martes, 7 de agosto de 2018

Drug-monitoring innovations help providers help their patients | Health.mil

Drug-monitoring innovations help providers help their patients | Health.mil

health dot mil banner image

Drug-monitoring innovations help providers help their patients

Two Military Health System innovations are helping to ensure best practices for patients with pain, and for patients who’ve been diagnosed with post-traumatic stress disorder. (U.S. Air Force photo by Senior Airman Curt Beach)

Two Military Health System innovations are helping to ensure best practices for patients with pain, and for patients who’ve been diagnosed with post-traumatic stress disorder. (U.S. Air Force photo by Senior Airman Curt Beach)



FALLS CHURCH, Va. — Two Military Health System innovations are helping to ensure best practices for patients with pain, and for patients who’ve been diagnosed with post-traumatic stress disorder.
The MHS Opioid Registry utilizes cutting-edge technology for data management and reporting to identify patients who’ve been prescribed opioids, said Chris Nichols, the Defense Health Agency’s program manager for Enterprise Intelligence and Data Solutions. Clinical pharmacy professionals, physicians, and other authorized providers can use the patient lookup capability to proactively monitor and manage patients, and intervene as appropriate.
Opioids such as oxycodone, hydrocodone, codeine, and morphine are prescribed to relieve pain. But they are highly addictive, health care experts say, and overuse can lead to death.
The rates of opioid addiction and overdose deaths are lower in the military than among the general population, said Vice Adm. Raquel Bono, DHA director, during a House Armed Service Committee hearing in June on Military Health System reform. Still, she said, the MHS has a role to play.
“Our beneficiaries are no strangers to chronic pain,” Bono said.  “While our primary focus is on our own patient population, we’re also cognizant of the larger public health crisis surrounding opioids. As health professionals and public servants, we have an obligation to help confront that crisis.”
The MHS Opioid Registry was launched in December 2016 and released to all sites in 2017.  Data in the registry includes more than 200 variables including demographics, medications, morphine equivalence daily dose, results of urine drug testing, and opioid risk factors. In the future, MHS Opioid Registry users will also be able to evaluate and track alternative non-opioid therapies for pain management.
Nichols said a registry that’s accessible by both DoD and VA providers and staff is currently under development.
The PTS Provider Prescribing Profile was developed by the DHA’s Pharmacy Operations Division. It lists all providers at military treatment facilities who are treating patients with PTSD or acute stress disorder, said Sushma Roberts, Ph.D., a clinical psychologist and senior program manager for DoD/VA Integrated Behavioral Health, Clinical Communities Support Section, Clinical Support Division. The tool also documents the medications providers are prescribing. 
From February 2000 to June 2018, about 230,000 active-duty service members were diagnosed with PTSD, Roberts said, adding that 75 percent were diagnosed following a deployment of 30 days or longer. 
The clinical practice guideline released in 2017 recommended against prescribing benzodiazepines for PTSD patients, Roberts said. Benzos, also known as tranquilizers, act on the brain and central nervous system to produce a calming effect. People can easily develop a tolerance to benzos, health care experts say, needing higher doses and increased frequency to achieve the same effects. People also may suffer withdrawal symptoms, including insomnia, irritability, anxiety, panic attacks, and seizures.
 “Benzos aren’t necessarily bad,” said Army Lt. Col. Dennis Sarmiento, a psychiatrist and chair of the DHA’s Behavioral Health Clinical Community. “There are indications for their use. Short-term, they can help with anxiety, panic, and sleep. Treating such symptoms can help providers engage patients in care and better establish or reinforce rapport.”
But medications other than benzos are recommended for treating PTSD because they’re more effective, Sarmiento said. For example, antidepressants such as Zoloft, Paxil, Prozac, and Effexor raise the brain’s level of serotonin, a chemical that reduces symptoms of depression and anxiety. 
They also can be used with trauma-focused psychotherapy, Sarmiento said. Those therapies include talking or writing about traumatic events, or learning and practicing meditation or deep-breathing exercises to manage anxiety.
Sarmiento notes that throughout the MHS, benzo prescriptions have been on a downward trend since peaking in 2012.
According to the tool, the number of benzos prescriptions for MHS beneficiaries diagnosed with PTSD dropped from 1,922 in the first quarter of fiscal year 2017 to 1,622 for second quarter of FY 2018.




