Florida has been called soil zero of the prescription drug question . According to the Florida Medical Examiners Commission Report in c~tinuance Drugs identified in deceased persons, prescriptions medicines, so as benzodiazepines, oxycodone, methadone and morphia were the leading cause of fortuitous deaths in Florida, killing nearly 3,000 Floridians. (Florida Department of Law Enforcement, 2010) This is not a marvellous statistic, given that Florida accounts during 89% of all the Oxycodone sold nationwide in 2009. (FL Office of Drug Control, 2009) Much of these were dispensed at “pill mills,” that are advertised as pain management clinics. People get to from all over the country to “learned man-shop,” which involves going to multiple fret clinics and filling prescriptions at multiple pharmacies over the state. However, statistics show that the more than half of individuals obtain prescription medication in quest of non-medical use from friends and kindred members. (CDC, 2011) This is just title to physician overprescribing. In 2009, the Florida Legislature approved the creation of the Prescription Drug Monitoring Program (PDMP). The Electronic – Florida Online Reporting of Controlled Substances Evaluation program (E-FORCSE) is Florida’s prescription drug monitoring database. The PDMP was created ~ dint of. the 2009 legislature in an power to begin to encourage safer prescribing of controlled substances and to lessen drug abuse and diversion within the state of Florida. In addition, it is expected that it determine improve quality of care as the database allows physicians to retrospect medications prescribed to their patients. It is besides expected to help doctors reduce disproportion prescriptions as left-over pills are single of the biggest sources of diverted drugs, separately amongst youth. Unfortunately, funding issues delayed the implementation of the PDMP, limit the system eventually went live in not long ago 2011.
Situational Analysis
Doctors are in a sole position to identify prescription drug misuse, help the patient recognize the moot point and seek appropriate treatment. However, education in substance use disorders remains defective in the medical training curriculum. Prescription mix with ~s abuse, although a growing health problem, is specifically addressed in medical breeding even less widely. Yet, screening and temporary intervention provides an opportunity for clinicians to be intermediate early and potentially enhance medical care ~ means of increasing awareness of the likely impulse of substance use on a patient’s overall health. The Substance Abuse and Mental Health Service Administration (SAMHSA) has sponsored a count of states in their efforts to study the effectiveness of Screening, Brief Intervention, and Referral to Treatment (SBIRT). (U.S. Dept. HHS, 2009) It is a full, integrated, public health approach to the travail of early intervention and treatment services on this account that persons with substance use disorders, of the same kind with well as those who are at jeopard of developing these disorders. Primary care centers, hospital pinch rooms, trauma centers, and other community settings provide opportunities for early agency with at-risk substance users in front of more severe consequences occur. SAMHSA is also involved in developing Current Procedural Terminology (CPT) codes to be distended payment for screening and brief interposition in primary care physicians’ offices, considered in the state of lack of time and reimbursement is seen in the same manner with a barrier to physicians adopting these processes.
Substance dishonor prevention and treatment is important, unless nearly half of those who died of overdose in Florida had a good opioid prescription at their time of death. (FL Office of Drug Control, 2009) The full age of them were not drug addicts through an illegal source of drugs, nevertheless instead, were in the care of a medical man when they died. (Association of State and Territorial Health Officials, 2008) Many of them were distress benzodiazepines and other medications in league with opioids, with deadly consequences. Given these facts, the take arms to end unintended deaths in Florida begins with physician education and subsequent process changes in their practices.
There is a stiffness between patients seeking pain relief and the usage drug abuse epidemic, particularly for aboriginal care providers (PCPs). A survey achieved by the American Academy of Pain Medicine (AAPM) identified sure pain management as one of PCPs’ surpass concerns. (AAPM, 2008) There is a importunate need for education in managing of long duration pain and safe opioid prescribing. There possess been several promising programs aimed at provider discipline at the state level. Utah implemented a sum of ~ units year program utilizing provider education, in precise physician detailing. This contributed to a 12.8% decrement in opioid related deaths in the declare. (Cochella, 2011) North Carolina implemented a uniform program aimed at educating PCPs attached safe opioid prescribing that was also associated with decreased opioid related departure rates. (Project Lazarus, 2011)
The Florida PDMP Foundation has been charged by funding and supporting E-FORCSE. (FL PDMP, 2009) We think to be true the success of the program is hanging upon physicians accessing the database and utilizing the supplies it provides. This requires education and moreover some practice redesign. While we are charged through securing funding to support the continued performance of the Florida PDMP, we require also taken on the mission of ensuring medical man stakeholder support to increase its capableness to decrease prescription drug deaths. For this thinking principle, we have designed the following campaign to put up with this mission.
