Wyoming Care Coordination NetworkMountain-Pacific Quality Health

December 13, 2018

Who’s in the Room?

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Get to Know Each Other

• Which organization are you representing?

• How many Americans over 65 suffer from depression?

a) 1 million

b) 3 million

c) 6 million

d) 7 million

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Mountain-Pacific Chronic Care Management (CCM) Support

Provide care

coordinators with

targeted educational

tools and resources to

distribute to patients

• Focus on 20-minute

monthly interventions

Engage patients and

empower them for long-

term continued program

participation

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Mountain-Pacific CCM Support

• Disease-specific information

Vaccines

Nutrition

Safety

• Medication safety tools

Medication disposal

Medication bags

Pill planners

Adherence and health literacy

• Plus MORE, visit our website

frequently for new tools and resources

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Calendar of Events

• October 11: Kickoff! Polypharmacy and medication adherence

Community resource discussion: patient safety in harsh weather

• November 15: Nutrition The right diet for your health

Community resource discussion: How to find fruits and vegetables in the winter

• December 13: Stress and Loneliness in Winter Combating seasonal affective disorder and social isolation

Community resource discussion: Community events to connect and socialize

• January 10: Revisiting the Care Plan Incorporating patient goals and priorities in wellness

Community resource discussion: How to keep moving in the winter

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Mountain-Pacific CCM Support

What you can expect:

• Monthly newsletter

Timely tools and resources

• Monthly education event

• Community resource review

• Case studies and troubleshooting

• Resources from Mountain-Pacific

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Mountain-Pacific CCM Support

What we are asking in return:

• Participate in live events

Encourage group learning

• Complete brief surveys following learning

events

• Complete evaluations sent with tools and

resources

• Share your knowledge and experiences

• Help guide our discussions and content8

Medication MinuteTraveling and Medication

What you need to know….

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What Do I Need to Bring With Me?

• Prescription medicines you usually take Including medications you just need

sometimes, like rescue inhalers or allergy medications

• Special prescriptions for the trip Antibiotic prescribed by your doctor

for self-treatment of moderate to severe diarrhea

Medication to prevent altitude sickness

Nausea medication

• Over-the-counter medicines Antidiarrheal medication Antihistamine and/or Decongestant Anti-motion sickness medication Medicine for pain or fever (such as

acetaminophen, aspirin, or ibuprofen)

Mild laxative Cough suppressant/expectorant Cough drops Antacid Antifungal and antibacterial

ointments or creams 1% hydrocortisone cream

Where and How Should My Medication Travel?• Put your medicines in your

carry-on luggage Bring enough medicine to last

your whole trip, plus a little extra in case of delays

Carry all of your medication —even vitamins and supplements — in their original containers or packaging in a clear plastic bag in carry on luggage▪ Ensure all prescription

medications are clearly labeled with your full name, doctor’s name, medication name, and dosage

• If your travel plans take you across one or more time zones, you may need to change the time you take your medications each day during your trip. Talk with your doctor and create a dosage schedule.

TSA Medication Travel Tips

• You don’t need to to notify an officer about any medication you are traveling with unless it is in liquid form.

• Liquid medication more than 3.4 ounces is allowed in carry-on bags. You are not required to place medically required liquids in a zip-top bag. However, you must tell the officer that you have medically necessary liquids at the start of the security screening. Medically required liquids could receive additional screening that could include being asked to open the container.

• You can bring your medication in pill or solid form in unlimited amounts as long as it is screened.

• You can travel with your medication in both carry-on and checked baggage. You should place keep your medication in your carry-on in case you need to access them immediately.

• TSA does not require passengers to have medications in prescription bottles, but states have individual laws regarding the labeling of prescription medication.

• Medication is usually screened by X-ray; however, if you do not want a medication X-rayed, you can request an inspection instead.

• Nitroglycerin tablets and spray (used to treat episodes of angina in people who have coronary artery disease) are permitted and have never been prohibited.

TSA Travel Tips – Traveling with Medication. September 5, 2014. Available from: https://www.tsa.gov/blog/2014/09/05/tsa-travel-tips-traveling-medication

What About Traveling Abroad?

