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Chronic Pain Initiative. CCNC and Project Lazarus: Chronic Pain and Community Initiative.

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Chronic pain initiative

Chronic Pain Initiative

CCNC and Project Lazarus:

Chronic Pain and Community Initiative


Community Care of North Carolina (CCNC), in conjunction with non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

Goals

  • Reduce opioid-related overdoses

  • Optimize treatment of chronic pain

  • Manage substance abuse issues (opioids)


What is the Chronic Pain Initiative? non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

  • A set of interrelated programs designed to improve the medical care received by chronic pain patients, and in the process, to reduce the misuse, abuse, potential for diversion and overdose from opioid medication.

Model is based on proper assessment, diagnosis, and treatment plan with

Pain agreement as necessary


Why are we looking at replication
Why non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI). are we looking at replication?

  • Evidence exists that the Wilkes County approach is changing conditions in ways that will reduce misuse, abuse, diversion and overdose from prescription opioids.

    • Changes in how medical professionals manage chronic pain patients and monitor their prescription use.

    • Change in opioid prescribing policy and practice within ED of Wilkes Regional Medical Center

    • Increased access to Naloxone and understanding of when and how to use

    • Pill take-back days

    • Community awareness, coalition building for community education

  • Reduction in unintentional poisoning deaths, especially those stemming from narcotics prescribed by providers based in Wilkes County


Unintentional poisoning deaths by county n c 1999 2009
Unintentional Poisoning Deaths by County: N.C., 1999-2009 non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

1999 - 2001

Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2009 Analysis by Injury Epemiologyand Surveillance Unit


Unintentional poisoning deaths by county n c 1999 20091
Unintentional Poisoning Deaths by County: N.C., 1999-2009 non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

2002 - 2005

Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2009 Analysis by Injury Epemiologyand Surveillance Unit


Unintentional poisoning deaths by county n c 1999 20092
Unintentional Poisoning Deaths by County: N.C., 1999-2009 non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

2006 - 2009

Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2009 Analysis by Injury Epemiologyand Surveillance Unit


Poisonings on the rise
Poisonings on the Rise non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

NC mortality rates, unintentional and undetermined intent poisonings, 2001-2010

Mortality rate/100,000 population

*Source: NC. State Center for Health Statistics; annually generated poisoning report for Project Lazarus. ** Mortality rates calculated from bridged population estimates (2001-2009) and 2010 US Census counts.


Problem acute in wilkes county
Problem Acute in Wilkes County non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

Unintentional and undetermined intent poisoning mortality ratesWilkes County, NC 2003-2009

Mortality rate/100,000 population

Source: NC SCHS, August 2009


Nc cost of hospitalizations for unintentional poisonings
NC non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI). Cost of Hospitalizations for Unintentional Poisonings

  • Average cost of inpatient hospitalizations for an opioid poisoning*: $16,970

  • Number of hospitalizations for unintentional and undetermined intent poisonings**: 5,833

  • Estimated costs (2008): $98,986,010

    Does not include costs for hospitalized substance abuse

    * Agency for Healthcare Research and Quality

    ** NC State Center for Health Statistics, data analyzed and prepared by K. Harmon, Injury and Violence Prevention Branch, DPH, 1/19/2011


Medicaid Network Patient Case Management non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).


Controlled substances overdoses
Controlled Substances/Overdoses non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).


Opioids a rising nc problem
Opioids a Rising NC Problem non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

Narcotics causing or contributing to fatal unintentional and undetermined intent poisonings*: N.C. residents, 2001-2010

t

*Source: NC State Center for Health Statistics; annually generated poisoning report for Project Lazarus


Key ingredients in chronic pain initiative
Key Ingredients non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI). in Chronic Pain Initiative

  • Establishment (or prior existence) of a community coalition that is able to develop and implement effective strategies to reduce substance use

    • A sense of urgency among local actors who have influence

    • Dedicated manager of the coalition with skills in process and content

  • Appropriate strategy for achieving a change in prevailing medical practice re: treatment of chronic pain patients (PCP and ED locations)

    • Tailored to local conditions

    • Includes education on the extent of the problem in the community and the role of providers in limiting supply and opportunities for diversion

    • Includes useful tools that providers can adopt (e.g., Medication Agreements, guidelines for proper script writing)

    • Explicit recommendations for hospital policies that limit dispensing of narcotics (especially to ED patients)

    • Take advantage of leverage points in larger environment (e.g., CSRS, Medicaid lock-in policy)


Key Ingredients in Chronic non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI). Pain Initiative

  • Makes effective use of various partners in carrying out strategies including but not limited to:

    • Public health department – multiple strategies

    • County Medical Director – to reach physicians and ED

    • Medical providers – to change their own practice and educate other providers

    • Pharmacist – to other pharmacies in community

    • Law enforcement

    • Schools

    • Behavioral Health, Prevention and Treatment Programs and Organizations


Contents of the toolkit
Contents of the Toolkit non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

