What is Pain?media.mycrowdwisdom.com.s3.amazonaws.com/ascp/... · 2. Opioid Selection, Dosage,...

7/27/2017

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800 Tydings Lane 800.799.4673 / 410.273.6600Havre de Grace, MD 21078 AshleyTreatment.org

SmartPrescribingof OpioidMedications

2016

OBJECTIVES

• Identify the prevalence and characteristics of chronic paincomplaints

• Describe the risks and benefits of opioids for chronic vs. acutepain treatment

• Assess the potential for opioid prescriber guidelines to help orhinder pain management

What is Pain?

“An unpleasant sensory and emotional experienceassociated with actual or potential tissue damage, ordescribed in terms of such damage.”

- International Association for the Study of Pain (IASP)

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Neurobiology of Pain

• Complex- Involves peripheral, dorsal horn, ascending track anddescending inhibition mechanisms

• Pain results from activation of peripheral receptors (nociceptors)by a stimulus

• Chronic pain- Caused by changes in peripheral nerves, spinalcord structures and supraspinal structures

Acute vs. Chronic Pain

• Acute: Typically lasts 3-6 months

• Is the result of actual tissue damage secondary to injury, surgery or theexacerbation of chronic disease

• Chronic: Persists on a daily basis for a month beyond what would beconsidered necessary to heal the underlying injury

• Seems to serve no purpose and is much more complex and difficult tomanage than acute pain

• Divided into cancer/terminal and non-cancer/non-terminal categories

The Many Causes of Pain

• Injury (trauma, surgery)

• Disease (pancreatitis, PUD)

• Neuropathy (diabetic, alcoholic, impingement)

• Joint degeneration

• Side effect of drugs

• Infection (pyelonephritis, abscess)

• Unknown???

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Common Chronic PainSyndromes• Low Back Pain

• Peripheral Neuropathic Pain

• Postherpetic Neuralgia

• Arthritis (often post-traumatic)

• Chronic Daily Headache andMigraine

• Complex Regional PainSyndrome

• Pelvic Pain

• Fibromyalgia

• Orofacial Pain• Trigeminal Neuralgia• Temporomandibular Disorder

• Somatic Symptom Disorder

• Phantom Limb Pain

• Central Post-stroke Pain

• Spinal Cord Injury

The Prevalence of Pain in the UnitedStates

• Pain is the number one reason that patients present to their physician

• 100 million adults in the United States are affected by a chronic pain condition

• Chronic back pain is the most common condition, followed by severe headaches,arthralgia and neck pain

• The total healthcare costs secondary to pain ranged from $560 billion to $635 billion in2010 (eclipsing the cost of heart disease, diabetes or cancer)

• Patients with chronic pain utilize about twice as many health care resources as thegeneral population

Pain is a Global Phenomenon

• Globally, it is estimated that 1 in 5 adults suffer from pain and that another 1 in 10 adultsare diagnosed with chronic pain each year

• Primary care settings in Asia, Africa, Europe, and the Americas had patients reportingpersistent pain prevalence of 10 to 25%

• True for both the developed and the developing world

• Developing countries bear higher burdens of persistent pain and lesser likelihood of effective treatment

• Chronic pain is typically accompanied by substantial comorbidities

• Pain should be a global public health priority• Understanding pain as a disease (rather than a symptom) may reduce the global burden of this health

problem and its comorbid conditions

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Prevalence of Pain in Persons withSubstance Use Disorders• Substance use disorder and pain are interrelated, with each condition

influencing the treatment of the other

• Chronic pain complicates the efforts of many individuals with substanceuse disorders to enter and sustain recovery

• 24% of patients admitted for treatment of addiction experienced severechronic pain

• 37% of patients in methadone maintenance treatment programs (MMTPs)reported severe chronic pain

• ~80% of patients in both groups reported pain of some type and duration

• These patients are at increased risk of receiving inadequate painmanagement

Pain Assessment

• Pain complaints should always be taken seriously

• No diagnostic test to measure existence or severity of pain

• Thorough history• Quality and location of pain

• Associated signs and symptoms

• Exacerbating and alleviating factors

• Temporal aspects

• Interference with daily functioning

• Response to prior treatments

Pain Assessment

• Psychological history• Prior psychiatric diagnoses• Work history• Legal history• Substance abuse history• Prior or current suicidality

• Focused physical exam (neurological and musculoskeletal)• Sensory changes• Motor changes• Passive and active range of motion• Postural and gait abnormalities

