Archive for July, 2018

Were You a Part of History? More than 170 Attended the 2018 Summer Family Medicine Weekend!

June 14-17, 2018 marked the GAFP’s first joint meeting with the Georgia Primary Care Association (GPCA).  This year we hosted more than 170 family physicians, FQHC/CHC members and other health care professionals at Omni Amelia Island Beach Resort.

With an expansive number of lectures and workshops, attendees were able to claim as many as 35 AAFP prescribed credits on a wide variety of topics pertinent to the broad range of practice needs of our members.  All AAFP CME credits will be posted July 15th. If you have any further questions, please feel free to contact Megan Neuffer at mneuffer@gafp.org.

In addition to lectures and workshops, the GAFP offered three Knowledge Self-Assessment Modules (KSAs) in an effort to fulfill the Maintenance of Certification Part II – Self-Assessment and Lifelong Learning.  More than 40 family physicians successfully completed the modules.

We also hosted an Alliant Quality Workshop – Double the Credit! Designing your Improvement Activity to meet MIPS and Maintenance of Certification, which was facilitated by Dr. Adrienne Mims, and included faculty from Alliant GMCF (the State’s QIO), and Shana Scott, MPH, JD from the Department of Public Health.

Overall, attendees deemed the meeting a success and offered the following comments on their post-meeting evaluations:

  • Amelia Island is one of our favorite spots for the GAFP Summer Meeting. Thanks for putting together another great event!
  • The food was excellent and healthy.
  • The topics and speakers were phenomenal this year!
  • Great time, location, and information.
  • Everyone was very friendly and happy to provide information.

The meeting’s success was based on the hard work, time, and effort of the Education & Research Committee.  The 2018 Committee members are Theresa Jacobs, MD – Chair; Ken Howard, MD – Vice Chair; Dolapo Babalola, MD; Karla Booker, MD; Mike Busman, MD; Wanda Gumbs, MD; Johnathan Gore, MD; Ambar Kulshrestha, MD; Evelyn Lewis & Clark, MD; Carl McCurdy, MD; Yuan-Xiang Meng, MD; Adrienne Mims, MD; Viktoria Nurpeisov, MD; Harry Strothers, MD; and Blair Funk, MD – resident.

Mark your calendars now with the dates of the 2018 Annual Scientific Assembly!  This year’s Annual Meeting will be held Thursday, November 8 – Saturday, November 10 at the Marriott Evergreen in Stone Mountain. We look forward to seeing you there!

Opioid CME Requirement for GA License Renewal

During the Summer CME Meeting, we were asked to provide information on required CME for Opioid training in the state of GA. Please read the requirements below. Additionally, members should keep the certificates from CME lectures for verification that you obtained the required opioid hours if audited.

Opioid CME Requirement for GA License Renewal

The Georgia Composite Medical Board (GCMB) has ruled that as of January 1, 2018, every physician must complete 3 or more hours of AMA/AOA PRA Category 1 CME of opioid prescribing CME in order to renew their Georgia medical license.

The updated GCMB ruling says that, (4) Effective January 1, 2018, every physician not subject to Rule 360-15- .01(3) who maintains an active DEA certificate and prescribes controlled substances, except those holding a residency training permit, shall complete at least one time three or more hours of AMA/AOA PRA Category 1 CME that is designed specifically to address controlled substance prescribing practices. The controlled substance prescribing CME shall include instruction on controlled substance prescribing guidelines, recognizing signs of the abuse or misuse of controlled substances, and controlled substance prescribing for chronic pain management. Any controlled substances prescribing guidelines coursework taken within two years of [the physician’s] last renewal will count toward this requirement. Completion of this requirement may count as three hours toward the CME requirement for license renewal.

If you have any additional questions, please reach out to Megan Neuffer. mneuffer@gafp.org

The Georgia Healthy Family Alliance Awards $24,719 in Second Cycle Community Health Grants to Support Local Health Projects

Third Cycle Grant Application Deadline is July 9th

The Georgia Healthy Family Alliance (GHFA) awarded five Community Health Grant Award applicants $24,719 in second cycle 2018 grants.  Grant awards were made to GAFP member affiliated community organizations that support GHFA program priorities including underserved populations and outreach programs. The application deadline for third cycle 2018 grants is July 9, 2018.