Partnerships
The Florida PDMP Foundation came into subsistence as a partnership amongst various stakeholders in the common. We consist of both community and walk of life leaders working to save lives through funding and supporting the Prescription Drug Monitoring Program to contend against the deadly consequences of drug lampoon and diversion. The Foundation’s steering committee is comprised of a parade county sheriff, a President of a Florida-based health care company, an officer of a bank located in Florida, a antecedent director of the Office of Drug Control, the CEO of a company that conducts educational training and ~y attorney focused on assisting this non-bring good. In addition to the steering committee, we be favored with recruited members of the Florida State Medical Board, the Florida Department of Health’s Division of Medical Quality Assurance, and the American Association of Pain Physicians. We esteem also subcontracted portions of the information efforts to The Florida Quality Improvement Organization (FQIO).
They are a individual, non-profit, community-based organization dedicated to improving soundness and health care, that is unmoved of locally governed organizations in Florida. Their specialty is acting with a diverse set of common stakeholders to lead, develop and instrument appropriate change in the health care results. They have worked for two decades up~ the body various health care improvement projects in the condition of Florida and have strong ties to hospitals and cure associations around the state. FQIQ was charged by coordinating educational outreach and with connecting providers by the committee’s guidelines and recommendations, end educational sessions and other methods. Their support also assisted physicians and their pole in developing care processes that incarnate the educational tools.
SWOT Analysis
Strengths
Weaknesses
Internal
outreach team has existing relationships through providers across the state
strong base of maintain by existing organizations/stakeholders
access to existing wealth/support materials within the Florida act of worship of Drug Control and the PDMP
funding allows us to yield CME’s will be free of cost to physicians
expensive to provide individual of the college detailing
limited time to organize and instrument program with current resources while PDMP enlarge is still fresh
no previously trusty state data on outcomes of these emblem of interventions in Florida so ~t any best practices established yet
Opportunities
Threats
External
supports trust of PDMP so eligible for basis funding
recent launch of PDMP step physicians are open for education in c~tinuance prescribing guidelines and how to practice the database
national focus on prescript deaths due to recent celebrity deaths
SAMSHA push in the place of SBIRT reimbursement so potential financial provider incentives
physicians are time pressured
doubt on part of physicians, fear of reducing passage to patients who really need the meds
seeking to refund existing models of physician behavior, with equal rea~n resistance to change
confounding issues, intellectual health, addiction, diversion
Target Audience
Our target audience is primary care physicians in Florida for example our analysis suggests that primary care is a major source of unsafe pain medication and use as a result of inadvisable prescribing practices and medication address failures. There appears to be a according among pain management experts that nurture and the proper training of providers is a most important first step in addressing this society health problem. The White House’s 2009 National Prescription Drug Abuse Prevention Strategy includes medical man education as one its primary recommendations in addressing the nation’s prescription drug epidemic. In a recent article published in the Journal of the American Medical Association, researchers concluded that there is a need for better drilling in pain management, opioid pharmacology, and principles of rate and addiction. (Volkow & McLellan, 2011) Clinicians are in painful desire for best practices and guidelines. PCPs are time-strapped and ~times operate at the bounds of their discernment as a generalist, but surveys exhibition that they realize they need in addition training in substance abuse and bore management. In addition, as the ~fare on prescription drugs heats up in Florida, physicians are cowardly of prosecution while legitimately providing management for pain. (Ziegler & Lovrich, Jr., 2009) Many of them keeping the PDMP, but there is a trouble about learning the new rules and the strange technology. The only education the commonwealth currently provides are rules workshops that shroud the basics of logging onto the cob~ system, regulation and statutes. These abridgment workshops are not mandatory and physicians are not awarded continuing medicinal education point for attending. Given the time constraints of physicians and the continuing training requirements of 40 CME’s every two years, there is an opportunity to unite the two as an incentive during the term of their time.
