Public Health

February Physician Focus: Concussions

Posted in Physician Focus, Public Health on February 24th, 2016 by MMS Communications – Comments Off on February Physician Focus: Concussions

The severity and potential of long-term health effects of concussions are now recognized at all levels of sports, from the professional ranks to youth leagues.

To add to the public awareness of this injury, the February episode of Physician Focus features Dr. Ann McKee (photo, seated), Chief of Neuropathology at the VA Boston Healthcare System, Professor of Neurology and Pathology and Director of the Chronic Traumatic Encephalopathy Center at the Boston University School of Medicine, and one of the nation’s foremost experts on the effects of concussion and head trauma. Hosting this edition is Dale Magee, M.D. (photo, standing), a past president of the Massachusetts Medical Society.

While acknowledging the multiple benefits that young people gain by participating in sports, Dr. McKee offers valuable, basic information on what she characterizes as an “invisible injury,” one that carries no recognizable signs of harm such as bleeding or pain.

The conversation includes information on many aspects of the injury: its symptoms, difficulty of diagnosis, what to do with a player when a concussion is suspected, gender differences in susceptibility to the injury, as well as the dangers of second and multiple concussions, “sub-concussive” impacts to the head, and the development of “skill sets” by athletes to reduce the risk of concussion in sports.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and online at www.physicianfocus.org, www.massmed.org/physicianfocus, and YouTube.

The President’s Podium: Engaged in the battle? Yes!

Posted in Department of Public Health, Drug Abuse, Health Policy, opioids, Public Health on November 3rd, 2015 by MMS Communications – 1 Comment

by Dennis M. Dimitri, M.D., President, Massachusetts Medical Society

The voices of the media are becoming more frequent and more pointed about the nation’s opioid epidemic, and the Dr. Dennis Dimitri, MMS Presidentnarrative that physicians are part of the problem continues.

The suggestion that physicians are lax in addressing the opioid epidemic or are reluctant to work toward solutions has been espoused by national and local media. A November 2 editorial in The Boston Globe takes our medical society to task, suggesting that we are reluctant to work with public officials and are even obstructing progress because we believe there needs to be more flexibility in the Governor’s proposed limit of a 72-hour supply of opioids for first-time prescriptions.

The idea that physicians are standing on the sideline or hindering progress toward solutions to the opioid epidemic is simply wrong. The fact is that MMS officers and staff have been meeting and working with Governor Baker, Health and Human Services Secretary Sudders, Attorney General Healey, and Public Health Commissioner Bharel for some months in order to address this crisis and develop strategies and responses. There has been nothing casual about the MMS response to this crisis.

Our opioid prescribing guidelines, issued in May, were in fact a response to the Governor’s request for assistance in addressing the epidemic. Our guidelines outlining use of the lowest effective dose for the shortest time presaged the Governor’s opioid bill by several months, and were subsequently adopted by the Massachusetts Board of Registration in Medicine and incorporated into its comprehensive advisory to physicians on prescribing issues and practices.

Additionally, the MMS has called for every physician to rethink their prescribing practices with the goal of reducing the number of opioids prescribed. We ‘own’ that part of the problem.

We have worked with members of the Baker administration on several initiatives and have invited them to work with us as we reach out to physician leaders for help. Physicians are firmly committed to working with government leaders, public health officials, and others in the medical community to stem the tide of opioid and prescription drug abuse.

Our other actions speak to that, as well.

Our continuing medical education courses on opioid prescribing and pain management have been taken by nearly 2,000 individuals since we began offering them free in May. Nearly 5,000 courses have been taken.

We have reached out to the medical community and beyond with our annual public health forum and our Opioid Misuse and Addiction Summit, which brought together physicians, pharmacists, law enforcement officials, and government officials to create awareness and discuss strategies to reduce opioid abuse.

We have been engaged for several years in efforts with the Department of Public Health to improve the state’s Prescription Monitoring Program and are now collaborating with the DPH and the deans of the four Massachusetts medical schools to improve education on opioids and pain management for medical students.