• Imaging as indicated

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Addiction Assessment

• Urine toxicology screen

• Relevant substance use history• Frequency, duration, amount used

• Route of administration

• Previous attempts at reduction or cessation

• History of withdrawal, tolerance, blackouts, seizures

• Previous treatments

• Assess readiness to stop or cut down

Addiction Assessment

• Other History• Failure to fulfill major obligations• Recurrent use in hazardous situations• Recurrent legal problems• Continued use despite negative consequences

• Mental Status Exam• Sensorium, intoxication, mood, psychosis, suicidality

• Physical Exam• Liver, heart, lungs, CNS/PNS• Track marks• Lymphadenopathy

The History of PainManagement

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John Bonica

• Opened America’s first pain clinicat UW School of Medicine in1960

• Utilized many specialties withinmedicine to treat pain

• Used bio-psycho-social,comprehensive approach withminimal role of opioids

• Patient must participate andcannot be “fixed” likeautomobiles

• Many clinics followed thisapproach, but were dissolved bythe 1990’s as insurancecompanies balked at payment

The History of Pain Management

• Throughout most of the 20th century doctors who prescribed opioids weretreated as virtual outlaws

• In the 1970’s attitudes began to change

• 1980: Dr Jan Stjernsward from Sweden was made chief of the cancerprogram for the World Health Organization (WHO)

• Created WHO “Pain” Ladder, which included opioids for intractable pain

• WHO also claimed that freedom from pain is a universal right

The WHO Pain Ladder

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Kathleen Foley

• 1980’s - Dr Kathleen Foley(Memorial Sloan Kettering CancerCenter) became the voice for dyingcancer patients

• Pioneered the field of palliativecare medicine and promoted theuse of opioids in cancer patients

• She also advocated for the use ofopioids in the treatment of non-cancer pain

Russell Portenoy

• Neurologist who did a fellowship underFoley

• He was thrilled to be able to relieve thecrippling pain he saw in patients

• “I believe in drugs. I thinkpharmaceuticals are a great gift tohumankind.”

• Pushed for the use of opioids in non-cancer pain

How Opioids Became So Prevalent

• Release of long acting opioids

• Marketing of OxyContin

• More insurance companies reimbursing for pills, but not therapythat was not strictly medical

• “Pill Mills”

• Climate: WHO ladder, universal right to pain treatment, 5th vitalsign, providers really want a solution

• Prescription opioids link to heroin

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Opioid Prescriptions haveSkyrocketed in Past Twenty Years

Public Health Goals

• Heighten awareness about pain and its health consequences

• Emphasize the prevention of pain

• Improve pain assessment and management in the delivery of healthcareand financing programs of the federal government

• Use public health communication strategies to inform patients on how tomanage their own pain and limit opioid use

• Address disparities in the experience of pain among subgroups ofAmericans

Current Regulatory Issues

• Joint Commission• “Recognize the right of patients, residents or clients to appropriate

assessment and management of pain”• “Screen patients, residents or clients for pain during their initial assessment

and, when clinically required, during ongoing, periodic reassessments”

• State Laws• http://www.painpolicy.wisc.edu/database-statutes-regulations-other-policies-

pain-management• Maryland has a Board of Physicians educational guideline, requires 1 hour

CME on pain for physician licensing

• Centers for Medicare and Medicaid Services (CMS) require painassessment, treatment and ongoing review of patient response

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What are “effective” paintreatments?Traditional Medical Model

• Medication

• Surgery

• Nerve Blocks

• Physical Therapy

• Cognitive Behavioral Therapy

• Comprehensive Program

Usually covered by insurance. Taught in traditional medicalschools. Overseen by FDA.

“Less” traditional

• Massage

• Acupuncture

• Exercise / stretching

• Prayer

• Chiropractic medicine

• Herbal remedies / homeopathy

• Self-help

• Biofeedback

• Pilates

Less often covered by insurance. Not taught intraditional medical schools. Not as available.