Helping the healers through the power of mobile technology

Article
7/22/2018
The Provider Resilience app offers health care providers tools to guard against emotional occupational hazards, including compassion fatigue and burnout. An updated version of the app is expected to be released in the fall. (Courtesy photo)
App guards against emotional occupational hazards
Recommended Content:
Technology | Innovation

Soldiers test Army's newest transport telemedicine technology

Article
7/20/2018
Soldiers test MEDHUB during an exercise at Camp Atterbury, Indianapolis. (U.S. Army photo by Greg Pugh)
MEDHUB is really about life-saving situational awareness
Recommended Content:
Technology | Innovation

Air Force, NASA seek potential medical collaboration

Article
7/19/2018
David Loftus M.D., PH.D, medical officer and principal investigator space biometrics research branch, NASA Ames Research Center, meets with members of the 60th Medical Group at Travis Air Force Base, California. NASA and David Grant Medical Center are meeting for a potential collaboration between the two organizations to help in future space exploration. (U.S. Air Force photo by Louis Briscese)
NASA and the military share a lot of similar medical issues
Recommended Content:
Innovation

Navy Care app enables medical appointments from work, home

Article
7/13/2018
A Sailor uses the Navy Care app on her cell phone for a virtual health visit with a Naval Hospital Jacksonville provider. Navy Care enables patients to have a live video visit with a clinician on a smartphone, tablet, or computer. It’s private, secure, and free. (U.S. Navy photo by Petty Officer 1st Class Jacob Sippel)
The app delivers convenient care with the quality of a face-to-face visit
Recommended Content:
Technology | Innovation

DHA PI 6490.01: BH Treatment and Outcomes Monitoring

Policy
This Defense Health Agency-Procedural Instruction (DHA-PI), based on the authority of References (a) and (b), and in accordance with the guidance of References (c) through (k): a. Establishes the Defense Health Agency’s (DHA) procedures for the collection and analysis of BH outcome data. b. Addresses how DoD will standardize BH outcome data collection to: assess variations in mental health and substance use care among in-garrison medical treatment facilities (MTFs) and clinics; assess the relationship of treatment protocols and practices to BH outcomes; and identify barriers to provider implementation of evidence-based clinical guidance approved by DoD. c. Designates the Army as the DoD lead Service for maintenance and sustainment of the Behavioral Health Data Portal (BHDP) in specialty care mental health and substance use clinics, referred to collectively as BH clinics, until BHDP functionality can be integrated with GENESIS or another electronic health record (EHR) system managed by DHA. d. Designates DHA Information Operations (J-6) as lead on transitioning BHDP functional requirements related to outcomes monitoring to future EHR data collection platforms and processes.

There is hope

Article
7/11/2018
Medically assisted treatment for opioid use can break the cycle of addiction.
More than 350,000 deaths are attributed to opioid overdoses nationwide since 1999
Recommended Content:
Mental Health Care | Substance Abuse | Addiction | Mental Wellness

Life without liquor

Article
6/29/2018
There are 2.5 million alcohol-related deaths worldwide each year, according to the National Council on Alcoholism and Drug Dependence. (Courtesy photo)
One service member’s story of how he overcame a drinking problem
Recommended Content:
Mental Wellness | Substance Abuse

Progress in preventing opioid abuse, more needs to be done

Article
6/26/2018
Air Force Staff Sgt. Matthew Pick, with the 66th Security Forces Squadron, holds a nasal applicator and naloxone medication vial at Hanscom Air Force Base, Massachusetts. Naloxone is one of several medications designed to temporarily reverse the effects of an opioid overdose. Hanscom was the first Air Force installation to issue the drug to law enforcement personnel under permission of the base commander. (U.S. Air Force photo by Mark Herlihy)
The Military Health System has a shared responsibility in addressing the nation’s opioid epidemic
Recommended Content:
Substance Abuse

DHA PI 6025.04: Pain Management and Opioid Safety in the MHS

Policy
The purpose of our MHS Pain Management Campaign is to enable Clinical Communities to provide evidence-based pain management guided by clinical practice guidelines (CPGs): effectively treat acute and chronic pain; promote non-pharmacologic treatment; prevent acute pain from becoming chronic; and minimize use of opioids with appropriate prescribing only when indicated. The Pain Management Clinical Support Service achieves these ends through clinical improvements in pain care, clinician and patient education, and research. This Defense Health Agency-Procedural Instruction (DHA-PI) is a dual effort between the Pain Management Clinical Support Service and the Clinical Communities to achieve our stated purpose through implementation of the MHS Stepped Care Model.