Our dedicated website and public service advertising campaign speak to the importance of safe storage and disposal by patients, two critical elements in curbing abuse.

Physician activity in addressing the opioid crisis by the MMS is not something new in 2015. MMS efforts in alerting patients about prescription drug abuse go back nearly five years, and my predecessors Dr. Ron Dunlap and Dr. Rick Pieters were instrumental in bringing the urgency and importance of opioid abuse to our members and the patient population.

As I wrote back in July, physicians have made the commitment to be part of the solution. We will remain so and will continue to work with government and public health officials, our colleagues in the medical community, and our patients to attack this crisis.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Dimitri’s commentary on a range of issues in health and medicine.

Innovation, Disruption Themes of MMS State of the State Health Care Leadership Forum

Posted in Health Reform, Public Health, State of State Forum on October 23rd, 2015 by Erica Noonan – Comments Off on Innovation, Disruption Themes of MMS State of the State Health Care Leadership Forum

By Erica Noonan, Vital Signs Editor

Turning his health system into a patient-centered institution on a retail model meant a top-to-bottom reworking of every area, including the shocking move of eliminating wait time for doctor visits and waiting rooms,  said David Feinberg, MD, MBA, president and CEO of Geisinger Health System.

Now when patients call, the first thing they are asked “Would you like to be seen today?” And when they arrive, a smart card in their car alerts the office that the patient will be entering the building in several minutes. Upon arrival, the patient is greeted by a staffer who says “We’ve been expecting you,” and escorts them directly to an exam room where a doctor will meet them.

“Waiting rooms add no value to care,” said Dr. Feinberg, a featured speaker at the 16th Annual State of the State’s Health Care Leadership Forum held Oct. 22 at MMS headquarters in Waltham.

Geisinger calls its initiative “Proven Experience,” and even offers a money-back warranty where patients are asked for detailed feedback on their experience, and unhappy customers are asked how much money they would like refunded. Billing statements are as simple as a restaurant receipt, he said.

“Most patients are much more interested in giving feedback they think will be valued than getting money back,” said Dr. Feinberg. He admitted the unconventional model is “about patients, not doctors.”  He said, “We are here to serve patients, not protect organized medicine or protect doctors.”

The forum also featured Mass. Attorney General Maura Healey, Mass. Public Health Commissioner Monica Bharel, MD, and CVS Health Chief Medical Officer and Executive Vice President Troyen A. Brennan, MD. It was moderated by Jim Braude and Margery Eagan, co-hosts of WGBH’s Boston Public Radio.

Healey spoke about the state’s move to demand more cost and price transparency from health care providers and its impact on the delivery of care. Despite the state’s impressive insurance coverage rate of 96 percent, citizens without coverage remain overwhelmingly Latino and poor, she said. And despite moves to publish price differences between various health systems, unwarranted price variations unrelated to quality measures persist across Massachusetts. “We have more work to do,” she said.

Dr. Bharel spoke about public health trends and persistent health disparities, even in a city with world-renowned medical care. Premature death rates are 50% higher in the Dudley Square neighborhood of Boston than in more affluent suburb of Arlington, just two miles away. “Access isn’t enough,” she said.

Dr. Brennan discussed the expansion of CVS Health Minute Clinics nationwide and how its acute services aim to integrate with traditional practice care via EHRs.  The clinics have no intention of replacing medical practices, he said, but rather “meet a very specific need and we’re very good at it.”

The ongoing push towards integrated care and global budgets may see physicians sending patients to a Minute Clinic near their homes for hypertension monitoring, ensuring medication compliance, or even collaborating with a CVS nurse via telemedicine tools,” he said.

“We are trying to integrate care, not disintegrate care,” said Dr. Brennan.

See  the presentations from the MMS’ 16th Annual State of the State’s Health Care Leadership Forum here.

