Increase Access to Non-Pharma Therapies - Revision history

K.castelo at 13:11, 1 July 2021

2021-07-01T13:11:12Z

K.castelo at 13:08, 1 July 2021

2021-07-01T13:08:30Z

Rwashington: Rwashington moved page Increase Access to Alternative Therapies to Treat Pain to Increase Access to Non-Pharma Therapies

2020-11-07T19:14:15Z

Rwashington moved page Increase Access to Alternative Therapies to Treat Pain to Increase Access to Non-Pharma Therapies

Pkalch at 01:48, 7 April 2020

2020-04-07T01:48:59Z

Josiebeets at 23:55, 24 November 2019

2019-11-24T23:55:56Z

Josiebeets at 23:55, 24 November 2019

2019-11-24T23:55:12Z

Josiebeets at 23:54, 24 November 2019

2019-11-24T23:54:37Z

Josiebeets at 23:46, 24 November 2019

2019-11-24T23:46:54Z

Snkennedy3327 at 21:55, 23 October 2019

2019-10-23T21:55:21Z

Billb at 22:50, 29 November 2018

2018-11-29T22:50:23Z

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 '''Areas of Intervention/Training'''<br/> Education for Future Doctors<br/> When future doctors go through school, there seems to be very limited education detailing pain and pain management. Pain curricula in medical school education for both MDs and DOs in the U.S. ranges from 1-31 hours during the 3-4 year curriculum, with a mean of 11.13 hours. Thus, the current training system has left primary care practitioners with inadequate tools to deal with some of the most common problems doctors will come across during their years of practice. Any meaningful effort to improve pain management will require a basic culture shift in the nation’s approach to mandating pain-related education for all health professionals who provide care to people with pain.
-One possible solution is cross-training between fields. Many, if not most, pain clinics are still housed in anesthesiology clinics, but fellowship pain training can now be pursued not only by anesthesiologists but other specialists in neurology/psychiatry, PM&R, and internal and family medicine. Physicians who receive fellowship training in pain care learn interventional pain strategies that originated in regional anesthesia and acute pain care, including non-pharmacological options. The expansion of these strategies, which are the mainstay of anesthesiology and acute pain practices, to chronic pain care have had more modest success and only in carefully selected patient.<ref>file:///C:/Users/Owner/Downloads/Evidence-BasedNonpharmacologicStrategiesforComprehensivePainCareWhitePaper12.15.17%20(1).pdf))</ref><br/> &nbsp;
+One possible solution is cross-training between fields. Many, if not most, pain clinics are still housed in anesthesiology clinics, but fellowship pain training can now be pursued not only by anesthesiologists but other specialists in neurology/psychiatry, PM&R, and internal and family medicine. Physicians who receive fellowship training in pain care learn interventional pain strategies that originated in regional anesthesia and acute pain care, including non-pharmacological options. The expansion of these strategies, which are the mainstay of anesthesiology and acute pain practices, to chronic pain care have had more modest success and only in carefully selected patient.<ref>http://www.asacu.org/wp-content/uploads/2017/11/JIM-Acupunctures-Role-in-Solving-the-Opioid-Epidemic.pdf</ref><br/> &nbsp;
-'''Insurance and Coordinated Care'''<br/> Coordination of care across disciplines and access to nonpharmacologic care have not been optimized in the current system in most states and territories, and improvement to these systems could help reduce opioid use. There are a few state Medicaid policy initiatives aimed at increasing access to effective nonpharmacologic therapies as a first line treatment for pain conditions. For example, the Oregon Health Plan (OHP – Oregon’s Medicaid program) covers acupuncture therapy, chiropractic and osteopathic manipulation, physical therapy and cognitive behavioral therapy for all back conditions. Vermont’s legislature is piloting a program where they will cover acupuncture therapy for back pain in a Medicaid population and monitor health outcomes and cost-effectiveness. Such programs are promising and there is hope that with more interventions like this, the number of opioids being prescribed will decrease.<ref>file:///C:/Users/Owner/Downloads/Evidence-BasedNonpharmacologicStrategiesforComprehensivePainCareWhitePaper12.15.17%20(1).pdf)</ref>
