BSc Clinical Methods I: Overview of Physical Examination and Diagnosis
In this BSc course, students delve into history taking, physical examination techniques, and the process of making medical diagnoses. The curriculum covers various body systems, differential diagnoses, and the importance of accurate observations. Through practical skills labs and clinical methods, learners gain a comprehensive understanding of healthcare assessment and decision-making. Emphasis is placed on conducting thorough medical histories, recognizing symptoms and signs, and differentiating between conditions to provide effective treatment.
Uploaded on Mar 01, 2025 | 0 Views
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
Oklahoma PMP Prescription Drug Abuse
Definition The term doctor shopping has traditionally referred to a patient obtaining controlled substances from multiple health care practitioners without the prescribers knowledge of the other prescriptions.
National Restrictions Almost all states have a general fraud statute that adopts verbatim or with slight alteration the provision in the Uniform Narcotic Drug Act of 1932 or the Uniform Controlled Substances Act of 1970. These statutes prohibit obtaining drugs, including through doctor shopping, by any or all of the following means: fraud, deceit, misrepresentation, subterfuge, or concealment of material fact.
Applicable Laws Category Physical Examination/ Patient Physician Relationship Legal Citation Okla. Stat. tit. 59, 509 Okla. Admin. Code 535:15-3-13 Tamper-Resistant Forms Okla. Admin. Code 317:30-5-70.2 Prescription Limits Okla. Admin. Code 317:30-5-77.1 ID Requirement Okla. Admin. Code 475:30-1-15 Okla. Stat. tit. 63, 2-309C Okla. Stat. tit. 63, 2-309B
How PMPs Can Help Doctors say they often rely on their own instant judgments in the office and have little reliable means of double-checking the patients' information It puts doctors in the uncomfortable position of playing private eye. Unfortunately, with the widespread misuse of controlled substances and diversion risks, we're often taken advantage of Doctor shoppers often visit facilities where medical professionals don't know them
Types of Doctor Shoppers Patients who have pain but cannot not find a doctor who will adequately treat it Patients who are addicted Patients who divert prescription drugs for profit and/or to feed their addiction
What Every Pharmacists Should Know It's a relatively insignificant source of diverted prescription drugs, as compared with theft from drug stores, warehouses, acquisition over the Internet, theft from people's homes
Fraud and Forgery Stolen Script Pads Reproduced Script Pads Early Fills Cash Fills vs. Insurance Pill Mills Script Mills Scripts Called In
Oklahoma Shoppers 15/15 Period 5/5 6/6 7/7 8/8 9/9 10/10 Notes Online system in place 3 years by this point. Data collected every 30 days Q1 2010 524 224 98 46 25 17 2 Q2 2010 658 272 140 77 44 24 3 Q3 2010 811 344 141 75 46 27 2 Q4 2010 656 280 128 60 32 20 1 Daily Reporting Begins Q1 2011 630 246 117 59 32 13 1 Q2 2011 596 258 112 58 30 18 4 Q3 2011 649 232 101 40 21 9 0 Q4 2011 475 162 79 40 14 5 0 Voluntary Real-Time Reporting Begins Q1 2012 478 168 72 33 17 10 0 Real-Time Reporting Required Four Online Alerts Broadcast on Specific Patients (Unsolicited Reports Pending) Q2 2012 424 147 49 21 9 3 0
Impact In general, the number of doctor shoppers represent a very small number of total patients A study in West Virginia found that doctor shoppers are at a much higher risk of death from overdose and abuse Doctor shoppers divert care from legitimate patients especially in emergency rooms In Oklahoma, a single doctor shopper visited 108 doctors and 93 pharmacies in less than a year Prescribing more doses than needed increases opportunity
PMPs and What They Do A statewide electronic database that gathers information from dispensers of controlled substances Pharmacies Doctors Veterinarians A tool used to guard against the diversion of controlled drugs A diagnostic tool used by practitioners to evaluate patients A research tool to identify trends and help identify solutions
Controlled Drugs in Oklahoma 2011 Prescriptions by Therapeutic Class Tranquilizers 19% Stimulants 10% Pain Killers 58% Sedatives 13%
Trends Oxycodone Prescription Totals (Tabs and Capsules Only) 800,000 700,000 600,000 # of Scripts 500,000 400,000 300,000 200,000 Year 2002 264,551 282,545 304,928 300,396 342,269 472,881 512,376 578,256 619,458 673,645 719,294 762,572 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Oxycodone
#1 Hydrocodone Hydrocodone (2008 - 2013) 100,000,000 95,000,000 90,000,000 85,000,000 Totals 80,000,000 75,000,000 70,000,000 65,000,000 60,000,000 1H 08 2H 08 1H 09 2H 09 1H 10 2H 10 1H 11 2h 11 1h 12 2h 12 1h 13 2h 13 Total 61,319,85 66,266,74 74,173,92 78,701,89 75,586,47 81,456,69 88,388,43 93,797,04 96,141,81 93,185,65 96,003,73 97,361,65