October Physician Focus: “Big Problems” in Children’s Health

Posted in Health, Physician Focus, Public Health on September 30th, 2015 by MMS Communications – Comments Off on October Physician Focus: “Big Problems” in Children’s Health

For nine years, the C.S. Mott Children’s Hospital of the University of Michigan Health System Dr. Young (l), Dr. Goodman (r) N_editedhas conducted an annual survey of adults about what they think are the “big problems” in children’s health.

It’s hard to argue with the 2015 poll results: obesity, bullying, and drug abuse are the top three, with child abuse and neglect, smoking and tobacco use, and school violence also included in the top ten.

While the survey provides insight into what adults and parents think are the major child health problems – serious issues, to be sure – the doctors who care for children tend to have a wider perspective.

The October edition of Physician Focus features the pediatrician’s thoughts on the topic of child health in a conversation between program host Lynda Young, M.D., and guest Elizabeth Goodman, M.D.

Dr. Young (photo, standing) is a Clinical Professor of Pediatrics at UMass Medical School and a past president of the Massachusetts Medical Society, and Dr. Goodman (seated) is Associate Chief for Community-Based Research at MassGeneral Hospital for Children in Boston, a Professor of Pediatrics at Harvard Medical School, and a member of the Board of Directors of the Massachusetts Chapter of the American Academy of Pediatrics.

Bringing their years of experience in pediatric care to the conversation, the doctors discuss the C.S. Mott poll and its results, as well as what they believe are additional risks to children not captured by the survey.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.physicianfocus.org, www.massmed.org/physicianfocus, and on YouTube.

 

MMS, Medical Schools, Governor Join in Opioid Abuse Battle

Posted in Department of Public Health, Drug Abuse, opioids, Public Health on September 3rd, 2015 by MMS Communications – Comments Off on MMS, Medical Schools, Governor Join in Opioid Abuse Battle

MMS President Dennis M. Dimitri, M.D.

Taking another step in the battle against opioid abuse in the Commonwealth, the Massachusetts Medical  Society, along with representatives from the state’s four medical schools, met yesterday with Governor Charlie Baker and Commissioner of Public Health Monica Bharel, M.D., to discuss a physician-led approach in developing training and best practices for medical students on pain management and safe opioid prescribing.

Providing physicians with additional training on opioids was part of the comprehensive set of 65 recommendations released in June by the Governor’s Opioid Working Group. Yesterday’s meeting was a collaborate effort by the Governor, the Department of Public Health, and the state’s leading physicians to develop that recommendation.

MMS President Dennis M. Dimitri, M.D. described the meeting as one filled with a “spirit of cooperation and positive energy about what we can do working together” to continue the battle against opioid abuse.

Continuing medical education on opioids and pain management has been a prime focus of MMS in its efforts to help curb opioid abuse. In May, MMS issued its Opioid Therapy and Physician Communication Guidelines, offering evidence of best practices for prescribing and made its continuing medical education courses on opioids and pain management free to all prescribers. These courses have been accessed more than 3,200 times.

In a press conference following the meeting, Governor Baker said he was “pleased with the quality of the dialogue” and saw the meeting as the first of several discussions with physicians about their role in addressing the opioid epidemic. “Everybody’s got a role to play,” said Baker, “and we can’t move fast enough” in the fight.

DPH Commissioner Bharel said the meeting resulted in agreement to develop core competencies to educate future doctors on safe prescribing and pain management.

In offering the physicians’ perspective, Dr. Dimitri said physicians constantly face the “challenge of patients with ongoing pain, but the pressure of time, inadequate systems to help the physician and patient deal with pain, and the lack of alternative methods of pain relief covered by insurance put physicians in a tight box” where options to relieve pain were limited and the choice of opioids seemed the most appropriate one.

Dr. Dimitri added that doctors now recognize the impact of the number of opioids in the community and that too many have been allowed to be prescribed. Pledging MMS support of the Governor’s effort, Dr. Dimitri said “we’re very glad to participate in this process.”