FDA Approved Indications for thetreatment of Pain with Opioids• Pain (Moderate to Severe)

• Postoperative pain, short-term management during hospitalization

• Pain, chronic, intractable (morphine)

• Pain, when opioid analgesics are appropriate

• Pain, chronic, in patients requiring daily around-the-clock analgesic(hydrocodone)

• Pain, chronic (Severe), in patients requiring a long-term dailyaround-the-clock opioid analgesic (oxycodone, fentanyl)

• Pain (Moderate to Severe), Not responsive to non-narcotic analgesics

• Breakthrough cancer pain, in opioid-tolerant patients

The health care provider must…

Often make clinical recommendations based uponinsufficient evidence

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Risks of Opioid Treatment

• Constipation (most commonproblem)

• Nausea / vomiting

• Overdose, decreasedrespiratory drive

• Euphoria

• Hypotension and bradycardia

• Sedation

• Confusion

• Physical dependence

• Opioid use disorder

• Sleep disruption

• Urinary retention

• Sexual side effects

• Immunosuppression

• Fractures (especially inwomen)

• MDD

• Opioid Induced hyperalgesia

Risks of Untreated or UndertreatedPain• Relapse / new SUD

• Mental health symptoms (ie,depression, anxiety)

• Suicide

• Exacerbation of cognitiveimpairment (esp. in elderly)

• Functional loss and increaseddependency

• Loss of productivity

• Impaired mobility (increasedrisk of falls/fractures)

• Impaired immune functionand healing

• Increased health careutilization and costs

• Sleep disturbances

• Withdrawal and decreasedsocialization

• Legal Problems

Risk of New Substance Use Disorderwith Chronic Opioid PainTreatment?

• The exact rate of OUD in chronic pain patients is not known, butis thought to increase as the daily opioid dose increases andmay be as high as 26% among patients prescribed opioids

• Persons at higher risk include those with• History of substance use disorder

• Comorbid mental illness

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Why use Opioids at All?

• Very few alternatives available (especially in rural or lowSES)

• Lack of access to specialty pain treatment

• Providers desire to relieve suffering

• Legal ramifications of under-treatment of pain

Opioid Prescribing Guidelines

• What is a guideline?• “systematically developed statements aimed at helping people

make clinical, policy-related and system-related decisions”http://www.agreetrust.org/

• Who usually writes guidelines?• Professional societies (local, national, international)• Policy makers• Insurance payers

• Audience for guidelines differ• Primary care providers, pain specialists, providers in certain

regions or certain specialties, hospital administrators

Examples of Guidelines – APS andother professional societies• http://americanpainsociety.org/uploads/education/guidelines/chronic

-opioid-therapy-cncp.pdf• Developed by pain researchers and clinicians• Audience: any provider treating patients with chronic non-cancer pain• “Although evidence is limited, the expert panel concluded that chronic opioid

therapy can be an effective therapy for carefully selected and monitoredpatients with chronic non-cancer pain.”

• https://www.asipp.org/Guidelines.htm• Meant for interventional pain specialists• “Since evidence supporting the efficacy for use of opioids as treatment of

chronic non-cancer pain is limited and based on short-term studies, long-termopioid therapy for chronic non-cancer pain should be reserved forselect patients with moderate or severe pain that significantly affectsfunction or quality of life. In addition, continuation of opioid therapy isindicated if documentation supports that opioids result in improvement in painand function.”

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Pain Association Guidelines- 2009(APS and AAPM)

• Full History and Physical• Substance abuse, misuse and addiction

• Benefit to harm evaluation

• Obtain Informed Consent

• Consider trial of chronic opioid therapy (COT) todetermine appropriateness


• Monitoring• Pain intensity

• Level of functioning

• Progress towards therapeutic goals

• Presence of adverse events

• Adherence to prescribed treatment

• Random urine drug screens for all patients

• In high-risk patients (h/o abuse, psychiatric issues, aberrant behaviors)

• More frequent and stringent monitoring

• Consultation with psychiatrist and/or addiction specialist


• Reassess and consider discontinuing COT when rapiddose escalation or high dose needed

• Anticipate, identify, and treat common opioid associatedadverse effects

• Routinely integrate psychotherapeutic interventions

• Clinicians should be aware of federal and state laws

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CDC Guideline for Prescribing Opioids forChronic Pain (2016)

1. Determining When to Initiate or Continue Opioids forChronic Pain

2. Opioid Selection, Dosage, Duration, Follow-Up, andDiscontinuation

3. Assessing Risk and Addressing Harms of Opioid Use

Determining When to Initiate or ContinueOpioids for Chronic Pain

1. Try non-pharmacologic and non-opioid pharmacologictreatments before opioids

2. Document Intended and actual clinical improvements

3. Counsel patients on risks and benefits

Opioid Selection, Dosage, Duration,Follow-Up, and Discontinuation

4. Try IR (vs ER) opioids first

5. Start with lowest effective dose

6. Prescribe in low quantities for acute pain

7. Re-evaluate benefits and harms often

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Assessing Risk and AddressingHarms of Opioid Use

8. Assess risk factors and mitigate risks

9. Check PDMP before prescribing and periodically thereafter

10.Conduct UDT before prescribing and periodically thereafter

11.Avoid concurrent benzodiazepine use

12.Refer patients with opioid use disorder to addiction treatment

Why is there controversy aroundguidelines?

