Project Lazarus/CCNC

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Project Lazarus/CCNC A statewide initiative to prevent drug overdose Dr. Robin Gary Cummings Deputy Secretary for Health Services State Health Director

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Project Lazarus/CCNC. A statewide initiative to prevent drug overdose. Dr. Robin Gary Cummings Deputy Secretary for Health Services State Health Director. Resources: Community Care of North Carolina. 1.4+ million Medicaid lives in CCNC Medical Homes in CCNC 14 Networks- local control - PowerPoint PPT Presentation

Transcript of Project Lazarus/CCNC

Page 1: Project Lazarus/CCNC

Project Lazarus/CCNC

A statewide initiative to prevent drug overdose

Dr. Robin Gary Cummings

Deputy Secretary for Health Services

State Health Director

Page 2: Project Lazarus/CCNC

Resources: Community Care of North Carolina

1.4+ million Medicaid lives in CCNC Medical Homes in CCNC

o 14 Networks- local controlo 1600+ Practiceso 4,500+ PCP providers

Behavioral Healtho 19 Psychiatrists in the 14 Networks o 14 Full-time Behavioral Health Coordinators in the Networkso 44 Network pharmacists, now with Behavioral Health

pharmacy trainingo 14 Identified Chronic Pain Coordinatorso 14 Clinical Directors- MD, non-psychiatrists

Data Management Toolso CPI Flagso Pain Agreements Uploadedo BH Care Alertso LME/MCO Priority Patients

2

Page 3: Project Lazarus/CCNC

Each CCNC Network Has: A Clinical Director

A physician who is well known in the community

Works with network physicians to build compliance with CCNC care improvement objectives

Provides oversight for quality improvement in practices

Serves on the State Clinical Directors Committee

A Network Director who manages daily operations

Care Managers to help coordinate services for enrollees/practices

A PharmD to assist with Medication Management of high cost patients

Psychiatrist to assist in mental health integration

Palliative Care and Pregnancy Home Coordinators

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Unintentional poisoning mortality rates by type of narcotic: North Carolina residents, 2000-2010*

4

*Source: NC SCHS, annual poisoning report prepared for Project Lazarus, based on ICD-10 T codes that identify the five narcotic categories associated with unintentional/undetermined intent poisonings on death certificates.

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

50

100

150

200

250

300

350

400

450

500

550

Cocaine & Heroine

Methadone

Other Opioids & Synthetic Narcotics

Men

tions

of S

ubst

ance

s Co

ntrib

uting

to D

eath

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2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

5

10

15

20

25

53

7

10

7

10 10

7

22

19

Year

Nu

mb

er o

f Dea

ths

Number of Unintentional Drug-Related Overdose Deaths By Year, Robeson County, N.C., 2003-2012 (N=100)

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Rates of Hospitalizations Associated with Drug Withdrawal Syndrome in Newborns per 100,000 Live BirthsNorth Carolina, 2004-2011

Source: N.C. State Center for Health Statistics, 2006-2011Analysis by Injury Epidemiology and Surveillance Unit

355% Increase

104.4154.4 157.5

221.8

314.7

394.9

475.1

197.1

0

100

200

300

400

500

2004 2005 2006 2007 2008 2009 2010 2011

Year

Rate

per

100

,000

live

bir

ths

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Where Pain Relievers Were Obtained

1 The Other category includes the sources: “Wrote Fake Prescription,” “Stole from Doctor’s Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.”

Bought/Took from Friend/Relative

14.8%

Drug Dealer/Stranger

3.9%

Bought on Internet

0.1% Other 1

4.9%

Free from Friend/Relative

7.3%

Bought/Took fromFriend/Relative

4.9%

OneDoctor80.7%

Drug Dealer/Stranger

1.6%Other 1

2.2%

Source Where Respondent Obtained

Source Where Friend/Relative Obtained

One Doctor19.1%

More than One Doctor

1.6%

Free from Friend/Relative

55.7%

More than One Doctor3.3%

Non-medical Use among Past Year Users Aged 12 or Older 2006

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Project Lazarus: A State Wide Response to Managing Pain

