA now eliminated), pain greater than 90 days after surgery, pain that persists beyond the usual course of the disease and beyond the expected time for healing from injury or trauma, pain which is associated with long term incurable or intractable medical illness or disease. i.e. chronic pain from abdominal adhesions post-operative.
Chronic pain can be differentiated from acute pain in that acute pain signals a specific nociceptive (pain that arises when the different nerve endings that respond to pressure, touch, heat, irritant chemicals, or pain are stimulated or damaged) event and is self-limited. Chronic pain may begin as acute pain, but it continues beyond the normal time expected for resolution of the problem or persists or recurs for other reasons.
Chronic pain may include varying amounts of disability, from none to severe, and may be independent of the amount of tissue damage and perceived severity (Melzack & Wall, 1965). Biological, psychological, social, cultural, and developmental factors can impact pain-related functioning.
Chronic pain is a significant public health problem in the US. In the 1980’s, pain was undertreated. The 90’s introduced the “Decade of Pain” and JCAHO defined pain as the fifth vital sign. And in the 2000’s, Pill Mills proliferated where cash was paid for physician visits and drugs. Some physicians transformed from “medical doctors” to MDD’s “medical drug dealers”.
Pain is the leading public health problem in this country and the most common symptom that leads to medical care. 35% of Americans have chronic pain. Per the Institute of Medicine, 116 million individuals suffer from chronic pain. 50 million Americans are partially or totally disabled by chronic pain. Chronic pain accounts for 50 million lost workdays per year and often results in unemployment. The cost of lost workdays per year is estimated to be over $100 billion per year in cost to society in lost productivity
and medical costs.³ ⁴ Back pain alone produces chronic disability in 1% of the U.S. population and is the leading cause of disability in Americans under 45 years old. As our population ages, the already significant problem of chronic pain in the elderly will increase.
Clinicians managing the care of residents in assisted living facilities, independent living environments, group homes, continuing care retirement centers, nursing homes and home health agencies may prescribe controlled substances, anti-psychotic and anti-depressant drugs for different reasons – pain management, mental health disorders, or neurological disorders.
“Outcomes Driven Medication Management” An Evidence Based Clinical Solution for Medication Reconciliation, can be a positive addition to any medication management solution within the post-acute care setting – it supports medication reconciliation for clinicians managing patients post-discharge from the hospital and other care settings, supports facility programs to eliminate hospitalizations and discharges, and fall prevention programs, delivers evidence based lab results to aid clinical pathways for medication reduction and management of care plans. American Clinical Solutions’ lab guided, outcomes driven medication management program provides confirmation and analytical reporting to support clinical best practices, and most importantly, resident/patient independence and quality of life.
Foley, Disbanding the Barriers: JAMA IIS
Opioid Guidelines Summary: American Pain Society-Academy of Pain Medicine Opioids Guidelines Panel, The Journal of Pain, Vol 10, No.2, February 2009
Rosenblum A, et al. JAMA. 2003:289:2370-2378
Study conducted by Ortho-McNeal – Pain and Absenteeism in the Workplace