Presentation on theme: "Project Lazarus/CCNC A statewide initiative to prevent drug overdose Dr. Robin Gary Cummings Deputy Secretary for Health Services State Health Director."— Presentation transcript:
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 o 14 Networks- local control o 1600+ Practices o 4,500+ PCP providers Behavioral Health o 19 Psychiatrists in the 14 Networks o 14 Full-time Behavioral Health Coordinators in the Networks o 44 Network pharmacists, now with Behavioral Health pharmacy training o 14 Identified Chronic Pain Coordinators o 14 Clinical Directors- MD, non-psychiatrists Data Management Tools o CPI Flags o Pain Agreements Uploaded o BH Care Alerts o LME/MCO Priority Patients 2
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
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.
Number of Unintentional Drug-Related Overdose Deaths By Year, Robeson County, N.C., 2003-2012 (N=100)
Rates of Hospitalizations Associated with Drug Withdrawal Syndrome in Newborns per 100,000 Live Births North Carolina, 2004-2011 Source: N.C. State Center for Health Statistics, 2006-2011 Analysis by Injury Epidemiology and Surveillance Unit 355% Increase
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 from Friend/Relative 4.9% One Doctor 80.7% Drug Dealer/ Stranger 1.6% Other 1 2.2% Source Where Respondent Obtained Source Where Friend/Relative Obtained One Doctor 19.1% More than One Doctor 1.6% Free from Friend/Relative 55.7% More than One Doctor 3.3% Non-medical Use among Past Year Users Aged 12 or Older 2006
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
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
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
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
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
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
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) 8/201230% 9/201333% (increase over 2400 prescribers) National average 28% Pharmacists 8/2012 17% 9/201342%
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
North Carolina’s Response: Coordinating with Many Partners
North Carolina Injury and Violence Prevention Branch Epidemiology, Policy, Partners, Community Poisoning Death Study Comprehensive 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
Call to Action: What can the Division of Public Health do?
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
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
Call to Action: What can Local Health Departments do?
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