• Turning chronic pain patients into adversaries of patients andfamilies suffering with substance use disorders

• With multiple guidelines available, are providers at increased risk oflegal action?

• What will insurance payers do?

• Who funded guideline development?

Are guidelines useful in helpingmanage chronic pain?

• Unfortunately, guideline production is flourishing but uptake incommunity is floundering

• Need to consider implementation during guideline development

• No evidence that guidelines improve pain treatment OR affectsubstance use disorder outcomes

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What are the unintendedconsequences of past guidelines?

• Vast increase in opioid prescription/use

• Patients with more pain, worse function, anddecreased quality of life

• Current opioid epidemic

Research Gaps• What is the effect of length of time in MAT on risk of relapse with acute pain

treatment?• Does 12-step meeting attendance provide protection against relapse with

opioid analgesic therapy?• What analgesic combinations can reduce opioid requirements in pain

treatment?• What is the prevalence of chronic pain patients successfully maintained on

opioids?• What risk stratification tools can predict which chronic pain patients

develop opioid use disorder?• What clinically should be done with the tens of millions of patients that may

be tapered off of opioids and still report chronic pain?• What is the acceptability and efficacy for non-opioid pain treatment

strategies in persons with history of substance use disorders?

Conclusions

• Chronic pain is a significant burden to individuals and to society.

• The increased reliance on opioids for chronic non-cancer paintreatment has been associated with a dramatic rise in personswith opioid use disorder and opioid overdose deaths.

• Guidelines designed to inform clinical practice differ inrecommendations for opioid use in chronic non-cancer paintreatment.

• Consensus is needed that balances access to adequate painmanagement with devastating harms of addiction.

Experts in geriatric medication management. Improving the lives of seniors.

ACollaborativeApproachtoFallPrevention

UsingtheASCP-NCOAToolkit


Agenda• OverviewoftheCDCSTEADIandASCP/NCOAToolkits• CaseStudyPresentationandDiscussion– Pharmacologic

andMedicalIssues• BuildingYourReferralNetwork• Interprofessional FallandFallRiskManagement:

IntroductiontotheRoleofPhysicalandOccupationalTherapy• CaseWork andDiscussion• Wrap-Up


Faculty• KathleenCameron,MPH

SeniorDirector,CenterforHealthyAging• MichelleFritsch,PharmD,BCGP,BCACP

Founder&President,MedsMASH,LLC• PennyShelton,PharmD,BCGP,FASCP

ExecutiveDirector,NorthCarolinaAssociationofPharmacists• AliceBellPT,DPT,GCS

SeniorPaymentSpecialist,AmericanPhysicalTherapyAssociation• JacquelineWilson,MS,OTR/L

ClinicalAssistantProfessor,AcademicFieldworkCoordinator,TowsonUniversity


OverviewoftheCDCSTEADIandASCP/NCOAPharmacistToolkits

PennyShelton,PharmD,BCGP,FASCPExecutiveDirector,NorthCarolinaAssociationofPharmacists

MichelleFritsch,PharmD,BCGP,BCACPFounder&President,MedsMASH,LLC


FacultyDisclosurePennySheltonandMichelleFritschdonothaveanyrelevantfinancialrelationshipswithcommercialinterestspertainingtothecontentpresentedinthisprogram.


LearningObjectives• IdentifyandutilizecomponentsoftheCDCSTEADItoolkit.• DescribethepurposeoftheASCP-NCOAFallsRisk

ReductionToolkitforpharmacistsandotherclinicalpractitioners.

• IdentifyandutilizeeachcomponentoftheASCP-NCOAFallsToolkitinasimulatedcase.

• DefinehowtheASCP-NCOAFallsToolkitmaybeusedinyourpracticeasafallsriskreductionresource.