Objectives
Goal: Reduce the compute of unintentional prescription drug overdose deaths in Florida end physician re-education
By May 2013:
Objective 1: Raise physicians awareness of direction drug abuse and diversion by 15%
Objective 2: Increase the designate by ~ of physicians using screening, intervention, and referral techniques (SBIRT) in their practices ~ means of 20%
Objective 3: Improve physician’s perception of the core components of the Federation of State Medical Boards Model Policy during the Use of Controlled Practices by 30%
Objective 4: Physicians prescribing trouble medications will electronically verify patient therapeutic histories 20% of the time
Our objectives adroitness the need for education to promote awareness that prescribers have a role to wanton in reducing prescription drug misuse and satirize. This includes teaching them the importance of appropriate prescribing and dispensing of opioids to impede adverse effects, diversion, and addiction, in what state to recognize substance abuse in their patients and nurture on treating pain. They also form into one body the basics of implementation and promotion of the Florida Prescription Drug Monitoring Program. This includes drilling prescribers/dispensers in its use and increasing the employment of Screening, Brief Intervention and Referral to Treatment (SBIRT) program to avoid healthcare providers identify and prevent custom drug problems in primary healthcare settings. Primary care providers lo many patients for pain issues. These visits are many times time consuming and difficult to manage so we expect physicians to bid ~ information that will help them improve their turn. to serve these patients. The educational interposition targeting primary care physicians focuses in the first place on closing the gap between current recommendations and the providers’ current perception. The process improvement interventions promote ways to utensil the correct procedures into current processes of care.
Strategy and Tactics
Traditional continuing curative education may affect knowledge and beliefs, still seldom results in behavior change. However, motivational strategies so as practice feedback reports and of influence peers can foster stage change. Interactive boldness-to-face or small group lore experiences are the preferred venue because educational outreach and academic detailing. This generalship can be enhanced by using existing relationships betwixt targeted providers and the outreach team, using estimable sources of information, maintaining flexibility in identifying, analyzing, and responding to provider concerns, and demonstrating veneration for targeted providers. A performance melioration continuing medical education (CME) program has been designed and exercise volition be offered to physicians in the set forth. The program will have three components steps in the manner that described below.
Like other people, physicians may furthermore undergo stages of change in adopting reinvigorated behaviors. Hence, we have utilized the Stages of Change Model in allowing for our strategy for this campaign. The form outlines a continuum of behavior change that can be used to remedy understand where the target audience is forward it, and to effectively reach the congregation-through targeted messages, strategies, and programs-to ensure behavior change. (National Cancer Institute, 1995)
According to the pattern, Pre-contemplation is the first step. Here, the physician is unaware that in that place is a problem. In our covering, it is not so much that physicians are not conscious of the prescription drug problem, especially from that time they live in the state that is heinous for creating prescription drug pipelines. Instead, that which they may not be aware of is in what way their prescribing habits can contribute to the practice and misuse of prescription medications and in this manner, to unintentional deaths. Next, the Contemplation staging is where they are thinking with regard to change in the near future. The following generalship address these two stages:
Step One of device: An introductory package will be mailed to in posse participants one month before attending a offering. It will contain an initial survey to assess their current knowledge, attitudes and beliefs not far from the PDMP, prescription drug abuse and their current prescribing practices. They are furthermore asked to pull patient advisory reports from the E-FORSCE data base for all patients they prescribed controlled substances to in the precedent month. They will be asked to appoint a one page summary of their findings and bring a copy of it to the station two presentation. They will be awarded 5 CME credits as far as concerns doing so.
The introductory packet leave contain the following:
Meeting Invitation including by all relevant information about the CME program, including program narration and requirements for credits
PDMP alertness: tutorial for accessing patient activity reports in the PDMP connected view, pulling the reports and forms to remembrance findings
Next we will attempt to propel the physicians to the Decision/Determination field. Our presentation will further support changes in their lore and awareness, as well as impressive them towards making a plan to vary. Our presentation and materials will befriend participants in developing concrete action plans, and setting regular goals. The following tactics in step sum of ~ units of our plan assist the cure participants in these stages.
Step Two of map: Participants will attend a community appearance. The following will be provided for the period of the presentation: an evidence-based educational packet on safe opioid prescribing practices and SBIRT techniques, being of the kind which well as patient education materials to appliance in their practice. The meeting be disposed be 1.5 hours in fulness. It will consist of a epitome explanation of the program to repeat again what was sent in the beginning packet and instructions on the requirements to get the CME credits. It will in addition consist of a facilitated discussion not far from the current prescription drug situation in Florida and the challenges and concerns they are experiencing, including their continued with the PDMP launch. A take home vessel will also be provided.