MMS commitment to the effort was evidenced by the presence at the meeting of its top three officers – Dr. Dimitri, President-Elect James Gessner, M.D., and Vice President Henry Dorkin, M.D. – and Executive Vice President Corinne Broderick. The medical schools were represented by Karen Antman, M.D., Dean of the Boston University School of Medicine; Harris A. Berman, M.D., Dean of the Tufts University School of Medicine; Terence R. Flotte, M.D., Dean of the University of Massachusetts Medical School; and Todd Griswald, M.D., Director of Medical Student Education in Psychiatry at Harvard Medical School.

Selected press coverage is available here: Boston Herald, MassLive.com/The Republican, WCVB-TV.

The President’s Podium: Being Part of the Solution

Posted in Drug Abuse, Health Policy, opioids, Public Health on July 31st, 2015 by MMS Communications – Comments Off on The President’s Podium: Being Part of the Solution

by Dennis M. Dimitri, M.D., President, Massachusetts Medical Society

 In October 2Dr. Dimitri1_edited013, the Trust for America’s Health rated Massachusetts as one of the top six states for developing  strategies to curb prescription drug abuse. Despite that ranking, the Commonwealth recorded more than 1,000 deaths from opioid overdoses in 2014, a jump of 33 percent from 2012.

Today, our state has developed an even firmer resolve in response to this epidemic.

Governor Charlie Baker and Attorney General Maura Healey have made this public health crisis a top priority. The Governor’s Opioid Working Group released an action plan in June that I believe is a smart, comprehensive approach to a complex problem. From the physician’s perspective, the plan has much to like. It reframes addiction as a medical disease, and recognizes the physician’s critical concern: “to ensure access to pain medication for individuals with chronic pain while reducing opportunities for individuals to access and use opioids for nonmedical purposes.”

The plan also supports initiatives that physicians have urged for some time and embrace wholeheartedly: more drug take-back days (an effort the Drug Enforcement Administration is also reviving), increases in the co-prescribing and bulk purchasing of the life-saving drug naloxone, more treatment programs, eliminating insurance barriers to treatment, and improvements in the state’s Prescription Monitoring Program.

The monitoring program is especially significant. The Centers for Disease Control describes such programs as one of “the most promising state-level interventions” to improve prescribing and protect patients at risk.

Changes in the monitoring program will make it easier for physicians to use, and compatible with those in other states. One key improvement: reducing the time for pharmacy reporting of opioid prescriptions from two weeks to 24 hours. This will provide better “real time” information on patient prescriptions and less “doctor shopping” by patients.

Another good sign: government is allotting more resources to fight the epidemic. The new state budget includes $111 million for substance abuse services, and the Governor has requested another $27.8 million in supplemental spending for treatment and prevention. U.S. Health and Human Services has also announced a $100 million effort for medication-assisted treatment, and Massachusetts will share in that program.

Creative new approaches have come from law enforcement as well. Gloucester’s Angels Program has enrolled nearly five dozen people into treatment since it began June 1, and the program has led to similar efforts in other communities.

For our part, the Massachusetts Medical Society has reached out to all prescribers with our Opioid Therapy and Physician Communication Guidelines, offering evidence of best practices for prescribing.

In May, we made our continuing medical education courses on opioids and pain management free to all prescribers, and since then, nearly 2,500 health professionals have taken one or more courses in the first two months. To meet demand, we have added nine courses since last year, when only 400 completed such courses in a comparable period.

We are reaching out to patients, focusing on the critical areas of proper storage and disposal of medications with a dedicated website and an upcoming radio public service campaign that will continue through the end of the year.

The American Medical Association is also taking action, concentrating on physician education in prescribing opioids, use of monitoring programs, and promoting access to treatment and naloxone.

But physicians – and all prescribers – can do better. More than half of enrolled prescribers don’t routinely use the prescription monitoring program, and most patients say their doctors don’t discuss the risks of addiction when prescribing pain medication. One of the best things prescribers can do is raise patient’s awareness of the risks of addiction and their responsibility to properly store and dispose of their medications.