Visit www.georgiahealthyfamilyalliance.org/grants/  for more information or to download the application. 2018 Second Cycle Community Health Grant Recipients are

“Get Fit and Be Healthy Project for Adults with Developmental Disabilities” $5,000 Sponsored by: Andrea Videlefsky, MD Marietta

Over the past year, the Adult Disability Medical Home has expanded their patient population to include multiple complex developmental disabilities including Autism, Fragile X, Microcephaly, and Cerebral Palsy. The Get Fit and Be Healthy Project which includes group visits, nutrition, exercise and health education has proven successful in providing health and nutrition information with 78% of patients losing weight. In concert with ADMH medical and team services, the goal is to expand this piloted program focusing on issues of health and wellness.  The 2018-2019 program will expand to serve between 12 – 16 individuals and their caregivers. Emphasis will be placed on promoting health and wellness resources through a website thereby increasing the number of people reached.

“Hearts & Hands Clinic Lab Tests” $5000 Sponsored by: Brian DeLoach, MD Statesboro 

The Hearts & Hands Clinic provides free medical and dental care to Bulloch County residents who are uninsured, ineligible for Medicaid and Medicare, and who live at or below 200% of the Federal Poverty Guideline. In 2017, it provided 2,411 appointments covering primary medical care, dental, vision, women’s clinic, men’s clinic, specialty referrals, lab draws, blood pressure checks, prescription assistance, and educational classes.  Each new patient requires basic lab tests which are repeated on an annual basis. Based on the results, many patients require follow up tests to determine their diagnosis and course of care. Because of this, lab fees comprise a considerable percentage of the budget. The clinic is requesting $5,000 to fund basic lab tests for

patients at their intake appointment and again annually. Funds will also cover specialized lab tests performed as needed.

“Lakeside High School Care Closet” $4779 Sponsored by: Sharon Rabinovitz, MD Tucker

Lakeside High School is a diverse school located in metro-Atlanta. Over 35% of the students receive free/reduced lunch: With a school population of approximately 2300 students, this amounts to over 800 students. The number of students who would qualify for the free/reduced lunch designation is believed to be higher. Anecdotal evidence supports the fact that because some students choose not to eat lunch at school and never have completed the meal application due to barriers. These additional students may be the ones most in need of additional nourishment and support, as they do not have access to nutritious meals during the day. In addition to daytime nutritional needs, Lakeside High School has students who are living in poverty, including homeless students.  Those students, who may eat breakfast and/or lunch at school through the free/reduced meal program, may have limited access to food, toiletries and other basic human needs upon leaving campus each afternoon.

The “Care Closet” will be stocked with items to support student physical/mental health and achievement. We provide students with access to healthy snacks and easy-to-make meals, including protein bars, peanut butter crackers, fruit cups, canned soup and tuna kits. Students may take items for school-day use, in addition to items they may need to supplement their nutrition after school. In addition, the closet holds various personal hygiene supplies to further positively support student health (i.e. dental, feminine hygiene and personal care products).

“Safety Net Clinic Case Management Project” $5000 Sponsored by: Adrienne Mims, MD Atlanta

The program will provide primary care to approximately 400 uninsured patients annually and will provide case management services to approximately 30 patients with diabetes. Based on

The Center for Black Women’s Wellness (CBWW) offers low and no cost healthcare services, group health education, and community-based screening services to uninsured adults in Metropolitan Atlanta. The SNC Case Management Program will utilize a contractual registered nurse to offer support for up to 30 patients with diabetes. The major components of this program will include an initial health assessment, individual care plan, periodic evaluation and clinician feedback, home/self-monitoring techniques, healthy lifestyle behavior goals, medication adherence, and the provision of testing supplies. The goal of this project is to empower patients by ensuring that they have sustained support to adhere to their care plans and better manage their diabetes

the patient demographic profile, it is estimated that of those served 100% will be low income and uninsured or underinsured, 98% will be Black, and 80% will be adult women.

“Clarkston Community Health Center Breast Health Project” $4940 Sponsored by: Patrice Shongo, MD, Clarkston

CCHC’s Breast Health Initiative (BHI) aims to decrease the breast cancer mortality rate among uninsured, immigrant, and refugee women in DeKalb County and the surrounding region through several activities in collaboration with local organizations, volunteers, and health services partners. The program is currently near the end of the first year. Through a small grant, in partnership with Dekalb Medical Center (DMC), CCHC has been providing free mammograms and follow-up, diagnostic testing for women age 40 years and older who are patients of the clinic, or eligible women who are referred to us.  To date, the current grant provides for mammograms for 200 women.  Project goal is to reach an additional 100 women with screening mammograms by the end of 2018.  To date: CCHC has provided 163 screening mammograms through a mobile mammography unit, 22 diagnostic mammograms, 20 diagnostic ultrasounds, and 3 biopsies. The $4,940 from GHFA will provide mammograms to 52 women to achieve the goal of completing screening mammograms for 300 women by the end of 2018.

