August 19th, 2011 by admin
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One of the criteria on our official medical marijuana Physician Certification Form includes an attestation by a physician that they’ve reviewed their patient’s profile on the Arizona Board of Pharmacy’s Controlled Substances Prescription Monitoring Program database before signing the certification. We included this requirement to ensure that physicians are acting in their patient’s best interest- and making sure that they’re using best practices and checking to see whether their patient has been prescribed other controlled substances before signing the marijuana certification. Another requirement that we included asks physicians to attest that they’ve reviewed the patient’s medical history including examining the last 12 months of the patient’s medical records before signing. We also think these requirements are important because other states that have medical marijuana programs have found that some physicians are more focused on getting revenue from signing certifications than on their patient’s health.
As a routine quality check in our certification system, we’ve been asking the Board of Pharmacy to verify whether or not certifying physicians are actually accessing the system (as they have attested). We’ve identified 3 MDs and 5 Naturopaths that have been routinely attesting that they’ve checked the Controlled Substances Prescription Monitoring Program when they appear to have not checked that regularly. Dr. Nelson and I sent letters to their licensing boards recently notifying them that it looks like these 8 physicians may be falsely attesting that they’re checking the Prescription Monitoring Program database. In each case, they appear to have written more than 100 certifications (some several hundred) that included attestations that cannot be verified by the Board of Pharmacy.
Our larger concern is that if these physicians aren’t completing this simple requirement (and making false attestations)- it’s likely that they’re taking other short-cuts that may be jeopardizing their patient’s health- such as not reviewing the patient’s medical history before writing medical marijuana certifications (also required in the series of attestations). Since these 8 physicians have signed nearly half of the 10,000 medical marijuana medical certifications, we think it’s important that the boards know about this so they can decide if the physician is acting in the patient’s best interest. The referrals may also have a side effect of discouraging physicians from writing recreational certifications.
August 19th, 2011 by admin
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School is back in session- which means it’s time to figure out your family logistics for getting to and from school. Fortunately, we have a new tool to help families make the healthy choice and consider an “active” solution. We just launched our new online assessment tool called the Active School Neighborhood Checklist to help families make safe and healthy school transportation choices.
We’re also partnering with the Arizona Department of Transportation Safe Routes to School Program to develop a tool that generates a score which represents the walk-ability, bike-ability and safety of schools. The results of this assessment will help communities, school facilities professionals, schools, and city officials identify barriers that prevent students from walking and biking to school each day and create solutions to encourage neighborhoods to be more physically active.
August 18th, 2011 by admin
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The August issue of Recovery WORKS! is now available in our website. Check it out…there are several new features including a recurring column called “Peer-Run Organizations Profiles” that will briefly highlight the tremendous work by our peer-runs; and the new “State Chatter” box which will share a variety of news from peers, family members, and general behavioral health stakeholders from around the state.
August 17th, 2011 by admin
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Our Behavioral Health team has completed the draft of our ($27M) 2012-2013 Joint Block Grant Application for Mental Health and Substance Abuse Prevention and Treatment Services. This year SAMHSA streamlined the application process to allow States to apply for grant funds under one combined application and has moved away from a standardized reporting template, allowing the States to determine their own needs and service directions. Our (150 page) application has been posted for public comment (through August 26) on our grant application website. Folks can provide comments to firstname.lastname@example.org.
States use this Block Grant for prevention, treatment, recovery supports and other services that will supplement services covered by Medicaid, Medicare and private insurance. For example, we use block grant funds to fill in for priority behavioral health treatment and support services for folks without insurance or for services not covered by Medicaid, Medicare or private insurance. Block grant funds also go toward primary prevention services like universal, selective and indicated prevention activities and services.
August 16th, 2011 by admin
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One of our Department priorities over the last few years has been to improve Arizona’s Trauma System. We know we can dramatically improve service and reduce costs by developing a coordinated and integrated system of trauma care for the entire state. More than 24,000 people are severely injured (called trauma) every year in Arizona, and more than 60% of these severe injuries occur in the rural and frontier areas of Arizona. Receiving treatment in this first hour is critical to survival.