The latest stages are Action and Maintenance. Here, they inclination be expected to implement the especial action plans we provide at the introduction into their practices. Our job in the pattern of the presentation is to assist through feedback, problem solving, social support, and reinforcement. Here we enjoin provide assistance in coping, reminders, discovery alternatives, avoiding steps/relapses.
Step Three of the Plan: Participants be disposed take their educational packets and full them within one month. At that time they elect receive a follow-up phone election to see if they have in ~ degree questions and to remind them that they new wine complete the online assessment surveys of their possess prescribing habits and SBIRT use in their acting out in month three. An email reminder inclination be sent as well. The follow-up survey will assess their changes in their judgment, attitudes and beliefs, as well in the same proportion that any changes in their prescribing habits. They desire be awarded ten continuing medical cultivation credits for completion of this drama of the program and additional five premium CME’s for completing all three steps.
Campaign Timeline
Start Date
Completion Date
Milestones
Responsible Parties
April 2012
June 1, 2012
Convene Steering Committee and make stable CME workgroup:
-CME Development
-Recruit Physician Peer Leaders to aid on CME Development
Florida PDMP Foundation Board w/Program Manager (PM)
June 1, 2012
August 1, 2012
-Develops and combine website, presentation and materials packets
-Develop Evaluation Surveys
CME Workgroup w/PM
June 1, 2012
July 1, 2012
-Scheduling of presentations in 3 locations:
-Primary: Central Florida
-South Florida
-North Florida
-Develop Advertising Communications to raise new soldiers participants
Subcontractors: FQIQ, reports by PM
July 1, 2012
July 31, 2012
-Target primeval care physicians with recruitment packages/invites
FQIQ w/ PM
August 1, 2012
October 30, 2012
Conduct 20-30 Community Workshops
-August: North Florida
-September: Central Florida
-October: South Florida
FQIQ w/ PM
September 1, 2012
December 1, 2012
-Follow-up Phone Calls to physician participants one month after each re~
FQIQ, reports to PM and monthly reports to Steering Committee
September 1, 2012
May 1, 2013
On-going Data Analysis
-monthly progress updates to steering committee
FQIQ w/PM, monthly reports to Steering Committee
June 2013
Final Report Due to Steering Committee
Program Manager
Proposed Budget
Funding-Grants
Amount
Harold Rogers Prescription Drug Monitoring Program
$85,000
National Association of State Controlled Substance Authorities
$35,000
Substance Abuse and Mental Health Services Administration
$75,000
Total
$195,000
Expenditures
Cost
Personnel
$75,000
Office Expenses
$15,000
Website Development/Maintenance
$15,000
Materials Expense
$30,000
Contractors: Florida Quality Improvement Organization
$60,000
Total
$195,000
Budget Narrative
The Florida PDMP Foundation, Inc. is the show-support organization authorized by section 893.055, F.S., to national debt the continuing operation of the PDMP. This includes breeding campaigns in support of the PDMP. As like, we have been awarded two Harold Rogers Prescription Drug Monitoring Program grants from the Department of Justice, Office of Justice Programs, and Bureau of Justice Assistance. We be in actual possession of also been awarded the three particular grants from the National Association of State Controlled Substance Authorities. If we have power to prove success in meeting our objectives, for example well as cost-effectiveness, then in that place is a possibility of implementing portions of the continuing curative education on an on-going basis to be included as part of our yearly operating budget.
Evaluation
A critical composing of the program is the online surveys accessed via the website. These can be accessed at the participant’s comfort. Physicians will not receive their CME credits outside of completion of the surveys after either component. Additionally, an extra 5 CME’s power of choosing be awarded for completion of all three surveys. This is to abet full participation in the performance meliorating program. Survey questions will assess figure message penetration, satisfaction with training, purpose to change behavior, engagement in implement care and process changes. The baseline surveys direct provide us with information about the furniture of the interventions on moving the participants at the same time the continuum of the stages of make some ~ in..
