Much Massachusetts news on the #heroin #overdose epidemic and #opioid abuse

Opioid abuse: Now a huge topic in Massachusetts and nationally. Here are a few new and notable links on how it is playing out:

From 2011 State House Rally: Names of overdose victims.

From 2011 State House Rally: Names of overdose victims.

Politics: From the Globe: There is a drumbeat growing in both parties that could move the highly personal, painful matter of heroin and opioid drug addiction, which has metastasized into an epidemic, higher on the national agenda than at any time since the rampant crack crisis more than two decades ago.

Doctors: The Massachusetts Medical Society weighed in: Bold Steps to End the Opioid Epidemic – The Physician Contribution to the Solution. Here’s a Globe story on the move.

Narcan: From BHN: An 2010 audio story on Narcan. Note that in Cambridge, which was part of the state’s early Narcan Program, 37 people died from overdoses in between 2003 and 2007. Between 2008 and 2012, that number dropped to 13.  Many other communities are seeing increases.

Policy: From a recent forum at Harvard SPH: Michael Botticelli, Director of National Drug Control Policy at the White House; Monica Bharel, Commissioner of the Massachusetts Department of Public Health; and other experts discuss “the role of policymaking in addressing this crisis.”

More Narcan: From WBUR and Commonhealth: A report from an April community meeting and a post entitled The Lazarus Effect: A health work a The Dimock health center in Roxbury tells the tale of using Narcan to deal with this:

It didn’t take long to recognize the source of that distress call: a mother who had just driven from south of the city with her son, who was now slumped over in the back of their gray, two-door convertible. He was in the throes of an overdose, barely breathing, his lips so blue they were almost black.

This video is from Learn to Cope, a support group for families of addicts. They all carry Narcan. Warning to parents of teens and young adults: Lots of photos of kids who didn’t make it.

This series of videos if from  Opioid Overdose Education and Prevention Network, via the city of Cambridge on what do  to prevent an overdose, and what do in case of an overdose:

Cooking classes at new wellness center on Bowdoin Street

Not much for ribbon cuttings or press releases, but this one is a go. In this neighborhood, one of the major public health issues is gun violence. The Globe did a narrative, multimedia portrait of the Bowdoin-Geneva Check it out and then check out this release on the new wellness center that opened up there this week.

From BIDMC16948171144_1fb8707af4_m, the health center’s parent:

DORCHESTER, MA – The Bowdoin Street Health Center today celebrated the opening of its new 4,100-square-foot Wellness Center, the only facility of its kind in the community, designed to promote healthy eating, healthy cooking and increased exercise for patients who include children, teens, adults and seniors.

The new Wellness Center includes an exercise studio, weight room, physical therapy rooms, a demonstration kitchen for cooking classes and expanded behavioral health services to provide the resources and support people need to make healthy changes in their lives…

The Wellness Center builds upon existing programs at Bowdoin Street Health Center, such as Fitness in the City for children at risk of obesity; the Healthy Food Access Program, which includes a farmer’s market; the Healthy Corner Store Initiative to bring fresh fruits and vegetables to local markets; and the Healthy Champions program, where local youth create and manage a community garden and sell their produce at the farmer’s market to educate neighborhood peers and families about healthier eating habits.

Should the FDA approve Vertex’s new cystic fibrosis drug?

The scene at the FDA hearing was familiar. All the  advisory committees have seen it play out again and again. Yesterday, it was the Pulmonary-Allergy Drug committee: The pharma doc with the convincing statement. The weeping patients. The drug likely to cost a couple thousand a month offering a slim  benefit over an existing drugs. But it works, and it’s safe.

From the Globe:VertexLogoSOP

“I think this is a much-needed advance for patients with cystic fibrosis,” said committee member Dr. Michelle S. Harkins, associate professor of medicine at the University of New Mexico Albuquerque, one of the majority voting to recommend approval.

The lone dissenter in the 12-1 vote recommending approval of the drug, Dr. Yanling Yu, the president and cofounder of Washington Advocates for Patient Safety in Seattle, said she was not convinced the data generated by the Vertex testing supported the approval of Orkambi.

“I really understand the patients critically need a new drug, but sometimes a new drug does not provide [the needed effectiveness],” she said.

From The New York Times story:

An issue for the advisory committee was that Orkambi had what the F.D.A. said was only modest effectiveness, improving lung function by only about 3 percentage points relative to placebo.

Some family members or advocates, some of them crying, pleaded with the committee to endorse the drug.

