Understanding the Health Professionals Services Program

Transcription

1 Understanding the Health Professionals Services Program James Alexander, R. Ph. MN Pharmacists Association MN Pharmacists Recovery Network HPSP Advisory Committee S. Bruce Benson, R. Ph., Ph.D. College of Pharmacy, University of Minnesota HPSP Advisory Committee Monica Feider, MSW, LICSW HPSP Program Manager Purpose of this presentation is to enable the participant to: Discuss the development and growth of the HPSP Discuss the mission, operation and benefits of HPSP Describe the impact of HPSP on Minnesota pharmacy Describe the impact of HPSP on public health in Minnesota Describe results of surveying state programs that monitor pharmacists with illnesses First, a bit of History The Backstory 1980 to 1994 Minnesota Board of Pharmacy concerns Special MSPhA Committee responds Pharmacists Aiding Pharmacists, Inc. 1

2 Backstory (con t) Pharmacist Support Group Univ. of Utah School Pharmacy Section PRN/MN replaces PAP, Inc. HPSP created by Legislature Backstory (con t) Boards controlled monitoring of clients Advisory Committee has input to HPSP Alternative to disciplinary action Safety of Public Health Practices Overview of Minnesota s Health Professionals Services Program (HPSP) 2

3 Health Professional Services Program HPSP is a state of Minnesota program of the healthlicensing boards that provides monitoring services to health professionals with illnesses that may impact their ability to practice. HPSP implements monitoring plans to ensure that the health professionals obtain adequate treatment and do not cause patient harm. As of June 30, 2009, a total of 33 persons regulated by the Minnesota Board of Pharmacy were among the 566 persons enrolled in HPSP. Mission The mission of HPSP is to enhance public safety in health care. HPSP s goals are to promote early intervention, diagnosis and treatment for impaired health professionals and provide monitoring services as an alternative to board discipline. HPSP Legislation 1994: Legislation created HPSP to protect the public from persons regulated by the boards who are unable to practice with reasonable skill and safety by reason of illness, use of alcohol, drugs, chemicals or as a result of any mental, physical, or psychological condition. (Minn.Stat ) 2000: Legislation requiring all health licensing boards and 3 programs administered by the Dep. Of Health to Participate in HPSP by July 1, : Legislation passed requiring participation by Hearing Aide Dispensers, Speech Lang. Therapists, Occupational Therapists and Assistants 3

4 Structure The following are statutorily required: Program Committee (board representatives) Advisory Committee (assoc. representatives) Administering Board (Board of Dentistry) HPSP also meets informally with board staff to review program processes and address any questions or concerns that may arise. Nursing Medical Practice Pharmacy Dentistry Chiropractic Social Work Behavioral Health & Therapy EMSRB Physical Therapy Participating Boards Psychology Veterinary Medicine Podiatric Medicine Optometry Nursing Home Administrators Dietetics and Nutritionists Marriage & Family Therapy Dept. of Health (Speech Therapists, Hearing Aide Dispensers, Occupational Therapists and Assistants) Benefits Health professionals can report illness to HPSP in lieu of licensing board Individuals reporting impaired health professionals have legislative permission, confidentiality and immunity Protects public by monitoring and restricting practice of those impaired Ensures licensees receive appropriate level of care. 4

5 Unique Characteristics Primary focus is patient safety Provides services to persons with substance, psychiatric & medical disorders Eliminates the duplication of services: Offers a single point of contact for all regulated health professionals, providers, and employers Allows all boards to access the same services Pharmacist Participation in the Minnesota s Health Professionals Services Program (HPSP) Examples of How HPSP Protects the Public Employers report practitioners to HPSP for: Stealing narcotics suspicion or caught Showing up to work intoxicated Appearing manic or psychotic Concerns about dementia and cognitive functioning 5

6 Examples of How HPSP Protects the Public Health professionals contact HPSP when they: Have been caught stealing drugs Have been terminated or put on LOA due to mania, psychosis, cognitive impairment or other medical disorders Are in treatment for substance abuse or psychiatric reasons How HPSP Responds HPSP may ask practitioners to refrain from practice if their illness is active HPSP requests that practitioners obtain assessments or evaluations (substance, psychiatric and/or medical) HPSP utilizes the above to determine if monitoring is appropriate, and if so, to implements monitoring plans that protect the public and foster recovery How HPSP Responds Intake Intake Tennesen Warning Program Described Eligibility Determined Brief social, vocational, medical, psychiatric and substance histories gathered 6

7 How HPSP Responds Intake Request for evaluations Records gathered Develop Participation Agreement and Monitoring Plan Standard conditions Individualized conditions Why HPSP Develops Monitoring Plans on a Case by Case Basis Potential for Harm Considerations: -Profession -Specialty -Access to drugs -Supervision -Patient interaction Increase Practice Restrictions Standard Monitoring Refrain From Practice Increase Therapeutic Requirements Illness Considerations: -Insight -Tx compliance -Symptoms -Response to tx -Diversion -Illness history -Length sober or stable Pharmacist Referrals by First Referral Source:

8 Total Pharmacist Referrals BY FIRST REFERRAL SOURCE as of 8/25/ % not referred by the Board 70% of those referred with discipline had prior involvement in HPSP Total Pharmacists Illnesses Monitored ALL pharmacists referred as of 8/25/10 no duplicates of persons referred more than once 90% with substance disorders 38% with a comorbid psychiatric disorder 7% with a comorbid medical disorder 48% total with psychiatric disorders but only 10% without a comorbid substance disorder 9% with medical disorders, but only 1% without a comorbid substance or psych disorder Total Pharmacist Substances of Choice as of 8/25/ % list a prescription medication as a substance of choice 8