The Rise of z-Sedatives According to the National Institutes of Health, approximately 30 percent of all Americans complain of sleep disruption, while 10 percent display symptoms congruent with chronic insomnia. One of the most common treatments for insomnia is prescription sleep medications that help people fall asleep and remain asleep. Historically barbiturates were initially popular for treating insomnia, but their long "hangover" effect made them easily replaced with the introduction of the benzodiazepines. Triazolam (Halcion), diazepam (Valium), and oxazepam (Serax) rapidly became the treatment of choice for insomnia. Recently a new class of nonbenzodiazepines---the "z-sedatives"--has overtaken the older benzodiazepines as the most commonly prescribed sleep medications. The three most popular z-drugs are zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta). The Food and Drug Administration (FDA) also recently approved the production of zolpidem tartrate, a generic form of Ambien. Many dentists prescribe these medications for patients who have difficulty sleeping the night prior to an appointment or as a procedural sedative. With 43 million prescriptions for sleep medications filled in 2005, generating $2.7 billion for pharmaceutical companies, it is important that dentists be aware of these drugs' mechanism of action and potential drug interactions. http://www.ncbi.nlm.nih.gov/pubmed/18069595
Opiates and Benzos Some combinations of drugs can be dangerous and even deadly. Mixing benzodiazepines and opiates can be extremely dangerous. Both benzos and opiates are central nervous system depressants. When taking both a benzodiazepine, such as lorazepam, and an opiate like morphine, the drugs can lead to excessive depression of the nervous system, causing respiratory depression and ultimately death. http://www.desmoinesaddictiontreatment.com/rehab- guide/dangers-of-using-benzodiazepines-with-opiates/
Opiate/Benzo Research According to the evidence, there is a positive association between the risk of death and the use of benzodiazepines in combination with methadone. Though limited, there is an indication that opioids, including buprenorphine, have the potential for increased risk in combination with benzodiazepines. Clinical mechanisms are hypothesized. - See more at: http://www.thementalelf.net/mental- health-conditions/anxiety-disorders/is-it-safe-to- prescribe-benzodiazepines-and-opioids- together/#sthash.L92Va1MB.dpuf
Real Conversations from Drug Seekers UserX had this happen to him when he never did benzos (oxy+diazapam). the high was no where near as good as pure OC. now he cant do opiates without wanting benzos, its like the high is incomplete. but now hes a benzo addict... My doctor has me on 8 MG of Xanax daily. (QID) 2 MG. Xanax bars) then for my spinal infection Percocet 10/325 6 times a day. Im also on Zoloft 200 MG's a day... im only 27 years old and i feel like i am 50 years old. Im going to ask to be switched to Valium again because of the rebound anxiety i get with Alprazolam.. i also live in the state of CALIFORNIA i possess my Prop 215 Card for Medicinal Cannabis(i feel Cannabis is the best medicine for anxiety and severe pain HANDS DOWN!!!! im allowed to exceed the limit on my card. i can possess 6 pounds of buds, and grow up to 90 plants. I love California
When Overprescribing Becomes Criminal DrX 8th in Schedule II Prescribing 1st in Scehdule III Prescribing 1st in Scheudle IV Prescribing At one point was writing nearly 3% of all opiates dispensed in Oklahoma 10+ Overdose Deaths Multiple Counts of Murder Previous felony convictions involving controlled drugs Motivation?
Morphine Equivalent More than 100mg of morphine equivalent per day increases the risk of death by overdose by 9 times. Direct correlation between mortality and morphine equivalent Opiate Na ve Patients
Making a Difference Nationally Recognized as the Leaders in Innovation and Leadership Among State PMP s Real Time Reporting by Dispensers (Within 5 Minutes) Practitioner Use up 167% Pharmacy Use up 1,085% Law Enforcement/Regulatory Use up 60% For the 1st Time in the Last Two Years Accidental Overdose Deaths have Declined Full Time PMP Trainer Hired De-Identified PMP Data Being Provided to ODMHS Nov. 1, 2013
Leadership and Innovation Question and Listen Challenge and Communicate Risk Experimentation Reflect Consider Dynamics Inside and Outside the Organization Be Authentic Be Outcome Driven Dare to Imagine
New Laws Interstate Data Sharing (November 1, 2014) Access by Federal Medical Professionals without being Registrants Enumerated Delegate Accounts Mandatory PMP Queries New Processes Recommended prescribing guidelines Prescriber dispensing education
Vision We cannot solve a problem by using the same kind of thinking we used when we created them. [A. Einstein]