We completed a full assessment of Arizona’s trauma system a few years ago and concluded that our greatest weakness was our rural and frontier Arizona trauma capacity. Our priority has been to establish Level IV Trauma Centers in rural AZ hospitals so that folks can be treated closer to where they’re hurt- or to be resuscitated and stabilized so they can be transported (preferably by ground) to a higher level of care if necessary. Designation as a Level IV requires the least resources and capabilities and typically will resuscitate and stabilize a patient and transfer the patient to a more appropriate Level, based on the patient’s injuries. We started small- with a couple of early adapter hospitals coming on line as Level IV trauma centers.
Our team has stuck with it- and this week we welcomed Wickenburg Community Hospital to our family of 13 Level IV Trauma Centers. We now have a vastly improved network of trauma resources in rural Arizona. We’ll continue to press ahead to recruit additional Level IV Trauma Centers in rural AZ- but also to recruit 2 or 3 Level III trauma centers in select rural communities that can care for moderately injured patients whose injuries are severe enough that our Level IV centers can’t care for them, but who don’t require the specialized care that is available from the Level I trauma centers.
August 12th, 2011 by admin
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Many people don’t realize one of the critical functions the Department performs is certifying Emergency Medical Technicians (EMT’s), including Paramedics. Our Bureau of Emergency Medical Services and Trauma System currently certifies hundreds of new EMT’s and Paramedics each year, helping ensure that Arizona’s Fire Departments and ambulance companies have sufficient staff that are properly trained and ready to spring into action when a crisis happens. Most people don’t think about it until they need help, but our EMS Bureau is a critical part of the public health system.
Over the last year and half, there’s been a lot of discussion about adding another Paramedic certification pathway to augment the existing method which uses the National Registry of EMT’s. Currently, the statutes related to this are vague and our Rules require that those seeking to be EMTs use the National Registry of EMT’s for their certification.
We’ve been working with stakeholders to explore the possibility of opening up this process to allow for another option for Paramedic Certification. We don’t see any reason to stay on the single track if another verifiable and validated process exists and there is no added financial burden to the Department.
It will be really important to move this issue from the drawing table to putting a plan in place in the next couple of months. Legislation has to be considered, internal procedures need to be modified as many parts of EMT training, testing and certification are changing in the next year or so. We’re working with our EMS stakeholders to help outline these changes and we look forward to achieving some needed updates during the next Legislative session.
August 12th, 2011 by admin
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We’ve had to make lots of difficult decisions in response to the ongoing funding shortfalls in our behavioral health system (as well as everywhere in state government). Many decisions (while painful in the short term) have been necessary to maintain long term system stability as Arizona continues to emerge from this unprecedented fiscal crisis. While Arizona is gaining ground economically, the progress is slow and requires ongoing, innovative approaches and strong collaboration by all behavioral health system partners. Because of our partnerships- our system remains strong.
State government has been working hard to protect coverage and services for individuals with behavioral health needs. A recent public letter from Dr. Nelson outlined some of our innovations to creatively reinforce our behavioral health system. We’ve needed to reduce behavioral health provider reimbursement rates, but we’ve taken other actions to help out behavioral health providers and folks that receive services. For example, we increased the percentage that must be spent on services and decreased the amount of profit behavioral health authorities are allowed to earn- pressing a larger percentage of the total money into services. We’ve also further reduced administrative costs, pressing more of the available funds into services.
We’ve also been encouraging the integration of physical and behavioral healthcare among behavioral health providers with acute care health plans and community health centers around the state. While these partnerships should also reduce overall healthcare costs, they also aim to improve quality of care and health outcomes. We’re also engaged in exciting planning activities to increase integration of physical healthcare and behavioral healthcare. In collaboration with AHCCCS, on July 15 we released a Request for Information to seek feedback on the feasibility of developing as “health homes” for folks that have a serious mental illness which we think will offer additional reductions in overall healthcare costs while improving member health outcomes.
Our primary goal—even during these challenging budgetary times—is to provide the best possible behavioral health care to our members and we’re committed to achieving that goal along with our partners in the behavioral health system.