9 Substances of Abuse by Profession Substance of Abuse Pharmacist Physician Nurse Alcohol 25% 54% 43% Illicit 2% 1% 9% Opiate 42% 29% 20% Other Prescription 8% 5% 3% Polysubstance 23% 11% 25% Total Rx 73% 45% 48% For the purpose of this document, polysubstance represents a prescription medication and at least one other substance. Pharmacist data is from all pharmacists monitored by HPSP through 8/25/10 Physician data is from physicians monitored on 6/16/2010 Nurse data is from nurses monitored on 7/14/2010 Total Pharmacists Discharges as of 8/25/2010 MONITORED 74% NOT Monitored 26% % of monitored % of not monitored Completed 64% No Contact 18% Non Compliance 25% Non Cooperation 47% Ineligible 5% Ineligible 21% Voluntarily Withdrew 5% Deceased 1% No illness to monitor (non jurisdictional) 15% Comparing Referral Sources by Profession Profession Self Third Party Board Voluntary Board Discipline Total Referred Pharmacist 39% 29% 16% 16% 69 Physician 54% 16% 23% 6% 281 Dentist 27% 24% 45% 4% 55 Based on referrals from 1/1/2005 to 6/30/2010 Note: Most pharmacists referred with discipline had previously been enrolled in HPSP and discharged for non compliance 9

10 HPSP survey of state programs that monitor pharmacists with illness Survey HPSP developed a comprehensive survey to identify similarities and differences among state monitoring programs for pharmacists with illness. The surveys were mailed to all United States programs on the national Pharmacists Recovery Network website and distributed at the University of Utah s School on Alcoholism and Other Drug Dependencies (2009), with seventeen responses being received. Survey Topics Program Administration Funding Staffing Illnesses Monitored Monitoring Reporting Restrictions Mutual Support Groups Toxicology Screening General Questions 10

11 Program Administration How are programs administered: Licensing Board: 24% Professional Association: 24% Private: 28% Other: 24% Program Administration Is monitoring confidential from board? Yes: 53% No: 12% Varies/Case by Case: 35% Programs are in State Statute 76% Funding Funding Sources: Board 88% Grant 6% Professional Association 6% Annual Budget Average: $180,000 11

12 Funding Participants charged for service: Yes: 58% No: 42% Average charge: $88.00/month Staffing Current pharmacist enrollees average: 51 Treatment Provided Yes: 6% No: 94% Mutual Support Groups Average weekly frequency of required attendance Year Year Year Year Year

13 Toxicology Screening Average Monthly Frequency of Required Screens Year Year Year Year Year Days per week participants are required to be available = 6 Illnesses Monitored Substance Disorders: 100% Psychiatric Disorders w/out comorbid substance disorders: 53% Psychiatric Disorders with comorbid substance disorders : 94% Medical Disorders w/out comorbid substance disorders : 44% Medical Disorders with comorbid substance disorders: 88% Illnesses Monitored Medical Disorders with comorbid psychiatric disorders : 50% Medical Disorders without comorbid psychiatric disorders : 38% Competency Issues: 18% (violations of practice act) Boundary Violations : 28% Behavioral Problems : 12% (Anger Management, Sexual Misconduct ) 13

14 Monitoring Monitors persons who have been sober for one to four years (at time of referral) Years of Would Reported Monitor Sobriety upon initial contact Case by Case Average Length of Monitoring 1 65% 29% 5 years 2 65% 29% 4.8 years 3 64% 18% 4.7 years 4 64% 12% 4.8 years Reporting Relapses reported to licensing board Yes 40% No 7% Determined Case by Case 53% Reporting Participants discharged for positive screen Yes: 6% No: 75% Determined case by case: 19% Participants discharged for relapsing once Yes: 6% No: 65% Determined case by case 29% Participants discharged for multiple relapses Yes: 12% No: 299 Determined case by case: 59% 14

15 Restrictions: Practice While On Medication Prescribed Narcotics Yes 18% No 23 Determined case by case 59% Methadone Yes 19% No 50% Determined case by case 31% Buprenorphene Yes 25% No 31% Determined case by case 44% Biggest Issues Facing Monitoring Programs 1. Funding Issues 2. Use of Prescription Drugs (narcotics, or other prescription drugs that can be abused) Measuring Success Public safety. Continuing sobriety and safe return to practice identified as success by most programs. 15

16 Survey Conclusion State Monitoring Programs are important professional adjuncts for small numbers of U.S. pharmacists. Results indicate that there are both similarities and differences between the 17 responding state monitoring programs for pharmacists. Among them, three out of five monitoring programs report they are in state statute, most are funded by a health licensing board, most do not provide treatment, and the most common illness monitored is substance abuse (all respondents). Survey Conclusion cont. Conversely, results demonstrate variation among monitoring programs in several areas. Results also indicate that HPSP s practices generally are consistent with the national norms. The survey results obtained should be of value to state monitoring programs in the United States as they assess and try to improve their respective services. Closing Statements Why HPSP works: Board support Professional association support Confidential participation Easy reporting Statutory mandate 16

17 Closing Statements What you can do: Address concerns as they occur Ensure policies are in place Ensure policies are followed 17