Cases


CDCSTEADI• Toolkitforprofessionals• Toolkitforpatients


STEADIProfessionalComponents


STEADIPatientComponents


ASCP/NCOAToolkitComponents• FallsRiskChecklist• FallsApplicationCases• CommunicationsDocuments• BuildYourReferralNetwork• Bibliography

SupportprovidedbySanofi


FallsRiskChecklistFourkeyareasofthechecklist• Gettoknowyourpatient• MedicalConditions• MedicationAssessment• FallRiskInducingDrugs(FRIDs)


GetToKnowYourPatient• Age• TransitionStatus• LivingArrangements• SubstanceUse• VitalSigns• AmbulationStatus• SensoryFunction• LowerExtremities• MedicationSelfManagement• FallsHistory

Know Me





MedicalConditions• GaitandBalanceAltering• PainRelatedGaitandBalanceChanges• VascularRelatedConditions• CentralNervousSystem• Incontinence• Obesity• Malnutrition• Infections• OrganFunction

Treat Me




MedicationOverview&LabAssessment

LabValues- Criticallyimportantlabs

- Electrolytes,glucose,SCr,BUN,&hepaticenzymes- Calculateestimatedcreatinine clearance(CockcroftGault)

- Possiblymedicationconcentrations

MedicationOverview- Numberofmedications(routine/asneeded)>4-6(polypharmacy =fallsrisk)

- Numberofdosesperday&complexregimensassociatedw/fallsrisk- Recentmedicationchanges


MedicationAssessmentGeriatricAppropriateMedication

Beer’sListSTOPPSTARTMAI

MedicationRelatedProblemsEachmedicationisnecessarySafestevidence-basedtherapyDosetoolowtobeeffective

Dosetoohighcausingadverseeffectsorunnecessaryrisk

Interactionsbetweenmedications,food,medicalconditions

Abilitytoeffectivelyadministereachmedication

AllergiesandintolerancesIndicationwithoutanassociatedtherapy



FallsRiskInducingDrugs(FRIDs)• CNSDepressants• Anticholinergics• PainTherapy• Anticonvulsants• Antihypertensives• HypoglycemicAgents• Over-The-Counter




12 3

45

Tally the

Risks


Considerations• Numberperclass/risktype

– < 2CNSdepressingmedications• Limitanticholinergicburden• Medicalconditions,medications,otherfactors• Patientspecific• (Pharmacistsareuniquelysuitedforthisin-depthanalysis)• Considerallrisksandbenefits

AGSBeersCriteria.JAmGeriatr Soc 2015


Alternatives• Newergenerationoptionswithfewersideeffects• Avoidbenzodiazepinesand“Zdrugs”• Avoidtricyclicantidepressants,paroxetine• Topicalinplaceofsystemic• Acetaminopheninplaceofskeletalmusclerelaxants,NSAIDs,or

opioidswheneverpossible• Short-actingoverlong-actingoptions(e.g.hypoglycemics,opiates)• Lowestpossibledosetoachievetherapeuticgoal• Usenonpharmacologic approacheswheneverpossible

HanlonJT,etal.JAmGeriatr Soc 2015.FerrariS,etal.JGeriatricPharmacother 2008.


Documentation&Communication

Patient & family


LIMITTHOSEFALLS!


BuildingYourReferralNetwork:ACollaborativeApproachto

FallsPreventionKathleenCameron,MPH

SeniorDirector,CenterforHealthyAgingPennyShelton,PharmD,BCGP,FASCP

ExecutiveDirector,NorthCarolinaAssociationofPharmacists


Who’sInvolvedinFallsPrevention?• Physicians,nurses• Physicaltherapists• Occupationaltherapists• SNFsandALFs• Seniorhousing• Homehealth• EmergencyMedical

Services/1st responders

• HospitalsandTraumaCenters

• Publichealth/injuryprevention

• Schoolsofpharmacy,nursing,OT,PT

• TheAgingNetwork


Department of Health and Human ServicesAdministration for Community Living/Administration on Aging

State Units on Aging

Area Agencies on Aging

Local Service Providers

Consumers

Access Services

Senior Centers

Nutrition Services

In-Home Services

Community-based Services

Legal Assistance

Tribal Organizations

Institutional Services

Transportation

Governors and State Legislatures

Local Government

TheAging

Network


FallsPreventionPrograms• OtagoExerciseProgram• AMatterofBalance• SteppingOn

– Includesapharmacistpresentation

• TaiChi• StayActiveand

IndependentforLife(SAIL)


PaymentforFallsPrevention?• PrimaryCarePractices• AccountableCareOrganizations• MedicareAdvantagePlans• PatientCenteredMedicalHomes• Hospitals• Others


CPTCodes

OutpatientVisitType BillingCodes Considerations

WelcometoMedicareExaminationAfallsriskassessmentisarequiredelementoftheWelcometoMedicareexamination(InitialPatientPreventativePhysicalExam).

