Keri D. Hager

Opioid prescribing patterns for non-malignant chronic pain for rural versus non-rural US adults: a population-based study using 2010 NAMCS data

BackgroundNon-malignant chronic pain (NMCP) is one of the most common reasons for primary care visits. Pain management health care disparities have been documented in relation to patient gender, race, and socioeconomic status. Although not studied in relation to chronic pain management, studies have found that living in a rural community in the US is associated with health care disparities. Rurality as a social determinant of health may influence opioid prescribing. We examined rural and non-rural differences in opioid prescribing patterns for NMCP management, hypothesizing that distinct from education, income, racial or gender differences, rural residency is a significant and independent factor in opioid prescribing patterns.Methods2010 National Ambulatory Medical Care Survey (NAMCS) data were examined using bivariate and multivariate techniques. NAMCS data were collected using a multi-stage sampling strategy. For the multivariate analysis performed the SPSS complex samples algorithm for logistic regression was used.ResultsIn 2010 an estimated 9,325,603 US adults (weighted from a sample of 2745) seen in primary care clinics had a diagnosis of NMCP; 36.4% were prescribed an opioid. For US adults with a NMCP diagnosis bivariate analysis revealed rural residents had higher odds of having an opioid prescription than similar non-rural adults (OR = 1.515, 95% CI 1.513-1.518). Complex samples logistic regression analysis confirmed the importance of rurality and yielded that US adults with NMCP who were prescribed an opioid had higher odds of: being non-Caucasian (AOR =2.459, 95% CI 1.194-5.066), and living in a rural area (AOR =2.935, 95% CI 1.416-6.083).ConclusionsOur results clearly indicated that rurality is an important factor in opioid prescribing patterns that cannot be ignored and bears further investigation. Further research on the growing concern about the over-prescribing of opioids in the US should now include rurality as a variable in data generation and analysis. Future research should also attempt to document the ecological, sociological and political factors impacting opioid prescribing and care in rural communities. Prescribers and health care policy makers need to critically evaluate the implications of our findings and their relationship to patient needs, best practices in a rural setting, and the overall consequences of increased opioid prescribing on rural communities.

Development of an interprofessional and interdisciplinary collaborative research practice for clinical faculty

ABSTRACT This article describes an interprofessional collaborative research practice fellowship designed to foster the research skills of clinical faculty. The year-long fellowship was grounded in big data analysis and the triangle of informatics—knowledge, information, and data. Fellows were selected to include diverse perspectives, training, and knowledge but had limited experience in team science or being a member of an interprofessional research team. The underlying philosophy of the fellowship was experiential learning. Protected time and formal mentorship were necessary factors for developing the interprofessional research practice and the skills to participate in an interprofessional research team. We believe that this innovative interprofessional faculty research fellowship is a viable option for supporting scholarly activity and research collaboration. The findings could inform interprofessional clinical practice and be implemented for patient care. Engagement in interprofessional collaborative research and incorporation of the perspectives, knowledge and expertise of multiple professions, is a model to de silo knowledge creation.

Retrospective analysis of billing at a standalone medication therapy management clinic

PURPOSE Results of a study comparing reimbursement for medication therapy management (MTM) services with a resource-based relative value scale (RBRVS) versus a time-based billing model are reported. METHODS Reimbursement claims for MTM services provided by a standalone clinic during a 6.5-year period were reviewed. Actual billing amounts calculated according to Minnesotas RBRVS for MTM services, which emphasizes case complexity as a determinant of payment rates, were compared with hypothetical billing amounts calculated using a strictly time-based method designed to more accurately capture the costs of providing MTM services. A paired t test was conducted to analyze differences in the billable amounts calculated via the two methods. RESULTS Reimbursement claims for a total of 525 face-to-face MTM encounters with 60 patients were analyzed. Using the RBRVS method, the mean ± S.D. billing amount per encounter was

Essentials of Ambulatory Care: An Interprofessional Workshop to Promote Core Skills and Values in Team-based Outpatient Care

83.71 ±

OPIOIDS: cultivating interprofessional collaboration to find solutions to public health problems

36.67; using the strictly time-based method, the mean ± S.D. billing amount was

Using peer teaching to introduce the Pharmaceutical Care Model to incoming pharmacy students

111.83 ±

From Drug Literature Evaluation to Evidence-Based Medicine: Transforming the Focus of a First Year Pharmacy Curriculum

34.55 per encounter (mean difference,

Pharmacist-provided Ambulatory Patient Care: Progressing Pharmacy Practice and Preparing the Next Generation of Pharmacists

28.12; p < 0.0001). These findings indicate that the use of time-based versus RBRVS-based billing methodology would have resulted in an additional

Teaching the Philosophy of Practice as a Key Component of Pharmaceutical Care Practice

14,763 in MTM services reimbursement for the 525 evaluated encounters. CONCLUSION The RBRVS-based method consistently resulted in a lower billing amount per encounter than the strictly time-based billing method, suggesting that reimbursement for MTM services may not be aligned with the actual costs of providing those services.

Beyond the Pharmacists’ Patient Care Process: Cultivating Patient Care Practitioners by Utilizing the Pharmaceutical Care Framework

Introduction Team-based, interprofessional approaches to outpatient care are critical to high-quality patient care. However, few specific educational interventions promoting these skills in graduate level health care trainees have been described to date. Methods University of Minnesota faculty from the Schools of Medicine, Pharmacy, and Nursing created an interprofessional workshop experience exploring core concepts in outpatient care for graduate level trainees in pediatrics, family medicine, medicine-pediatrics, internal medicine, graduate-level nursing, and pharmacy. We focused on four key content areas: teamwork, systems thinking, the patient-centered health care home, and patient-centered communication. The workshop included brief didactics, role-plays, team-based experiences, and interactive skill practice. Participants completed an end-of-day survey reflecting on knowledge and attitude. Results From 2014–2017, nine workshops reached 305 trainees. Survey results from the 2015–2016 academic year are representative of our overall results and revealed that learners found the content high yield, and that they valued the opportunity to learn with their interprofessional colleagues. Improvements in perceived knowledge were noted in all domains. Trainees also reported increased skills, with 81% reporting both increased confidence in working within the interprofessional team, and change in attitude, and 90% reporting increased interest in working with their interprofessional colleagues after the workshop. Discussion Creating an opportunity for postgraduate level trainees from a variety of disciplines and professions to convene and focus on interprofessional team-based skills can fill a gap in interprofessional learning as they enter practice. Trainees were able to draw on their everyday experiences and find common ground with their interprofessional colleagues.