Breaking down anxiety one fear at a time

Article
6/5/2018
Marine Staff Sgt. Andrew Gales participates in ‘battlefield’ acupuncture, also known as ‘ear acupuncture,’ at Walter Reed National Military Medical Center, as a treatment for anxiety related to PTSD. (U.S. Navy photo courtesy Mass Communication Specialist 2nd Class Kevin Cunningham)
Generalized anxiety, panic disorder, and anxiety related to PTSD are common disorders. In fact, an estimated 31 percent of U.S. adults experience anxiety at some point in their lives; one marine discusses his journey.
Recommended Content:
Mental Health Care | Preventive Health | Men's Health | Mental Wellness | Posttraumatic Stress Disorder

Military providers seek tailored approach to treating PTSD

Article
3/14/2018
The VA/DoD clinical practice guideline for managing post-traumatic stress disorder and acute stress disorder recommends against prescribing benzodiazepines. (U.S. Air Force photo by Airman 1st Class Joseph Pick)
New tool reviews, monitors provider prescribing habits
Recommended Content:
Mental Health Care | Military Hospitals and Clinics | Posttraumatic Stress Disorder

From an award ceremony to panel talks, senior leaders will have presence at HIMSS

Article
3/8/2018
Vice Adm. Raquel Bono, director of Defense Health Agency, will be honored as a recipient of the HIMSS Most Influential Women in Health IT Awards on March 8 in Las Vegas.
Federal health, IT experts come together for discussion on hot topics
Recommended Content:
Access to Health Care | Health IT Research and Innovation Strategy | Innovation | Patient Safety | Quality and Safety of Health Care (for Healthcare Professionals) | Research and Innovation

Traumatic Brain Injury and the Art of Paddling

Article
3/7/2018
Collins enjoys stand-up paddle boarding for how it helps him with TBI. His service dog, Charlie, likes it too. (Courtesy Photo by U.S. Army Special Operations veteran Josh Collins)
A U.S. Army veteran’s recipe for embracing life after several TBIs
Recommended Content:
Mental Wellness | Hearing Loss | Men's Health | Physical Activity | Physical Disability | Posttraumatic Stress Disorder | Traumatic Brain Injury | Vision Loss

Air Force robotic surgery training program aims at improving patient outcomes

Article
2/9/2018
Air Force Col. Debra Lovette (left), 81st Training Wing commander, receives a briefing from Air Force 2nd Lt. Nina Hoskins, 81st Surgical Operations squadron room nurse, on robotics surgery capabilities inside the robotics surgery clinic at Keesler Medical Center, Mississippi. The training program stood up in March 2017 and has trained surgical teams within the Air Force and across the Department of the Defense. (U.S. Air Force photo by Kemberly Groue).
Robotic surgery is becoming the standard of care for many specialties and procedures
Recommended Content:
Technology | Innovation | Military Hospitals and Clinics

Seizures among Active Component service members, U.S. Armed Forces, 2007 – 2016

Infographic
1/25/2018
This retrospective study estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. It also attempted to evaluate the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD. Seizures have been defined as paroxysmal neurologic episodes caused by abnormal neuronal activity in the brain. Approximately one in 10 individuals will experience a seizure in their lifetime. Line graph 1: Annual crude incidence rates of seizures among non-deployed service members, active component, U.S. Armed Forces data • A total of 16,257 seizure events of all types were identified among non-deployed service members during the 10-year surveillance period. • The overall incidence rate was 12.9 seizures per 10,000 person-years (p-yrs.) • There was a decrease in the rate of seizures diagnosed in the active component of the military during the 10-year period. Rates reached their lowest point in 2015 – 9.0 seizures per 10,000 p-yrs. • Annual rates were markedly higher among service members with recent PTSD and TBI diagnoses, and among those with prior seizure diagnoses. Line graph 2: Annual crude incidence rates of seizures by traumatic brain injury (TBI) and recent post-traumatic stress disorder (PTSD) diagnosis among non-deployed active component service members, U.S. Armed Forces • For service members who had received both TBI and PTSD diagnoses, seizure rates among the deployed and the non-deployed were two and three times the rates among those with only one of those diagnoses, respectively. • Rates of seizures tended to be higher among service members who were: in the Army or Marine Corps, Female, African American, Younger than age 30, Veterans of no more than one previous deployment, and in the occupations of combat arms, armor, or healthcare Line graph 3: Annual crude incidence rates of seizures diagnosed among service members deployed to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn, U.S. Armed Forces, 2008 – 2016  • A total of 814 cases of seizures were identified during deployment to operations in Iraq and Afghanistan during the 9-year surveillance period (2008 – 2016). • For deployed service members, the overall incidence rate was 9.1 seizures per 10,000 p-yrs. • Having either a TBI or recent PTSD diagnosis alone was associated with a 3-to 4-fold increase in the rate of seizures. • Only 19 cases of seizures were diagnosed among deployed individuals with a recent PTSD diagnosis during the 9-year surveillance period. • Overall incidence rates among deployed service members were highest for those in the Army, females, those younger than age 25, junior enlisted, and in healthcare occupations. Access the full report in the December 2017 MSMR (Vol. 24, No. 12). Go to www.Health.mil/MSMR
This infographic documents a retrospective study which estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. The study also evaluated the associations between seizures, traumatic brain injury (TBI), and post ...
Recommended Content:
Health Readiness | Posttraumatic Stress Disorder | Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report

No hay comentarios:

Publicar un comentario