Some patients who took the drug in clinical trials said it had made a huge difference in their lives, reducing their coughing, allowing them to exercise better, helping them gain weight or reducing how often they ended up in the hospital…

Michael Yee of RBC Capital Markets, for instance, expects the price will be $225,000 to $250,000 a year.

The vote is advisory. The FDA staff will make the final call.

More here:

The financial stakes for Vertex.

FDA briefing for meeting.

Vertex briefing for the meeting

Boston Globe on nasty #nursinghomes and #hospital #Medicare savings

Two stories of note in the Globe today, one on nursing homes and the other on Medicare.

From Kay Lazar. On front page but need to poke around the webpage to find it:

indexThe adult diapers supplied by the new owners at New England Health Center, a nursing home in Sunderland, were so flimsy they left elderly residents soaked in urine. A representative from the state ombudsman’s office insisted that the owner of the nursing home, a company called Synergy Health Centers, buy a better brand.

At Braemoor Health Center in Brockton, which had a blemish-free state review before Synergy took over, health inspectors have been summoned three times in the past year. They found lax infection control, among other concerns, and the nursing home was ordered to make improvements.

Synergy’s expansion in Massachusetts has been rapid — the chain has purchased 10 nursing homes since December 2012 — and with the expansion have come complaints.

On Medicare saving for everyone but Partners.

downloadFour Massachusetts health care organizations saved nearly $150 million in Medicare costs by coordinating care for patients and working to keep them healthy and out of hospitals, according to a federal report.

Those organizations — Beth Israel Deaconess Care Organization, Steward Health Care System, the doctors group Atrius Health, and the Mount Auburn Hospital doctors association — accounted for more than one-third of the nearly $400 million in Medicare savings nationwide under a pilot program that is testing a new system for delivering and paying for services.

A fifth Massachusetts health system participated in the pilot, but Partners HealthCare, instead of saving Medicare money, cost the program $17 million, according to the report.

Kaiser Health News: Hospitals systems like Partners Seek Patient Input

Reprinted with permission from Kaiser Health News

Jane Maier was one of a select group of patients invited in early 2012 to help Partners HealthCare, Massachusetts’ largest health system, pick its new electronic health record system – a critical investment of close to $700 million.

The system, which is now being phased in, will help coordinate services and reshape how patients and doctors find and read medical information. The fact that Partners sought the perspective of patients highlights how hospitals increasingly care about what their customers think.

“It’s such a great experience,” Maier said. “They treat us as a member – a partner

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– in their review process.”

Patient advisory councils, like the one Maier belongs to, often serve as sounding boards for hospital leaders – offering advice on a range of issues. Members are usually patients and relatives who had bad hospital experiences and want to change how things work, or who liked their stay and want to remain involved.

Spectrum Health Chief Quality Officer Kurt Knoth reviews feedback with Whitney Benedict, director of physician relations and market development, and Jan Heerspink, who is a member of one of the system’s patient advisory councils. (Photo courtesy of Spectrum Health)

For Maier, it all started in 2009 when she had surgery at Brigham and Women’s Faulkner Hospital, a Partners facility. Her husband wrote to the hospital’s CEO, praising her experience. The couple was then invited to speak at a hospital leadership retreat, sharing with top executives both the good and the not-so-good, and Maier was recruited to serve on a new patient advisory panel.

This hunt for patient perspective, which is becoming more and more common, is fueled in part by the health law’s quality-improvement provisions and other federal financial incentives, such as the link between Medicare payments and patient satisfaction scores.

“It’s a change in culture,” said Jayne Hart Chambers, senior vice president for quality at the Federation of American Hospitals, which represents for-profit hospitals.

This KHN story also ran in USA Today. It can be republished for free (details).

Data from 2013 suggested that 40 percent of hospitals had some kind of patient council, said Mary Minniti, a program and resource specialist at the Institute for Patient and Family Centered Care, a Maryland-based nonprofit organization. Though councils appear to have become more common in the past few years, experts say it’s too early to know whether they typically improve hospital practices.

“A lot of hospitals right now are very concerned because of the direction of [Medicare] payments,” said Carol Cronin, executive director of the nonprofit Informed Patient Institute, an advocacy group. “They’re very concerned about patient experience and patient satisfaction.”

But it’s not just federal incentives. Patients have greater expectations as they shoulder larger shares of health care costs, said Richard Evans, chief experience officer at Massachusetts General Hospital, another Partners facility. This, he added, leads hospitals to focus on customer service.

Cronin, who has had a relative stay for an extended time in the hospital, volunteers on the patient advisory council at Johns Hopkins Hospital in Baltimore. She was struck, she said, by the “meaty” topics the group addresses. Hopkins’ medical researchers have even pitched their projects to the council to find out what patients and families think are worthy of scientific investigation.