• Pack a note on letterhead stationery from the prescribing doctor (preferably translated into the language understood at your destination) including: All prescribed medications,

information on their active ingredients and the purpose of the medication

Controlled substances, such as marijuana, and injectable medicines, such as EpiPensand insulin.

• Check with the country you are traveling to, to insure all medications are legal in that country and that you meet local requirements for labeling

Combatting Seasonal Affective Disorder and Social Isolation

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What is Seasonal Affective Disorder (SAD)?

• A type of depression

• A mood disorder subset in which people who have normal mental health throughout most of the year exhibit depressive symptoms at the same time of each year, most commonly in the winter.

• Full Remittance during other seasons

• 2 Years of continuing pattern

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Who it affects

• 4-6 % of people in the United States

• More common the farther from the equator

• Onset is typically in 20 – 30 years of age

• More common in females

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Causes

• Circadian Rhythm – body’s natural 24 hour clock

• Serotonin - a compound present in blood platelets and serum that constricts the blood vessels and acts as a neurotransmitter.

• Melatonin levels - a hormone secreted by the pineal gland that inhibits melanin formation and is thought to be concerned with regulating the reproductive cycle.

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Risk factors

Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression.

Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions.

Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.

Sex. Females are more likely than males to suffer from SAD.

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Signs and symptoms of SAD

• Feeling depressed most of the day, nearly every day• Losing interest in activities you once enjoyed• Having low energy• Having problems with sleeping• Experiencing changes in your appetite or weight• Feeling sluggish or agitated• Having difficulty concentrating• Feeling hopeless, worthless or guilty• Having frequent thoughts of death or suicide

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Diagnosis

• Physical exam

• Lab tests

• Psychological evaluation

• DSM-5 criteria (F33.9)

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Treatment

• Light Therapy

• Cognitive Behavior Therapy

• Medications

• Increase Melatonin

• Increase Serotonin

• General Health• Diet, Exercise, Regular Sleep, Social

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National Suicide Rate

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WY 2007-2016 Ten Year Age-Adjusted Suicide Rate

0

5

10

15

20

25

30

35

STATE Big Horn Campbell Crook Fremont Hot Springs Natrona Niobrara Park Sweetwater Washakie

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WY 2016 Suicides by Means

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28

87

7

0

10

20

30

40

50

60

70

80

90

100

Poisioning Hanging Firearm Other

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Risk Factors for Suicide

• Female

• Living Alone

• Widowed

• Poor Social Support

• Poor Health

• Stressful Life Events

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Let’s have a critical conversation

• Patients may not be forthcoming with information

• Older patients tend to complain less about being “sad”

• Males are less likely to self-report depression

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So, what can you do?

• Approach with openness and frankness

• Ask “Have things become so bad that you consider

hurting yourself?”

• Ask “Have you ever felt life is not worth living?”

• Ask about plans, means and methods

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Resources

• Depression Zone Tool

Https://www.mpqhf.org/QIO/wp-

content/uploads/2018/11/Depression-for-Zone-Tool-508.pdf

• S:\Wyoming\CCM Project\2018-12-13 Wyoming Care Coordination

Network\Things to do to wave off holiday blues.docx

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• SAMHSA’s National Helpline: https://findtreatment.samhsa.gov, 1-800-662-HELP (4357)1-800-487-4889 (TTY)

• NAMI (National Alliance on Mental Illness)

• www.nami.org: 800-950-6264

• IN A CRISIS? TEXT NAMI TO 741741

• National Suicide Prevention Helpline: 1-800-273-8255 (TALK), https://suicidepreventionlifeline.org

• Wyoming Behavioral Health Division: 1-800-535-4006

• Wyoming Mental Health Ombudsman: 1-888-857-194229

Questions?

Nickola Bratton Crystal Morsenbratton@mpqhf.org cmorse@mpqhf.org

www.mpqhf.org

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Developed by Mountain-Pacific Quality Health, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Montana, Wyoming,

Alaska, Hawaii and the U.S. Pacific Territories of Guam and American Samoa and the Commonwealth of the Northern Mariana Islands, under contract with the

Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not

necessarily reflect CMS policy. 11SOW-MPQHF-WY-C3-18-23