Based on pilot project from Wilkes County

Funding mechanism: Kate B. Reynolds grant- $1.3 million

Matching funds from Office of Rural Health- $1.3 million

MAHEC grant for western counties

Total Funds available $2.6 million

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Areas of Focus

Clinical Education- tool kits and trainings focus on opioid prescribing for primary care docs, ED docs, and CCNC care managers

Community Involvement- Involvement of all levels of community to demonstrate the drug problem is a community problem

Outcome Study- evaluate the outcomes to assure the effectiveness of the interventions

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Partners

Partners in roll-out coordinated through CCNC: Project Lazarus- Community Coalitions (funding for 100

counties)

Governor’s Institute/CCNC- 40 Clinical Trainings for all prescribers and dispensers

Local Mentor program through CCNC

Local TA and Consultation through CCNC

UNC Injury Prevention Research Center- report outcomes of project

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Areas of Focus for Project Lazarus

Safer Opioid Prescribing- decrease in unintentional poisonings

Increased enrollment and use of CSRS

Education on and dispensing of Naloxone as rescue medication

Special projects: Dental Pain

Opioids in pregnant women

Sickle Cell disease and pain

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CCNC Infrastructure to Support Project Lazarus

Project Manager

Chronic Pain Initiative Coordinators in each of 14 Networks

Care Managers to support patients in connecting to and remaining in care

Network Psychiatrists to provide education and support to Primary Care Physicians

Informatics Center to make available pain contracts and

special treatment plans for patients

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Community Coalitions

Coalitions to be developed in each County

Involve local leaders from health departments, law enforcement, Public Health, school systems, advocate groups, local CCNC, and clinical leaders

Leadership of coalition to be determined by each county

Funding through Project Lazarus available to help support each county coalition

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Updates on Early Results since March 2013

Eight trainings for prescribers and dispensers- average attendance 55-60

Enrollment in CSRS: Prescribers (MD, DO, PA, FNP)

8/2012 30%

9/2013 33% (increase over 2400 prescribers)

National average 28%

Pharmacists

8/2012 17%

9/2013 42%

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Legislative Support in 2013

Supports for CSRS to enhance enrollment and use: Delegate authority

Reporting time of 72 hours from 7 days

Reporting of aberrant patterns in patients and physicians for follow-up by physicians and licensing Boards

Passage of Good Samaritan Law Supports distribution and use of Naloxone as rescue drug in

overdose situations

Supports physician prescribing

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North Carolina’s Response:Coordinating with Many Partners

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North Carolina Injury and Violence Prevention BranchEpidemiology, Policy, Partners, Community

Poisoning Death StudyComprehensive Community Approach Chronic Pain Initiative

Opioid Death Task Force

Policy & Practice Research

North Carolina

Policy

Monitoring System

Drug Take Back

Prescription Drug

Substance Abuse

Div. of Public Health,

SAC Poisoning Workgroup

Enforcement

SBI & Medical Board

Div. Medical Assistance,Div. Mental Health/ DD/Substance Abuse

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Call to Action:What can the Division of Public Health do?

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ASTHO’s Presidential Challenge

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ASTHO’s Presidential Challenge

Identify an area of concentration Improve Monitoring & Surveillance

Expand Prevention Strategies

Expand and Strengthen Enforcement

Improve Access to Treatment & Recovery

18 states to date have signed on

15x15: Reduce prescription drug use by 15% by 2015

Page 21: Project Lazarus/CCNC

ASTHO’s Presidential Challenge North Carolina’s Areas of Concentration

• Improve Monitoring & Surveillance Increase available data Continue & expand linkage projects Increase public health surveillance using CSRS

• Expand Prevention Strategies CCNC/ Project Lazarus Expand access to Naloxone

• Expand and Strengthen Enforcement Coordinate efforts with law enforcement

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Call to Action:What can Local Health Departments do?

Page 23: Project Lazarus/CCNC

Local Health Department Actions Coordinate with your CCNC Regional Director

Form or Join a Substance Abuse Coalition

Request your Poisoning Data tables from CCNC or DPH

Use NC DETECT to monitor your prescription drug ED visits

Enhance your data from local sources

Have a signed standing order for Naloxone by your Medical Director

Take an active role to facilitate and coordinate with local groups

Make presentations at local medical societies on your prescription drug prevention activities

Advocate with local providers to register and use CSRS