The Alliance is the philanthropic arm of the Georgia Academy of Family Physicians. Our nationally recognized Community Health Grant Program exists to support and create momentum in an area of need and provide vital funds for family physician sponsored healthcare projects across Georgia.  Since launching the program in 2012, the Alliance has awarded 50 charitable organizations more than $222,000.  The deadline to submit third cycle grant applications is July 9th. To download the application or learn more visit www.georgiahealthyfamilyalliance.org.

 

 

Reproductive Health Care for Women with Opioid Use Disorders

Reproductive Health Care for Women with Opioid Use Disorders

By – Angeline Ti, MD MPH

Assistant Professor, Emory University School of Medicine

Dept of Gynecology and Obstetrics/Family and Preventive Medicine

The impact of the current opioid epidemic is a significant public health issue, particularly for women of reproductive age – negatively impacting their families and communities. According to the Centers for Disease Control and Prevention (CDC), in 2016 21.8 percent of women in the US filled at least one prescription for an opioid and an estimated 15.3 percent of women used illicit drugs or misused prescription drugs. (Centers for Disease Control and Prevention, 2017)

Definitions

Opioids include illegal drugs such as heroin, as well as legal medications such as oxycodone, morphine or hydrocodone. Opioid use can fall on a spectrum ranging from medically-supervised low-risk use to risky use all the way to substance use disorder or “addiction.” The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) combines criteria from what was previously known as substance abuse and substance dependence in the DSM-IV into one diagnosis, substance use disorder. People with a substance use disorder can range from mild to moderate to severe, depending on the number and severity of symptoms – which can be related to impaired control, social impairment, risky use and certain pharmacologic criteria (e.g. tolerance or withdrawal). (American Psychiatric Association, 2013)

Gender-specific considerations

Research findings suggest women experience opioid use and opioid use disorders differently than men. Women have higher rates of chronic pain and use prescription opioids at higher doses and for longer periods compared to men. Women also tend to progress to physical dependence more quickly and at smaller drug amounts. Moreover, women appear to have different social risk factors for substance use compared to men. For women, histories of trauma, including intimate partner violence, sexual abuse, and childhood traumas have been associated with the initiation of substance use and the development of substance use disorders. (Office on Women’s Health, 2017)

In addition to the risk of death from overdose, opioid intoxication can cause slowed reaction time and confusion, as well as reduced consciousness thus increasing vulnerability to assault, including sexual assault. For women, prolonged opioid use can result in the decrease of certain hormones, leading to oligo or amenorrhea and infertility. While opioid use during pregnancy has not been clearly linked to any birth defects, it is associated with neonatal abstinence syndrome, or neonatal withdrawal. (American College of Obstetricians and Gynecologists, 2017)