+'''Insurance and Coordinated Care'''<br/> Coordination of care across disciplines and access to nonpharmacologic care have not been optimized in the current system in most states and territories, and improvement to these systems could help reduce opioid use. There are a few state Medicaid policy initiatives aimed at increasing access to effective nonpharmacologic therapies as a first line treatment for pain conditions. For example, the Oregon Health Plan (OHP – Oregon’s Medicaid program) covers acupuncture therapy, chiropractic and osteopathic manipulation, physical therapy and cognitive behavioral therapy for all back conditions. Vermont’s legislature is piloting a program where they will cover acupuncture therapy for back pain in a Medicaid population and monitor health outcomes and cost-effectiveness. Such programs are promising and there is hope that with more interventions like this, the number of opioids being prescribed will decrease.<ref>https://www.finance.senate.gov/imo/media/doc/Coalition%20of%20Accupuncture%20Associations.pdf</ref>
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+<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>
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 When future doctors go through school, there seems to be very limited education detailing pain and pain management. Pain curricula in medical school education for both MDs and DOs in the U.S. ranges from 1-31 hours during the 3-4 year curriculum, with a mean of 11.13 hours. Thus, the current training system has left primary care practitioners with inadequate tools to deal with some of the most common problems doctors will come across during their years of practice. Any meaningful effort to improve pain management will require a basic culture shift in the nation’s approach to mandating pain-related education for all health professionals who provide care to people with pain.
-One possible solution is cross-training between fields. Many, if not most, pain clinics are still housed in anesthesiology clinics, but fellowship pain training can now be pursued not only by anesthesiologists but other specialists in neurology/psychiatry, PM&R, and internal and family medicine. Physicians who receive fellowship training in pain care learn interventional pain strategies that originated in regional anesthesia and acute pain care, including non-pharmacological options. The expansion of these strategies, which are the mainstay of anesthesiology and acute pain practices, to chronic pain care have had more modest success and only in carefully selected patient.<sup class="reference"><span style="background-color:#e74c3c;"><ref>[8]Can't find the citation</ref></span></sup><br/> &nbsp;
+One possible solution is cross-training between fields. Many, if not most, pain clinics are still housed in anesthesiology clinics, but fellowship pain training can now be pursued not only by anesthesiologists but other specialists in neurology/psychiatry, PM&R, and internal and family medicine. Physicians who receive fellowship training in pain care learn interventional pain strategies that originated in regional anesthesia and acute pain care, including non-pharmacological options. The expansion of these strategies, which are the mainstay of anesthesiology and acute pain practices, to chronic pain care have had more modest success and only in carefully selected patient.<sup class="reference"><span style="background-color:#e74c3c;"><ref>[8]Can't find the source (( file:///C:/Users/Owner/Downloads/Evidence-BasedNonpharmacologicStrategiesforComprehensivePainCareWhitePaper12.15.17%20(1).pdf)) </ref></span></sup><br/> &nbsp;
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 == Insurance and Coordinated Care ==
-Coordination of care across disciplines and access to nonpharmacologic care have not been optimized in the current system in most states and territories, and improvement to these systems could help reduce opioid use. There are a few state Medicaid policy initiatives aimed at increasing access to effective nonpharmacologic therapies as a first line treatment for pain conditions. For example, the Oregon Health Plan (OHP – Oregon’s Medicaid program) covers acupuncture therapy, chiropractic and osteopathic manipulation, physical therapy and cognitive behavioral therapy for all back conditions. Vermont’s legislature is piloting a program where they will cover acupuncture therapy for back pain in a Medicaid population and monitor health outcomes and cost-effectiveness. Such programs are promising and there is hope that with more interventions like this, the number of opioids being prescribed will decrease.<sup class="reference"><span style="background-color:#c0392b;">[9]</span></sup>