  • General information

    • Managing chronic pain

    • Proper prescription writing

    • Precautions

  • Tools for managing chronic pain patients

    • Universal Precaution for Prescribing and Algorithm for assessing and managing pain

    • Pain Treatment Agreement

    • Format for progress notes

    • Medication flowsheet

    • Personal care plan

    • Prescriber and Patient education materials

    • Screening Forms and Brief Intervention

    • Naloxone Prescribing

    • Controlled Substance Reporting System (CSRS)


Primary care tool kit
Primary Care Tool Kit non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

  • Physician toolkit for treating chronic pain patients

  • Encourage the use of Pain Treatment Agreements with chronic pain patients

  • Encourage use of Provider Portal

  • Encourage use of Controlled Substance Reporting System (CSRS)

  • Encourage the assignment of pharmacy home for chronic pain patients lock-in program


Emergency department tool kit
Emergency Department Tool Kit non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

  • Care management for pain patients visiting ED

  • ED policy that restricts the dispensing of narcotics

  • Encourage the Use of the CSRS by ED physicians

  • Encourage the Use of Provider Portal in the ED

  • Identify Chronic Pain Patients and Refer for Care Coordination based on ED assessment


Care management tool kit
Care Management Tool Kit non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

  • Provide support to ED identification of chronic pain patients- referrals to PCP or specialty services

  • Provide care management for patients identified by PCP practice as CPI patient; consider pharmacy lock-in program

  • Ongoing care management for Medicaid patients with narcotic prescriptions above threshold pain patients via TREO data

  • Educate PCPs and providers in utilization of Chronic Pain Tool Kit


Project lazarus results
Project Lazarus Results non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

1. Lower Risk in the Community

2. Similar Benefit to Patients

69%

3. Improved Risk : Benefit

15%

15%


Can coalitions help reduce rx drug abuse
Can coalitions help reduce Rx drug abuse? non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

  • Counties with coalitions had 6.2% lower rate of ED visits for substance abuse than counties with no coalitions(could be due to random chance)

  • However, counties with a coalition where the health department was the lead agency had a statistically significant 23% lower rate of ED visits (X2=2.15, p=0.03) than other counties

  • In counties with coalitions 1.7% more residents received opioids than in counties without a coalition.

  • Coalitions may be useful in reducing the harms of Rx drug abuse while improving access to pain medications.

  • More professional coalitions may have a greater impact on reducing Rx drug harms.

Data Sources: NC Health Directors Survey, NC DETECT (2010), CSRS (2008-2010)


Camden non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

Alleghany

Currituck

Northhampton

r

Gates

Warren

Ashe

Surry

Stokes

a

Person

Rockingham

Caswell

Vance

Pasquatank

Hertford

Halifax

Watauga

Perquimans

Wilkes

Chowan

Yadkin

Granville

Avery

Forsyth

Bertie

Franklin

Orange

Guilford

Mitchell

Alamance

Durham

Caldwell

Alexander

Nash

Tyrrell

Davie

Yancey

Edgecombe

Madison

Wake

Washington

Dare

Iredell

Davidson

Martin

Burke

Wilson

Randolph

Chatham

McDowell

Catawba

Buncombe

Rowan

Pitt

Beaufort

Haywood

Hyde

Swain

Johnston

Lincoln

Rutherford

Lee

Greene

Graham

Henderson

Cabarrus

Harnett

Jackson

Wayne

Gaston

Stanly

Polk

Moore

Cleveland

Lenoir

Transylvania

Montgomery

Craven

Cherokee

Mecklenburg

Macon

Pamlico

Clay

Sampson

Cumberland

Jones

Richmond

Hoke

Union

Anson

Duplin

Scotland

Carteret

Onslow

Robeson

Bladen

Pender

New

Columbus

Hanover

Brunswick

Legend

AccessCare Network Sites Community Care Plan of Eastern Carolina

AccessCare Network Counties Community Health Partners

Community Care of Western North Carolina Northern Piedmont Community Care

Community Care of the Lower Cape Fear Northwest Community Care

Carolina Collaborative Community Care Partnership for Health Management

Community Care of Wake and Johnston Counties Community Care of the Sandhills

Community Care Partners of Greater MecklenburgCommunity Care of Southern Piedmont

Carolina Community Health Partnership

Source: CCNC 2011


Contact
Contact non-profit organization Project Lazarus, is responding to some of the highest drug overdose death rates in the country through its Chronic Pain Initiative (CPI).

  • Dr. Mike Lancaster

    • [email protected]

  • Fred Wells Brason II

    • [email protected]

  • www.communitycarenc.org

  • www.projectlazarus.org


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