Deprescribing Geri Kanne, MSN, RN, ANP-BC Deprescribing · 2018. 6. 4. · Geri Kanne, NP Mitch...
Transcript of Deprescribing Geri Kanne, MSN, RN, ANP-BC Deprescribing · 2018. 6. 4. · Geri Kanne, NP Mitch...
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DeprescribingJessica Visco, PharmD, CGP
SeniorPharmAssist
August 24, 2016
Deprescribing
Jessica Visco, PharmD,
CGP
SeniorPharmAssist
Webinar #1
Webinar #11
Interagency Care Team: Helping Your Geriatric Patients Remain Safe and Healthy at Home
Geri Kanne, MSN, RN, ANP-BC
Mitchell T. Heflin, MD, MHS
Melissa Black, MPH
Michael Patterson, BS
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Disclosures No commercial support has influenced the planning of the
educational objectives and content of the activity. Any
commercial support will be used for events that are not CE
related.
There is no endorsement of any product by DUHS
associated with the session.
No influential financial relationships have been disclosed by
planners or presenters which would influence the planning of
the activity. If any arise, an announcement will be made at
the beginning of the session.
This program is supported by a Geriatric Workforce
Enhancement Program (GWEP) grant (U1QHP28708) from
the U.S. Bureau of Health Professions Health Resources
and Services Administration (HRSA).
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Case-1
Ms. F is a 76 y/o widowed AAF
Lives by herself in Durham
Worked as a cook at a local diner until retired
Daughter lives locally, but works full-time
Does not drive and relies on a neighbor for
transportation
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Case-2Medical history
Cognitive impairment (no formal assessment)
HTN
Depression
Asthma
Other concerns: Urinary incontinence and intermittent
insomnia
Meds: oxybutynin, atenolol, paroxetine, albuterol
inhaler, promethazine, diphenhydramine
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Case-3
Recently:
Misses PCP appointments
Blood pressure elevated in clinic
Trouble affording her medications
Traditional Medicare but not enrolled in part D
$23/month from Food and Nutrition Services
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Case-Questions
What are YOUR priorities from a medical
perspective?
What are HER priorities in terms of her day to
day challenges and stressors?
How can we account for BOTH in providing her
care?
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Objectives for Today:
Define purpose of Interagency Care Team (ICT)
Describe services provided
Decide which patients are most appropriate for ICT
How to refer your geriatric patients
What to expect after the referral
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The GWEP: Who are we?
Partners:
Duke faculty—Nursing, Medicine, PA, RD, Epi, Educ, SW
Triangle J AAA
Community Resource Connection (CRC)
Senior PharmAssist
Durham Partnership for Seniors
Duke Connected Care
identify current
resources
identify needs and
gaps
Connect practices, geriatrics,
and community agencies
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The GWEP: What do we Do?
Activities:
Form partnerships
Host CE programs to develop geriatric expertise in primary care (GRTs)
Provide virtual geriatric consultations (ICTs)
Train A-GNP and MD fellows in geriatrics
Evaluate impact on trainees and outcomes at population level
identify current
resources
identify needs and
gaps
Connect practices, geriatrics,
and community agencies
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Improved care
of older adults
GWEP Faculty
and community
partners
GRT Educational Program
Communication:
IPCP trainingworkshop
Competencies:Best practices: dementia care, medications, transitions
Continuous Improvement: Focused projects
Connections: Referrals to ICT, community agencies
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ICT Consultation
GWEP/ICT
PACE
Duke Outpatient
Clinic
Just For Us
LincolnDurham Family
Medicine
Walltown
Triangle Family
Practice
• Virtual Consultation:
“Geri Rounds”
• Focus on resource
needs
• EHR tools
• Identify “at risk”
seniors
• Reimbursement
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Who Makes Up the Team? Geri Kanne, NP
Mitch Heflin, M.D., MHS
Marilyn Disco, pharmD
Melissa Black, Coordinator, Durham Community
Resource Connections for Aging and Disabilities
Rhonda Mack-Minnifield, Health Resources
Coordinator
Katie Huffman, Community Services Director
Geriatric NP and MD fellows
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Whom Should You Refer?
Patients aged 60 and older with complex care
needs who would benefit from community
resources to help them remain safe and
healthy at home
Issues: cognitive impairment, medication
management, insurance/access, transitions in
care, level of care/caregiving, transportation,
food insecurity, social isolation
GET clinic or ICT?
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What is the Process for
Making a Referral?
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What is the Process for
Making a Referral?
Primary Care site without access to Epic:
(919) 684-9507 (Geri Kanne, NP)
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What Happens Next?