To have an impact, though, these groups can’t operate in isolation.

Patient and family advisory councils are useful if they have the ear of hospital leaders, Minniti said. But the groups also have to be integrated into decision making.

Andy DeVries joined the first patient advisory council at Michigan’s Spectrum Health about 10 years ago, after he was hospitalized with life-threatening injuries from a motorcycle accident.

“Initially, nobody knew who we were and we had to sell ourselves,” said DeVries, who now serves on one of Spectrum Health’s 13 patient groups. Now, by contrast, his group offers input “any time there’s something new that involves patient or family care,” adding that the panel of patient advisers has tackled issues ranging from beefing up the facility’s security to how the hospital should give patients billing information. He’s even worked with the human resources department on what to look for when hiring doctors and nurses.

Craig VerBerg, a member of a Spectrum Health patient advisory council, brainstorms with the system’s director of neurosciences, Brenda Goorhouse. (Photo courtesy of Spectrum Health)

Such feedback led to marked increases in patient satisfaction scores, said Deborah Sprague, Spectrum Health’s program manager for patient and family services.

For instance, she said, a member of the orthopedics and neuroscience patient council noticed slow responses when he pushed the call button in his hospital room, a problem staff hadn’t noticed. The council worked with hospital employees to speed up response times. After the fix, positive patient assessments of the hospital jumped.

Maier, from the Faulkner council, recalled a time when hospital executives asked for help with patient complaints regarding nighttime noise levels. Late-night talking by staff was keeping patients awake.

The group discussed potential nighttime “quiet times” and other strategies to minimize noise without keeping doctors from doing their jobs. Once changes were made, patient satisfaction scores went up, Maier said — and a council member noticed a definite improvement the next time he was a patient.

Meanwhile, MedStar Health, which serves the District of Columbia and Maryland, has targeted advisory panels’ efforts to improve both the quality and safety of its care. The system has emerged as a model for finding ways to incorporate patients’ opinions, which was noted in a report from the American Hospital Association.

In one recent case, said David Mayer, MedStar’s vice president of quality and safety, patient advisers helped brainstorm ways to soothe the confusion and stress that often sets in when people have been in the ICU for more than a day. When implemented, the ideas led to reduced instances of patient confusion – known as delirium – which is linked to more destructive behavior, like patients trying to leave the room or bed before they should.

But even as the role of patient advisory committees grows, recruiting members continues to be a challenge. Finding people from diverse backgrounds with both the inclination and time to serve can be tricky, Cronin said. As a result, council members are often “middle-aged and older, white and English-speaking, and a lot of women,” said Deb Wachenheim, health quality manager at the Massachusetts-based advocacy group Health Care For All.

For some hospitals and health systems, though, these panels are just the beginning. Massachusetts General puts patients on various policy setting committees, and Faulkner has a non-voting patient board member.

“As we continue to evolve,” Maier said, “the hospital looks to us more and more.”

ShefaliL@kff.org | @Shefalil

In #Boston, young adults do battle with #cancer metaphors

The  Dana-Farber young adult cancer program dealt with an important issue at its recent conference — battle metaphors and cancer.

The language used to talk about cancer often focuses on battle words – those who are cured “won” or “survived,” while those who die from cancer “lost” their “fight.” But is cancer really something to be won or lost?

…Loved ones and those without cancer often consider cancer patients “heroes,” but, as one young adult put it, “I don’t feel very heroic when I’m going through treatment; I just take my medications and do what I’m told to do.” Another young woman added: “The intention is, ‘you inspire me; it inspires me to watch you survive,’ but they don’t do a good job at expressing that.” Being labeled as a hero may put undue pressure on patients or make them feel like they aren’t allowed to look sick or express negative emotions about their experience.

More here on the topic from the NYTimes

Below, keynote talk from Carolyn Ridge, who offered advice for young adults coping with cancer.

Medical reports from the #BostonMarathon

Dr. David King ran the race in 2013 and helped treat the wounded. In an interview with WBUR after the race, King said he ran his best time ever.

Good story, bad headline. A Globe report on the medical tent at the Boston Marathon,

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Volunteers pushed runners into the tent in wheelchairs, and some carried them in from the cold.

Dr. Pierre d’Hemecourt, co-medical director inside one of the tents, said they have been treating runners for numbness and swelling of the limbs. To warm them up, volunteers were wrapping runners in wool blankets and feeding them broth.

“We’re trying to thaw them out,” he said.

More from the Globe on the medical team:

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