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Bupe Update

posted Nov 23, 2013, 12:55 PM by PC/SM Chief Resident
From Chinazo: 

To make sure we are all in the loop, I want to inform you of what was discussed at the bupe meeting yesterday:


1. Treatment Agreements - When we first starting providing bupe treatment, we did not use treatment agreements. However, over the past year or so, for all new patients seeking bupe tx, Angela has been doing treatment agreements and putting these agreements in providers' boxes so that they can review them at the next visit with the patient. However, many people who started treatment a while ago do not have treatment agreements. We decided that it is best to make these uniform, so we will review the list of active bupe pts, and for those without treatment agreements we will use a pop-up to remind providers to use an agreement. The agreements are available on the pc/sm website (we will include a link to the website on the pop-up message).


2. iSTOP - All providers at the meeting had just begun using the PMP and thought it was helpful. Many providers d(including me) didn't know that the NY state "icon" on the top left section of the page can be clicked to bring you directly to the PMP, thereby eliminating a few steps to get on the PMP page. One specific situation was discussed in which a patient's record showed other opioids and amphetamines. After much discussion with the pt, phone calls to the pharmacies, and phone calls to the other physician, it appears as though someone else is getting these scripts and not the patient. In unique cases like this, it's best to document what the clinical judgment is, but no further notification/investigation is required. If we feel this is becoming a pattern, we can discuss this issue further with administration or even the legal dept at Montefiore.


3. Prior Authorizations - Existing processes to get PAs seem to be working quite well. There remain a few instances in which pts have had to wait for some days, and these tended to be when the insurance company required more complicated procedures (e.g., utox results faxed to them) which Lola may not be aware of.


Lola is now sending flags to herself, Angela, and the provider a few weeks prior to the authorization expiration date so that we can begin to address the PA issue in advance without the pt present. When providers get this flag, we should start a phone note to Lola (and Angela) indicating the necessary information for the PA (e.g. diagnosis, X number, dose, strip/tab, # pills/mo, etc).


One last issue that we will address with Lola is to improve follow-up. Sometime when the PA process is prolonged, it seems that follow-up may be lacking and it is only when the patient gets upset that follow-up then occurs.


4. Missed follow-up appts - It is not uncommon for pts to be told to follow up in 4 weeks or 1 month, and then they get an apt for 5 weeks and run out of meds. To try and address this issue, we discussed:

- writing the exact date for the next apt (e.g. "make appt to see Dr. Cunningham in 4 weeks - on Dec 17)

- telling pts that if there are problems with getting timely appts and pts will run out of meds, they should call Angela (Angela will put a small stack of her business cards in rooms so that we can give them to pts, and they can call her on her direct line)

- We will also create a summary sheet of expectations for pts when they first start tx. Although we review the importance of keeping appts with the treatment agreement, most pts don't want a copy of the agreement. So, we will give them a 1-page summary sheet of expectations in which there will be info about appts and Angela's phone number.


Next bupe meeting will be Dec 18 (3rd Wed of the month).