Medical Director of FQHCagencymeddirectors.wa.gov/Files/COTS/12d_Shames_Oregon Pain...
Transcript of Medical Director of FQHCagencymeddirectors.wa.gov/Files/COTS/12d_Shames_Oregon Pain...
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Who am I?
• 1973: Family Practice in Southern Oregon
• Medical Director of FQHC
• Health Officer for Jackson County Oregon
• Medical Director of an OTP clinic.
• Chief Medical Officer for Synergy Health Consulting
• I have no conflicts to
disclose
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Community efforts to assist providers in pain and use disorder management
• Local Community • Provider/Clinic assistance• Future Challenges
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Jackson County Oregon: 2006 (46 overdose deaths)Population 200,000
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Jackson County Oregon: Creation of Oregon Pain Guidance (formerly the Opioid Prescribers Group)
• It takes a village to raise awareness
•Building the plane while we are flying (evolving best practices)
• Education
•Dispelling myths and bias
• Supports for team based care
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How to get them to the table?
•Personal Relationships
• Enticements (Financial support, practice supports, food)
• Threats (fear of Board action)
•CME
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At the table…now what?
•Brainstorm the problem
• Establish leadership
• Set achievable goals
•Bring in outside expertise
• Leverage technology
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Accessible Education
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Establish Community Best Practice Guidelines
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If we don’t solve this problem as a community, we are only passing it on to the next provider.
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Provider/Clinic Support
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Pain Management Improvement Team
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Example: Remote clinic in trouble with the Board
• Frontier rural family practice
• DEA identified worrisome prescribing
• Board investigation produced concerning practices
• Board action could jeopardize a large geographic portion of the State
• Clinic was offered an ”intervention” versus usual action
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What did we do?
• In person meeting: Board/Clinic/PMIT team
• Established 2 parallel tracks: clinic staff and provider staff
• Monthly meeting with both
• Discussed difficult patients, established trust
• Brought in expertise
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Collected Baseline DataThe Six Building Blocks of Pain Management and Safe Opioid Therapy in Primary CareOregon Health Authority, Oregon Prescription Drug Overdose Project
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Improvement after 1 year
“There have been big changes and now this is then norm, it is easier in the office now with the new changes with prescribing”-Support Staff
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Results:
•All the docs became X wavered• Total MED, high doses, and
overall prescribing went down• Transition of difficult
patients to buprenorphine•Reported back to the
Board
“Prior to OMB involvement they (the MDs) knew there was a problem but didn’t know what to do about it” Support Staff
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Future Challenges:
• The Taper Dilemma
• Pushback from frightened patients
• Still too many pills in the community