+Coordination of care across disciplines and access to nonpharmacologic care have not been optimized in the current system in most states and territories, and improvement to these systems could help reduce opioid use. There are a few state Medicaid policy initiatives aimed at increasing access to effective nonpharmacologic therapies as a first line treatment for pain conditions. For example, the Oregon Health Plan (OHP – Oregon’s Medicaid program) covers acupuncture therapy, chiropractic and osteopathic manipulation, physical therapy and cognitive behavioral therapy for all back conditions. Vermont’s legislature is piloting a program where they will cover acupuncture therapy for back pain in a Medicaid population and monitor health outcomes and cost-effectiveness. Such programs are promising and there is hope that with more interventions like this, the number of opioids being prescribed will decrease.<sup class="reference"><span style="background-color:#c0392b;"><ref>[9] Can't find source/ ((file:///C:/Users/Owner/Downloads/Evidence-BasedNonpharmacologicStrategiesforComprehensivePainCareWhitePaper12.15.17%20(1).pdf))</ref></span></sup>
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 = Current Status =
-*Attorneys general (AGs) from 37 states have let the insurance industry know that the fight against the nation's opioid crisis won't be won unless health care providers are encouraged to prioritize nonopioid pain management options, including physical therapy, over opioid prescriptions for the treatment of chronic, noncancer pain.<sup class="reference">[1]</sup>
+*Attorneys general (AGs) from 37 states have let the insurance industry know that the fight against the nation's opioid crisis won't be won unless health care providers are encouraged to prioritize nonopioid pain management options, including physical therapy, over opioid prescriptions for the treatment of chronic, noncancer pain.<sup class="reference"><ref>[1]AGs From 37 States Call for Better Insurance Coverage for Nonopioid Pain Treatment. (n.d.). Retrieved November 24, 2019, from http://www.apta.org/PTinMotion/News/2017/9/27/AGsToAHIP/
-*Brandeis University Professor Dr. Andrew Kolodny said efforts to limit opioid prescribing in recent years have been positive steps but warns that there are about 10 million to 12 million patients in the U.S. who have been on painkillers for years and need alternative therapies to offset the potential damage that could be caused by being cut off cold turkey.<sup class="reference">[2]</sup>
+</ref></sup>
 = Complementary Health Approaches =
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 = Benefits of Active Self-Care Therapies =
-In contrast to medication-based therapies, many Non-Pharmaceutical Pain Care (NPPC) strategies involve significant patient participation and a commitment to self-care. NPCC strategies tend to increase self-efficacy in managing pain and correlate with improved mood and outcomes in many chronic conditions, including pain.<sup class="reference">[3]</sup> For example, the military has studied “active self-care therapies” as a category of pain management that may be of value in an integrated, multi-modal approach.<sup class="reference">[4]</sup>
+In contrast to medication-based therapies, many Non-Pharmaceutical Pain Care (NPPC) strategies involve significant patient participation and a commitment to self-care. NPCC strategies tend to increase self-efficacy in managing pain and correlate with improved mood and outcomes in many chronic conditions, including pain.<ref>[3] Marks, R., Allegrante, J. P., & Lorig, K. (2005). A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: Implications for health education practice (part II). Health Promotion Practice, 6(2), 148–156. https://doi.org/10.1177/1524839904266792
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 == Little Falls, Minnesota's Program to Reduce Opioid Prescriptions for Pain ==
-In 2014, doctors in Little Falls, Minnesota noticed that there were a large number of opioid prescriptions and drug-related arrests. Through heightened addiction treatment and monitoring of prescriptions - as well as working with community partners like schools, local health departments, law enforcement, and health alliances - they were able to wean 324 patients off opioids entirely and lower prescriptions of opioids from 48,000 a month to 37,000. Patients must sign a contract when they are prescribed opioids that allows for electronic monitoring of their medical records to look for patterns of abuse, and law enforcement will alter doctors if opioids the doctors prescribed are found in possession of someone other than the patient to whom they were prescribed. Patients caught selling and abusing opioids are not punished; rather, they are given access to Suboxone and to a support team - including a nurse and mental health specialist. Although the program started off as an abstinence-based program, doctors changed to a medically-assisted program when patients started to die.<sup class="reference">[5]</sup>