August 10th, 2011 by admin
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Here in the Sonoran Desert monsoon season = scorpion season. There are more than 56 species of scorpions in Arizona- but only one- the bark scorpion is of any public health significance. The problem is that it’s the most common scorpion found in Arizona homes. Since you live in the bark scorpion’s territory, you probably have them around or maybe even inside your home. The Arizona Poison and Drug Information Center and Banner Good Samaritan Poison & Drug Information Center answer thousands of calls every year about scorpion stings- and last year they recorded more than 10,000 scorpion stings in AZ.
Scorpion stings are super painful but usually don’t require special medical treatment. Washing the sting area and using a cool compress along with over the counter pain medication handles the injury. The pain and numbness can last several days. But… sometimes a scorpion sting causes severe symptoms that require fast and expert medical care. Symptoms to look for are difficulty breathing, uncontrolled jerking, drooling and wild eye movements. Small kids are the highest risk group for these more severe reactions. Each year there are about 200 kids in Arizona end up needing intensive medical treatment. A recent study by the Banner Good Samaritan Poison and Drug Information Center showed that 33% of scorpion stings happen in the bedroom with 24% in the living room and 6% in bathroom.
OK… but what should you do in scorpion season? Here are some simple precautions:
- To prevent scorpions from either climbing or falling into a baby’s crib- move the crib away from the wall, and take off any crib skirts that reach to the floor.
- Roll back bed linens and check for scorpions before getting into bed.
- Shake or examine all clothing and shoes before putting them on.
- Move furniture and beds away from the walls.
- Wear shoes when outdoors, especially at night around swimming pools.
- Be especially careful of wet/damp towels in the bathroom and pool area.
We got some good news this week regarding scorpion sting treatment. The FDA approved Anascorp® which is an antivenin produced in Mexico and tested in clinical trials conducted through the U of A for use in treating patients suffering the effects of scorpion stings. Getting FDA approval took a lot of perseverance (12 years) partly because the antivenin process happens in Mexico… but it’s a good example of collaboration among academic and clinical researchers with partners in business and industry from both sides of the U.S.-Mexico border. Our own Arizona Biomedical Research Commission provided some of the funding for this research (P.S. check out our new ABRC Website). You can read more about the research that went into the approval in a recent article in the New England Journal of Medicine.
August 10th, 2011 by admin
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A new report is out that provides a state-by-state comparison of a wide range of behavioral health issues. Every state has to deal with some significant challenges with mental illness and substance abuse. For example, among people 12 and older, Alaska’s current illicit drug use rate more than double that in Iowa (13% versus 5%), yet Iowa was among the top 10 states when it came to binge drinking (28%).
The report was developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) and provides valuable insight to state public health authorities and service providers on the scope and type of behavioral health issues affecting their states. The report uses the combined 2008 and 2009 National Surveys on Drug Use and Health (NSDUH ), which is drawn from interviews with more than 100,000 persons from around the country, and provides a state-by-state breakdown along 25 different measures of substance abuse and mental health problems, including illicit drug use, binge drinking, alcohol and illicit drug dependence, tobacco use, serious mental illness, and major depressive episode. Other notable findings include:
- Fewer people in many states perceived that cigarette use can be risky. Between the combined years 2007-2008 and 2008-2009 the perception of great risk from smoking one or more pack of cigarettes a day decreased in 14 states among those aged 12 to 17; in 31 states among those aged 18 to 25 and in 9 states among those 26 and older.
- Current illicit drug use dropped among adolescents aged 12 to 17 in 17 states between 2002-2003 and 2008-2009; no increases in current illicit drug use occurred in any state in this age group over this time period.
- While the District of Columbia had the nation’s highest rate of past year alcohol dependence or abuse for those 26 or older (8.1%), it had the lowest rate among persons aged 12 to 17 (3.0%).
- Utah had the lowest rate of current marijuana use (3.6%) while Alaska had the highest rate (11.5%).
- Between 2007-2008 and 2008-2009 11 states showed declines in past year cocaine use among persons aged 12 or older (in alphabetical order — Arizona, Arkansas, Georgia, Indiana, Kentucky, Maryland, Minnesota, Ohio, Oregon, Tennessee and Virginia).
- Rhode Island had the nation’s highest rate of adults aged 18 or older experiencing serious mental illness in the past year (7.2%), while Hawaii and South Dakota shared the lowest rate (3.5%)