G0402Billablewithinfirst12monthsofenrollmentonly

AnnualWellnessVisitAreviewofindividualfunctionallevelandsafety(falls)isincludedintheinitialAnnualWellnessVisit(AWV).

G0438 InitialAWV

G0439 Subsequentfollow-uptoanAWV

EvaluationandManagement(E/M)Falls-relatedassessmentmaybecompletedaspartofascheduledofficevisitif>50%ofvisitwasface-to-faceeducation/counselinganddocumented(time)orbyanidentifiedandappropriatelydocumentedreimbursablemedicalcondition.(complexity)1

99201-99205 New-patient

99211-99215 EstablishedPatient

[


QualityMeasures

MIPS/PQRSMeasures/CPTCodes:Fallsscreening,assessment,andplanofcare

MIPS/PQRSMeasure154,155,318

0fallsinpastyear 1101F1fallinpastyearwithnoinjury 1101F1fallinpastyearwithinjury 1100F2ormorefallsinpastyear 1100FFallriskassessmentcompletedwithin12monthsinpersonswithfallhistory

3288F

FallCarePlandocumentedwithin12monthsinpersonswithfallhistory

0518F

ACOMeasures

Screeningforfuturefallriskatleastoncewithin12months 13

HEDISMeasuresforMedicareAdvantage

ReducingtheRiskofFalling MeasureC18


InterprofessionalFallandFallRiskManagement

IntroductiontotheRoleofPhysicalandOccupationalTherapy

AliceBellPT,DPT,GCSSeniorPaymentSpecialist,AmericanPhysicalTherapyAssociation

JacquelineWilson,MS,OTR/LClinicalAssistantProfessor,AcademicFieldworkCoordinator,TowsonUniversity


InterprofessionalFallandFallRiskManagement• Causesoffalls• When/whytoreferfortherapy• IndicationsforTherapyReferral• ReviewofAPTAClinicalSummaryonFallRiskinCommunity-DwellingElders• OccupationalTherapyEvaluation• OccupationalTherapyInterventions• TimedUpandGoTest• ReviewofPreventionofFallsinCommunity-DwellingOlderAdults:U.S.Preventive

ServicesTaskForceRecommendationStatement• EvidencebasedInterventions

– Dosespecificexerciseprescription


CausesofFalls• Notpartofagingprocess• Occurdueto:– Physicaldysfunction– Cognitivedeficits– Medications– Environmentalhazards


IndicationsforTherapyReferral/Consultation

• Changesinordifficultyinmobility– Unsteadygait– Reducedspatialawareness

• Useofnewordifferentmobilitydevice• Reportoffall• Difficultyrisingfromachair

– Muscleweakness• Reportofchangeinenvironment


IndicationsforTherapyReferral/Consultation

• Observedchangeinselfcaremanagement– Grooming– Dressing– Medicationmanagement

• Noticeablecognitive/motorchallenges– Handlingmoney– Paymentformedications– Organizingthoughtsinconversation– Problemsolvinganddirectionfollowing


Whentoreferfortherapy?Whyreferfortherapy?

• Time,Time,Time• Whenconsultingwithaclient,ifyoufeelthereisnotenough

timetoexplain,train,andmaintaintheregimenneededforsafetyandwell-being,thenconsidermakingareferralforoccupationaltherapyorphysicaltherapy.

• Therapistshavethetimeduringtheirtherapysessionstoaddressthespecificneedsandgoalsofaclient.


APTAClinicalsummary• Examinationrecommendations• Riskfactors• Testsandmeasures• Interventions


OccupationalTherapyEvaluation• OccupationalProfile• Assessments• Identificationofstrengths,needs,• Collaborativedevelopmentofgoals• Consultationwiththeclientandcaregiver


OccupationalTherapyInterventions• Medicationmanagement

– Secureaprescription– Fillaprescription– Understandingtheprescription– Takingmedications– Medicationapps

• Fallsmanagement– Assessmentofhomeenvironment– Sensorimotoreducationandactivities


TimedUpandGoTest

https://www.youtube.com/watch?v=BA7Y_oLElGY


PreventionofFallsinCommunity-DwellingOlderAdults:USPreventativeServicesTaskForceRecommendationStatement

• SummaryofRecommendationsandEvidence


Evidence-BasedInterventions• DoseSpecificExercisePrescription


Interprofessional FallandFallRiskManagement


CaseWorkand

Discussion


Wrap-Up

What is Pain?media.mycrowdwisdom.com.s3.amazonaws.com/ascp/... · 2. Opioid Selection, Dosage,...

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