Chart review by ICT lead, pharmacist
Phone call to pt./HCPOA
ICT group meets
Consult note into Epic
Patient-friendly recommendations to patient in
the mail
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Back to the Case
PCP Concerns
Uncontrolled BP
Cognition
Depression
Transportation
Lack of drug plan
Patient Concerns
Incontinence supplies
Food Insecurity
Depression
Transportation
Insomnia
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Back to the case
Medication review by a geriatric pharmacist from Senior PharmAssist
Drug insurance review to ensure she is paying the least amount for her medication regimen
Connection to transportation services
Referral to meals on wheels, information on area food banks, Double Bucks at Durham Farmer’s Market
Facilitation of socialization through Durham Center for Senior Life
Connection to free incontinence supplies
Referral to Silver Linings for counseling
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ICT Consult Note
ISSUE ACTION NEEDED TO COMPLETE ASSIGNED
1. A) Medications: not on part
D drug plan
B) Misses doses
A) Make appointment with Senior PharmAssist to
enroll in part D drug plan
B) Discuss switching to pharmacy that delivers prefilled
meds in pill pack.
A) Information to pt.
B) Information to patient
2. Food Insecurity Receives $23/month from FNS. Would like information
on Double Bucks with Durham Farmer’s Market and
food banks
2. Information mailed to
pt.
3. Depression: feels isolated and
lonely since husband died
She would like to talk to someone about her ongoing
grief and depression. Agrees to referral to Silver Linings
3. ICT put in referral to
Silver Linings
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ICT Referral: Results (N=27)
Issue Addressed # of
Cases
Referral Agencies
Cognition/Depression/
Social Isolation
21 Behavioral Health; Senior Centers; Duke Family
Support; Silver Linings
Med Management 21 Pharmacy consult; SPA; Information to pt; RN home
visit to check meds
Food Insecurity 15 Meals on Wheels; Food Bank; More in My Basket;
SNAP
Personal Safety 15 PT/OT; DSS/in home aide; Duke Vestibular Rehab
Adv. Directives 14 POA form located in chart-mailed to pt/HCPOA;
Home health RN; SW at PCP office
Transportation 9 DSS/CapDA; Helping Hand; GoDurhamACCESS; Let’s
All Go/Alliance of Disability Advocates
Incontinence products 9 Diaper Bank; Caswell Co Senior Ctr
Financial assist/Rx 6 SPA (same pt referred for med mgemt);
LIS/application by DCSL; PAP; SW to assist with Duke
Hardship
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Durham Center for Senior
LifeOur mission is to enhance the lives of older
adults (55 and older) through Education,
Recreation, Nutrition and Social Services in a
welcoming community setting.
Membership is no cost, Come Join the Fun!
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DCSL Point of Contacts Maggie Perez – Social Services Coordinator
[email protected] 919-688-8247 ext. 104
Transportation, Weatherization / Home Repair, Housing Assistance, Legal Aid
Telephone Reassurance, Information and Assistance / Referrals, Latino Outreach
Michael Patterson – Support Services Manager
[email protected] 919-688-8247 ext. 122
Family Caregiver/ Respite Care/ Group Support
Food / Hygiene / Diaper Pantry, Utility Assistance
Information and Assistance / Referrals / Options Counseling, Outreach
Alvonia Baldwin – Center Director
[email protected] 919-688-8247 ext. 120
Congregate Nutrition / Satellite Senior Centers, Health Promotions
Center Programming / Presentations
mailto:[email protected]:[email protected]:[email protected]
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Durham Partnership for
Seniors Advocates for senior issues
Promotes and facilitates partnerships
Identifies opportunities that may improve the quality of
life for Durham’s seniors and adults with disabilities
Home and Community Care Block Grant Advisory Role
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Durham Community Resource Connections for Aging & Disabilities
Durham County Board of Commissioners
Home and Community Care Block Grant
Advisory Role
Durham’s Partnership for Seniors
Triangle J Area Agency
on Aging
Dementia Inclusive Durham
Durham’s Partnership for Seniors Organizational Structure
FY 2017 - 2018
Duke Geriatric Workforce
Enhancement Project
Legend:
Blue Boxes = Initiatives
Red Boxes = Funding Sources
Funding Direction
Specific DPfS
Initiatives
Collaboration
Senior Hunger & Nutrition
Age-Friendly Initiative
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Future Plans for ICT Evaluation:
Feedback: GRTs, patients and caregivers
Process: Were referrals completed?
Clinical: ED visits, hospitalization, aging in place
Efficiency:
Documentation during meetings
Realtime referrals to CBO’s?
Access:
Increase frequency and # reviews
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Closing Remarks Consider ICT for any complex geriatric patient that you
feel would benefit from geriatric evaluation, especially
those in need of community services.
Maestro Referral tab: E-Communication for Geriatrics
OR
Geri Kanne, NP (919) 684-9507
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Questions?
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Continuing Education Credits 1 hour of CE credit is being offered for this webinar.
For the live webinar, to obtain the credit you must:
Add your name to the chat box (to verify attendance)
Complete the survey. The survey will open automatically at the end of the webinar and the link will be sent in a follow-up email.
If you did not register for this webinar and would like CE credit, contact [email protected]
mailto:[email protected]