Let’s also remember the public has a critical role to play. More than 75 percent of those 12 and older who use pain relievers for nonmedical reasons are using drugs prescribed to someone else, whether obtained free, purchased, or stolen. As White House Drug Policy Director Michael Botticelli told our membership, the prescription opioid problem is, in one sense, “an epidemic that starts in the medicine cabinet.”

The Opioid Working Group declared that “strong partnerships” will be required to curb this abuse. Many groups are rising to meet the challenge, and physicians have made the commitment to be part of the solution as well. As those closest to the patients, as the ones who prescribe their medicines and treat their pain, we can do no less.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Dimitri’s commentary on a range of issues in health and medicine.

July Physician Focus: Guns and Public Health

Posted in gun control, Physician Focus, Public Health on July 2nd, 2015 by MMS Communications – Comments Off on July Physician Focus: Guns and Public Health

Deaths and injuries from firearms continue to shine a spotlight on gun violence as a public health issue. The latest mass shooting at a church in South Carolina joins a list that includes tragedies in Newtown, Connecticut, at Virginia Tech, and in the Colorado communities of Columbine and Aurora. These shocking incidents receive great attention because of the numbers of people killed and injured, the young ages of the shooters, and where they take place (schools, a church, a movie theater).

Those incidents, however, are just a few of  the total number, with many of them taking place at schools. Since the Newtown, Connecticut tragedy in 2012 that resulted in the deaths of 20 children and 6 adults, an additional 127 school shootings have occurred in the U.S., 73 of them in grades K-12, according to Everytown for Gun Safety, which tracks such data.

Physicians have since become some of the most vocal advocates for gun safety. In April, seven physician organizations, the American Public Health Association, and the American Bar Association issued a call to action, saying “Deaths and injuries related to firearms constitute a major public health problem in the United States.”

To continue to highlight this important topic, the July episode of Physician Focus features a discussion with Michael Hirsh, M.D., (photo, right) Surgeon-in-Chief of UMass Memorial Children’s Medical Center and Medical Director of the Public Health Department in Worcester, Mass., and Robert Sege, M.D., (center) Vice President of Health Resources in Action in Boston and a member of the American Academy of Pediatrics Committee on Child Abuse and Neglect. Hosting this edition is primary care physician Bruce Karlin, M.D. (left).

Among the topics of conversation: what parents can and should do to make a home with guns safer for children, how guns in the home can lead to homicide or suicide, how technology can help to make firearms safer, the physician perspective on ‘gag laws’ preventing doctors from discussing gun safety with their patients, and gun buyback programs as a way to reduce the violence.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.physicianfocus.org,www.massmed.org/physicianfocus, and on YouTube.

2015 Shattuck Lecture: CDC’s Dr. Tom Frieden on the Current and Future States of Public Health

Posted in Annual Meeting 2015, Drug Abuse, HIV, opioids, Public Health on May 2nd, 2015 by MMS Communications – Comments Off on 2015 Shattuck Lecture: CDC’s Dr. Tom Frieden on the Current and Future States of Public Health

Describing public health as the means that will “account for most of our health progress in the years to come,” Director of the U.S. Centers for Disease Control Dr. Tom Frieden spoke of the achievements and challenges in public health in delivering the 2015 Shattuck Lecture at the Massachusetts Medical Society’s annual meeting on Friday, May 1.

In a talk that was both entertaining and instructive and supported with statistical data, Dr. Frieden touched on a myriad of subjects, including antibiotic resistance, the opioid epidemic, the state of HIV care, tuberculosis, the impact of vaccines, the threats and improvements in cardiovascular care and hypertension, the continuing and new dangers of tobacco and nicotine delivery systems such as e-cigarettes, and the public health actions of a responsive government.

Among the highlights from his address:

On infection and the spread of drug-resistant bacteria: “The obsession to increase the population impact of our efforts is routinely complicated by infection, which could eventually undermine much of modern medicine. Our Antibiotic Resistance Initiative could reduce many infections over the next five years.”