+In 2014, doctors in Little Falls, Minnesota noticed that there were a large number of opioid prescriptions and drug-related arrests. Through heightened addiction treatment and monitoring of prescriptions - as well as working with community partners like schools, local health departments, law enforcement, and health alliances - they were able to wean 324 patients off opioids entirely and lower prescriptions of opioids from 48,000 a month to 37,000. Patients must sign a contract when they are prescribed opioids that allows for electronic monitoring of their medical records to look for patterns of abuse, and law enforcement will alter doctors if opioids the doctors prescribed are found in possession of someone other than the patient to whom they were prescribed. Patients caught selling and abusing opioids are not punished; rather, they are given access to Suboxone and to a support team - including a nurse and mental health specialist. Although the program started off as an abstinence-based program, doctors changed to a medically-assisted program when patients started to die.<sup class="reference"><ref>[5]A Minnesota Critical Access Hospital Uses Medication-assisted Therapy to Tackle the Opioid Crisis | AHA News. (n.d.). Retrieved November 24, 2019, from https://www.aha.org/news/insights-and-analysis/2018-03-28-minnesota-critical-access-hospital-uses-medication-assisted
-This program has gained national attention and is currently being looked at by national policymakers.<sup class="reference">[6]</sup> For example, On March 6, 2017, Minnesota State Representative Ron Kresha authored a bill designed to help more Minnesota communities develop opioid abuse prevention programs based on the program in Little Falls, MN. H.F. No. 2140 would establish opioid abuse prevention pilot projects throughout the state with appropriate funding. Each pilot project would establish a multidisciplinary controlled substance care team, deliver health care services and care coordination to reduce inappropriate use of opioids, address any unmet social service needs that create barriers to managing pain effectively and obtain optimal health outcomes, provide prescriber and dispenser education, promote best practices related to opioid disposal, and engage community partners outside the health care system in such efforts. The bill is currently going through revisions in Minnesota's house and senate.<sup class="reference">[7]</sup> Minnesota is all currently taking applications for places interested in starting pilot programs based on Little Falls' model [http://www.health.state.mn.us/divs/healthimprovement/content/documents-opioid/2018OpioidPreventionRFPFINAL.pdf Opioid Abuse Prevention Pilot Projects]<br/> &nbsp;
+This program has gained national attention and is currently being looked at by national policymakers.<sup class="reference"><ref>[6]Successful Little Falls effort to curb opioids gets big notice in D.C. - StarTribune.com. (n.d.). Retrieved November 24, 2019, from http://www.startribune.com/little-falls-effort-to-curb-opioids-gets-big-notice/448037143/
 &nbsp;
@@ Line 65: / Line 71: @@
 When future doctors go through school, there seems to be very limited education detailing pain and pain management. Pain curricula in medical school education for both MDs and DOs in the U.S. ranges from 1-31 hours during the 3-4 year curriculum, with a mean of 11.13 hours. Thus, the current training system has left primary care practitioners with inadequate tools to deal with some of the most common problems doctors will come across during their years of practice. Any meaningful effort to improve pain management will require a basic culture shift in the nation’s approach to mandating pain-related education for all health professionals who provide care to people with pain.
-One possible solution is cross-training between fields. Many, if not most, pain clinics are still housed in anesthesiology clinics, but fellowship pain training can now be pursued not only by anesthesiologists but other specialists in neurology/psychiatry, PM&R, and internal and family medicine. Physicians who receive fellowship training in pain care learn interventional pain strategies that originated in regional anesthesia and acute pain care, including non-pharmacological options. The expansion of these strategies, which are the mainstay of anesthesiology and acute pain practices, to chronic pain care have had more modest success and only in carefully selected patient.<sup class="reference">[8]</sup><br/> &nbsp;