Clinical considerations

  • While pathways to opioid misuse are complex, health care providers must recognize their role in primary prevention by using evidence-based practices for prescribing opioids, including following prescribing guidelines from the CDC and utilizing Prescription Drug Monitoring Programs (Centers for Disease Control and Prevention, 2017).
  • Universal screening, including screening of women and pregnant women, is crucial for identifying patients who have or are at risk for substance use disorders. A single question such as “How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?” may be used as the initial screen, followed by a more detailed questionnaire for those who screen positive (Shapiro, Coffa, & McCance-Katz, 2013). The Substance Abuse and Mental Health Services Administration (SAMHSA) has guidance on Screening, Brief Intervention, and Referral to Treatment (SBIRT), an evidence-based approach to addressing substance use disorders in primary care (Substance Abuse and Mental Health Services Administration, 2017).
  • Medication-assisted treatment (MAT) remains the prominent treatment for opioid use disorders which involves the supervised use of medications such as methadone or buprenorphine to prevent withdrawal and reduce cravings, in combination with counseling and support. Another important medication that is used to prevent overdose is naloxone, an injectable or inhaled opioid antagonist. MAT has been associated with improved patient survival and functionality, as well as improved birth outcomes for pregnant women. (Substance Abuse and Mental Health Services Administration, 2015)
  • For women of childbearing age with opioid use disorder, family planning is a critical part of routine care. While there are not specific guidelines for this population, the CDC has multiple resources to guide evidence-based family planning care. The Quality Family Planning guidelines provide recommendations on how to provide family planning services, including what services to offer and how they should be offered. The US Medical Eligibility Criteria provide guidance on the safety of contraception for women with medical comorbidities that may be associated with opioid use disorder, including depression, sexually transmitted infections, viral hepatitis, and other chronic conditions. The US Selected Practice recommendations provide guidance on issues related to initiation and use of certain contraceptive methods, including necessary exams and tests prior to initiation, providing same-day or quick start contraception, and managing certain side effects. (Centers for Disease Control and Prevention, 2017)
  • Pregnant and postpartum women with opioid use disorder have specific health care needs and vulnerabilities. Routine prenatal care should be tailored to the woman’s individual medical and social needs. MAT is recommended to optimize maternal and infant outcomes. Though initiation of MAT during pregnancy is safe, it must be done under close supervision, either inpatient or outpatient. Medically supervised withdrawal is not recommended, as it is associated with higher rates of relapse, however it may be considered if the woman is unwilling or unable to initiate MAT. Opioid use and MAT alone do not preclude breastfeeding, which should be encouraged if the mother is otherwise healthy. In labor, women with opioid use disorder should be offered the full range of options for anesthesia, however may require higher doses for adequate pain control. Women who are on MAT should continue their medications. More detailed clinical guidance should be consulted for those caring for pregnant women with opioid use disorder. (American College of Obstetricians and Gynecologists, 2017)(Substance Abuse and Mental Health Services Administration, 2018)

Citations

American College of Obstetricians and Gynecologists. (2017). Opioid use and opioid use disorder in pregnancy. Committee Opinion No. 711. Obstet Gynecol, 120, e81-94.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.

Centers for Disease Control and Prevention. (2017, September 18). Retrieved from CDC Contraceptive Guidance for Health Care Providers: https://www.cdc.gov/reproductivehealth/contraception/contraception_guidance.htm

Centers for Disease Control and Prevention. (2017). Annual Surveillance Report of Drug-Related Risks and Outcomes- United States, 2017. Surveillance Special Report 1. Department of Health and Human Services.

Centers for Disease Control and Prevention. (2017, August 29). CDC Guideline for Prescribing Opioids for Chronic Pain. Retrieved from https://www.cdc.gov/drugoverdose/prescribing/guideline.html

Centers for Disease Control and Prevention. (2017, October 3). What States Need to Know about PDMPs. Retrieved from https://www.cdc.gov/drugoverdose/pdmp/states.html

Office on Women’s Health. (2017). Final Report: Opioid Use, Misuse and Overdose in women. Washington, DC: US Department of Health and Human Services.

Shapiro, B., Coffa, D., & McCance-Katz, E. F. (2013). A Primary Care Approach to Substance Misuse. Am Fam Physician, 88(2), 113-121.

Substance Abuse and Mental Health Services Administration. (2015, September 28). Retrieved from Medication and Counseling Treatment: https://www.samhsa.gov/medication-assisted-treatment/treatment#medications-used-in-mat

Substance Abuse and Mental Health Services Administration. (2017, September 20). Resources for Screening, Brief Intervention, and Referral to Treatment (SBIRT). Retrieved from https://www.samhsa.gov/sbirt/resources

Substance Abuse and Mental Health Services Administration. (2018). Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Family Medicine Leads provides scholarships for GAFP Students and Residents

The winners of the 2018 Family Medicine Leads Scholarships for National Conference have been determined. Here is a list of scholarship recipients from Georgia.

  • Saira Bari (student)– Cairo
  • Deema Elchoufi (student) – Atlanta
  • Shilpa Jhol (student) – Marietta
  • Michael McCullagh (resident) – Augusta
  • Keisha Parker (student) – Atlanta
  • Setu Patel (student)– Valdosta
  • Vijay Venkatesan (student) – Alpharetta
  • Maria Westerfield (student) – Macon

This program provides $600 scholarships to help cover out-of-pocket travel and registration expenses for students and residents to attend National Conference, August 2–4 in Kansas City, MO. These scholarships are made possible because of donations from family physicians across the country. Nearly 600 scholarship applications were received, and 220 Family Medicine Leads Scholarships were awarded.

Family Medicine Leads Scholarships for National Conference are comprised of the following categories: Early Career Student, Student or Resident Primary Care Champion, and Family Medicine Interest Group (FMIG) Leaders.

Congratulations to all the Georgia recipients. See you in Kansas City!