On clinical care working with public health: “The intersection of clinical health care and public health is one of the essential concepts that underlie public health, and all too often they are going in different directions. There’s a lot we can learn from each other.”

On the Ebola crisis: “We learned two big lessons from the Ebola crisis. Every country needs to have a core public health capacity and the world has to move faster with outbreaks and epidemics.”

On the role of government: “The appropriate role of government is getting people to make healthy choices, with free and open information, by protecting individuals from harm caused by others, and by taking societal action to protect and promote health. These are the public health actions of a responsive government.”

On the responsibilities of individuals, providers, and government: “Until we have a collective responsibility for health-inducing environments, we will continue to have challenges.”

On the main goal of the CDC: “The goal of the CDC is a safer U.S and a safer world, to prevent avoidable catastrophes, to detect threats early, and to respond rapidly and effectively.”

Slides from Dr. Frieden’s presentation are available here.

A video of the full talk is available here:

May Physician Focus: Diabetes: Persistent Epidemic

Posted in Health, Physician Focus, Public Health on May 1st, 2015 by MMS Communications – Comments Off on May Physician Focus: Diabetes: Persistent Epidemic

Diabetes continues to be one of the most prevalent chronic conditions affecting Americans. Since 1980, the incidence of the disease has tripled; it now affects nearly 20 million adults 18 and older, according to the U.S. Centers for Disease Control and Prevention. And its spread is likely to continue: another 86 million Americans are living with pre-diabetes, and 90 percent of those are unaware of their condition.

The May episode of Physician Focus examines the current state of diabetes in the U.S., how and why it’s become so prevalent, and treatments for the condition. Guest is Michael Thompson, M.D., (right, photo) Ambulatory Physician Leader for the Diabetes Center of Excellence at UMass Memorial Health Care and Chief of Adult Diabetes Clinical Research at UMass Memorial Medical Center. Hosting this edition is primary care physician Bruce Karlin, M.D. (left, photo).

Among the topics of discussions are the risk factors, symptoms, and complications of the disease; how it is diagnosed; the importance of the hemoglobin A1C test; weight-loss surgery as a cure for diabetes; specific treatments for the disease; and the differences between Type 1 and Type 2 diabetes.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.physicianfocus.org, www.massmed.org/physicianfocus, and on YouTube.

Mass. Attorney General’s Office: Medical Community Is Part of the Solution

Posted in opioids, Public Health, Public Health Leadership Forum on April 8th, 2015 by MMS – Comments Off on Mass. Attorney General’s Office: Medical Community Is Part of the Solution

Massachusetts Attorney General Maura Healey has made prescription drug abuse a top priority for her office, and First Assistant Attorney General Christopher K. Barry-Smith’s message to Forum attendees was that Ms. Healey views the medical community as a “large part of the solution” to the problem of opioid abuse.

Barry-Smith said Ms. Healey decided on making opioid abuse a priority for her office as a result of her campaign for the office last year. In talking to citizens across the state, Healey discovered a recurring theme of concern from individuals and families: that drug and opioid abuse was a serious problem and something must be done about it.

Establishing opioid abuse as a priority, Barry-Smith said, takes three avenues of approach:  heroin trafficking, prescription drug trafficking, and unlawful prescribing, the last of which he said was a “small part” of the problem. He also noted that the Attorney General’s office would act to ensure that pharmaceutical marketers and dispensers take reasonable steps to reduce the risks of diversion and abuse.

Christopher K. Barry-SmithThe pricing of the anti-overdose drug naloxone and insurance coverage for behavioral health parity are other major concerns of the Attorney General, Barry-Smith said, as is the prescription monitoring program, “to make it as useful as possible.”

Finally, Barry-Smith, reprising the theme that the medical community is seen by the Attorney General as part of the solution, said that prescribing practices must take into account the possibility of overdose and he urged prescribers to “follow best practices.”

— Richard Gulla