Dennis Dimitri – Supervised Injection Facilities

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Today we are joined by Dr. Dennis Dimitri, the immediate past-president of the Massachusetts Medical Society (MMS) and current chair of the society’s Task Force on Opioid Prescribing and Physician Communication, to discuss supervised injection facilities, or SIFs. A SIF is a location where individuals may use illegal drugs under the supervision of a medical professional ready to assist in case of an overdose requiring treatment.

Later this month, the MMS will vote on whether to advocate for a task force to assess the feasibility of a pilot SIF in the state of Massachusetts. If the proposal is approved, the MMS will become the first statewide physician organization in the Bay State to advocate for such a pilot program.

We discuss with Dr. Dimitri what it would mean should the MMS advocate for SIFs. We review the evidence on the effect of SIFs on rates of fatal overdoseuptake of Substance Use Disorder treatment, and rates of transmission of HIV and HCV. We talk about the ethical considerations of such a program, whether SIFs enable behaviors harmful to people’s health or they represent harm reduction, and the complex legal considerations involved with a potential pilot program.

Major events of the opioid epidemic in the last few years, such as business owners planning for the possibility of overdose in bathrooms and a recent HIV outbreak stemmed by a needle exchange program in Indiana, raise the potential benefits of SIFs. If you’re interested in reading more, check out recent guest Dr. Sarah Wakeman‘s compassionate and evidence-based case for SIFs in this recent NEJM article. You can also listen to our past episode Dr. Jessie Gaeta on the SPOT program (supportive place for observation and treatment) when she also gave her thoughts on SIFs.

Dr. Dimitri is a family physician and Vice Chair of the Department of Family Medicine at University of Massachusetts and the UMass Memorial Medical Center.

What do you think? In the face of the opioid epidemic, could pilot SIFs in the US also reduce overdose deaths as in Canada and Australia? Tweet us your thoughts at @rospodcast or leave a comment on our facebook page at www.facebook.com/reviewofsystems.  Or, drop us a line directly at contact@rospod.org. We’d love to hear from you – and thanks for listening.

Graphic from of Centers for Disease Control, Opioid Overdose.

Andrew Schutzbank – Iora Health

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This week we are joined by Andrew Schutzbank, the Vice President of Product and Technology at Iora Health. His passion for revolutionizing health care began as a medical student at Tulane in pre- and post-Katrina New Orleans and continued during his Internal Medicine & Primary Care residency at the Beth Israel Deaconess Medical Center. He writes at schutzblog.com and joins us today to talk his work at Iora Health.

We discuss how the idea of completely starting over brought him to Iora Health after his residency, how Iora Health’s model works and how they navigate risk, the central role of Health Coaches in the care team, what challenges Iora is still grappling with, about Iora Health’s novel EHR, Chirp, and finish up with his reflections on how software development and patient care are similar.

Please rate and review us on itunes or stitcher, and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

David Buck – Caring for High Need, High Cost Patients

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This week, Thomas Kim hosts the show and interviews Dr. David Buck, a family physician and professor of family and community medicine at the Baylor College of Medicine.  He is the founder and president of Patient Care Intervention Center (PCIC), an organization that uses advanced population health methods to target super-utilization of the health care system and intervenes through intensive care coordination and case management. It’s based in Houston, Texas and recently opened a branch in Dallas, and they were recently featured on PBS NewsHour. Prior to Dr. Buck’s work at PCIC, he founded Healthcare for the Homeless – Houston (HHH), now a federally qualified health center for over 7,000 homeless in Harris County, as well as the associated Houston Outreach Medicine Education and Social Services (HOMES) clinic, a student-managed clinic at HHH in conjunction with BCM and the University of Texas Health Science Center. He is a co-founder of the Houston-based physician advocacy group Doctors for Change, and founded the Houston-Galveston Albert Schweitzer Fellowship. He helped found the international street medicine institute, and was appointed to the 15-member Consumer Operated and Oriented Plan Program advisory board created as part of the Patient Protection and Affordable Care Act in 2012.
You can find some CDC resources about Adverse Childhood Experiences, or ACEs here, and a New Yorker article about the effects of ACEs on health here.
Dr. Buck is a graduate of the Baylor College of Medicine and the University of Texas School of Public Health, as well as family medicine residency at the University of Rochester.

Journal Club: Association Between PCMHs & Adherence to Chronic Disease Medications

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On today’s Journal Club, we discuss a paper published in Annals of Internal Medicine in November 2016, entitled Association Between Patient-Centered Medical Homes and Adherence to Chronic Disease Medications, by Julie Lauffenburger and colleagues.

The North Carolina Medicaid study that Thomas mentions can be found here, and an interesting systematic review of strategies to improve medication adherence from 2012 here.

If you enjoy the show, please rate and review us on itunes or stitcher and share us on social media. Tweet us your thoughts @rospodcast and check out our Facebook page. Or, you can email us at contact@rospod.org. We’d love to hear from you. And thanks for listening.

 

Sarah Wakeman: Treating Patients With Substance Use Disorders & the Opioid Crisis

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Today we are joined by Sarah Wakeman to talk about substance use disorders, one of the most pressing public health issues of our time. Sarah is the Medical Director of the Massachusetts General Hospital Substance Use Disorder Initiative. She designs systems of care that draw on the strengths of communities to care for patients and residents with addictions. Sarah also practices in the Adult Medicine Department of the MGH Charlestown HealthCare Center.

We talk about the importance of language and discourse on the care for patients with substance use disorders (4:00), how an approach of compassion has proven more effective than the popularized tough love style (7:30) and how rewarding it can be to witness a patient have a Lazarus moment (10:00) in a journey to recovery. We also talk about the very real challenges of caring for this patient population (13:00), the complexities and power dynamics of monitoring (16:15), and what needs to be done to turn around the epidemic (20:45).

You can find the landmark report on the opioid epidemic from our Surgeon General Vivek Murthy here, which is full of helpful information on this topic.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Journal Club: Powers et al – Non-Emergency Medical Transportation; Delivering Care in the Era of Uber and Lyft

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This week we’re excited to bring you a journal club episode, highlighting a study published in the September 2016 issue of JAMA by Brian Powers and colleagues Scott Rhinefort and Sachin Jain from Caremore Health, entitled NonEmergency Medical transportation, Delivering care in the Era of Lyft and Uber. Powers and colleagues report on their pilot study of Caremore Health patients utilizing Uber and Lyft for non-emergency medical transportation to and from appointments.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.