+One possible solution is cross-training between fields. Many, if not most, pain clinics are still housed in anesthesiology clinics, but fellowship pain training can now be pursued not only by anesthesiologists but other specialists in neurology/psychiatry, PM&R, and internal and family medicine. Physicians who receive fellowship training in pain care learn interventional pain strategies that originated in regional anesthesia and acute pain care, including non-pharmacological options. The expansion of these strategies, which are the mainstay of anesthesiology and acute pain practices, to chronic pain care have had more modest success and only in carefully selected patient.<sup class="reference"><span style="background-color:#e74c3c;"><ref>[8]Can't find the citation</ref></span></sup><br/> &nbsp;
 &nbsp;
@@ Line 71: / Line 77: @@
 == Insurance and Coordinated Care ==
-Coordination of care across disciplines and access to nonpharmacologic care have not been optimized in the current system in most states and territories, and improvement to these systems could help reduce opioid use. There are a few state Medicaid policy initiatives aimed at increasing access to effective nonpharmacologic therapies as a first line treatment for pain conditions. For example, the Oregon Health Plan (OHP – Oregon’s Medicaid program) covers acupuncture therapy, chiropractic and osteopathic manipulation, physical therapy and cognitive behavioral therapy for all back conditions. Vermont’s legislature is piloting a program where they will cover acupuncture therapy for back pain in a Medicaid population and monitor health outcomes and cost-effectiveness. Such programs are promising and there is hope that with more interventions like this, the number of opioids being prescribed will decrease.<sup class="reference">[9]</sup>
+Coordination of care across disciplines and access to nonpharmacologic care have not been optimized in the current system in most states and territories, and improvement to these systems could help reduce opioid use. There are a few state Medicaid policy initiatives aimed at increasing access to effective nonpharmacologic therapies as a first line treatment for pain conditions. For example, the Oregon Health Plan (OHP – Oregon’s Medicaid program) covers acupuncture therapy, chiropractic and osteopathic manipulation, physical therapy and cognitive behavioral therapy for all back conditions. Vermont’s legislature is piloting a program where they will cover acupuncture therapy for back pain in a Medicaid population and monitor health outcomes and cost-effectiveness. Such programs are promising and there is hope that with more interventions like this, the number of opioids being prescribed will decrease.<sup class="reference"><span style="background-color:#c0392b;">[9]</span></sup>
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 [[TR_-_Increase_Access_to_Alternative_Therapies_to_Treat_Pain|TR - Increase Access to Alternative Therapies to Treat Pain]]
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 = Scorecard Building =
 Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;
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 = Resources to Investigate =
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-#[http://www.apta.org/PTinMotion/News/2017/9/27/AGsToAHIP/ http://www.apta.org/PTinMotion/News/2017/9/27/AGsToAHIP/]&nbsp;[[http://www.apta.org/PTinMotion/News/2017/9/27/AGsToAHIP/ 1]]
+&nbsp;
-#[http://www.modernhealthcare.com/article/20180505/BLOG/180509948 http://www.modernhealthcare.com/article/20180505/BLOG/180509948] [2]
-#Marks R, Allegrante JP, Lorig K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part II). Health Promot Pract. 2005;6(2):148-156.
+#<span style="background-color:#c0392b;">file:///C:/Users/Owner/Downloads/Evidence-BasedNonpharmacologicStrategiesforComprehensivePainCareWhitePaper12.15.17%20(1).pdf</span>
-#Type the content of your reference here.
+#<span style="background-color:#c0392b;">file:///C:/Users/Owner/Downloads/Evidence-BasedNonpharmacologicStrategiesforComprehensivePainCareWhitePaper12.15.17%20(1).pdf</span>
-#[https://www.aha.org/news/insights-and-analysis/2018-03-28-minnesota-critical-access-hospital-uses-medication-assisted [3]]
+</div> </div> </div> </div> </div>
 [[Category:SAFE-Prescriptions and Medical Response]]

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