Methods
Objective 1: Raise physicians awareness of prescription drug abuse and diversion by 15%
Pre-Survey, Post- offering Survey and 3 month Follow-Up Survey
Objective 4: Increase the figure of physicians using screening, intervention, and referral techniques (SBIRT) in their practices by 20%
Pre-Survey, Post- presentation Survey and 3 month Follow-Up Survey
Objective 3: Improve physician’s scholarship of the core components of the Federation of State Medical Boards Model Policy as being the Use of Controlled Practices ~ means of 30%
Pre-Survey, Post- presentation Survey and 3 month Follow-Up Survey
Objective 4: Physicians prescribing chafe medications will electronically verify patient sanatory histories 50% of the time
Pre-Survey, Post- giving Survey and 3 month Follow-Up Survey
The ultimate report will also include the following to have ~ing used to improve future interventions:
compute of invitation packets sent, percent physician response by location and specialty
website dissection to determine physician usage patterns
synoptical of physician feedback on education sessions and materials
The Florida Prescription Drug Management Foundation pleasure also continue to monitor prescription physic death rates in the state of Florida.
In Conclusion
Prescription medicine abuse and deaths associated with it are each emerging public health crisis in Florida. The White House and the Florida Office of Drug Control be under the necessity issued recommendations for health care providers. These comprise implementing a universal precautions approach to prescribing methods. We accept integrated this recommendation into our campaign through utilizing the Federation of State Medical Boards Model Policy on account of the Use of Controlled Substances. Another explanation recommendation is that providers complete continuing sanatory education on prescription drug use and deceive issues. This is exactly what we sought to chouse by developing the CME performance bettering program and including the Substance Abuse and Mental Health Service Administration provider guidelines in opposition to Screening, Brief Intervention and Referral. The White House has likewise encouraged states to utilize prescription monitor programs to deter doctor shopping and mix with ~s diversion. Teaching physicians how to make useful the programs and technology will also increase the database’s effectiveness and swell care.
Another important component of reducing custom drug deaths is patient education. While the campaign’s principal messages were aimed at primary care physicians, we allow that educating patients and their families regarding the risks of long-acting opioids and signs of toxicity, including educating patients and families forward the symptoms of overdose and the potential for emergency personnel to rapidly affliction opioid poisoning are also necessary. Our display does address the need for resigned education and the packet provided to the healer includes patient educational materials.
We designed and implemented the program to purchase the recent implementation of the direction drug monitoring program in Florida. As of the like kind, there was urgency in developing the materials and implementing the CME program. It is our confidence that we will be able to employment the outcomes of this program to prosperously design further health care provider interventions to cut down prescription drug deaths in Florida.
Appendix A: Figures
National Statistics
http://www.cdc.gov/VitalSigns/PainkillerOverdoses/
Florida Statistics
Sources of Prescription Pain Medicine
http://www.samhsa.gov/given conditions/NSDUH/2k10NSDUH/2k10Results.htm
Florida 2010 Medical Commissioner Report
http://www.fdle.parade.fl.us/Content/2010DrugReport.aspx
Appendix B: Theory
Traditional Stages of Change Theory
Physician Re-breeding Program Adaptation
Appendix C: Program Organization
Appendix D: Presentation
Presentation Learning Objectives
Appendix E: Evaluation
Type of accusation Collected:
•• Questions designed to gauge changes in knowledge, attitudes, norms, values, beliefs and behaviors including the provider’s purview to make changes in their care processes:
Are they planning to create the PDMP list of their patients?
Do they get the start of changing their prescribing practices due to intelligence from the presentation? If so, to what degree?
Are they planning to use the invalid education forms?
Do they anticipate needing superadded support to incorporate process changes in their exercise?
Do they have additional questions toward the clinical content experts?
Follow up by these providers at three months to prove to be identical and track process measures:
Did they be the occasion of and are they using the PDMP catalogue of their patients?
Have they changed their prescribing practices? If in the way that, how?
Are they using the persevering education forms?
Have they requested supplementary support to incorporate process changes in their usage?
Have they contacted the clinical ~ed experts with additional questions?
Process measures collected order also include:
How many practices implemented systems changes or other amendment activities based on this topic (and the types and world of these changes and activities),
How frequent accessed and used their DOPL facts and how they used it,
How people used the patient education materials and suppose that they plan to continue to employment it,
How many self-report changes in their prescribing patterns and a relation of those changes, and
Any anecdotal qualitative knowledge shared by providers will also exist captured and reported.
This evaluation is modeled ~wards the state of Utah’s provider mediation design.
Appendix F: SBIRT & PDMP Materials
National Institute attached Drug Use SBIRT Training Materials:
http://www.drugabuse.gov/publications/resort-guide/nida-quick-screen
Appendix G: General Materials
http://www.cdc.gov/VitalSigns/PainkillerOverdoses/
http://www.thefloridacurrent.com/point.cfm?id=23838069
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