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Impending Opioid E-Prescribing Mandate Guidance

Posted By Administration, Tuesday, September 11, 2018

Action Alert – Impending Opioid E-Prescribing Mandate Guidance

One of the most significant provisions of the Arizona Opioid Epidemic Act, SB 1001, is the prescriber electronic transmission requirements for prescribing opioids. Electronic prescribing of controlled substances (EPCS) mitigates prescription fraud to prevent the occurrence of fake prescriptions, as well as reduces prescribing errors and improves the accuracy of medication dispensing. These new requirements go into effect in 2019.

Opioid E-Prescribing Requirements
Beginning January 1, 2019, each prescription order for a Schedule II opioid in
Maricopa, Mohave, Pima, Pinal, Yavapai, and Yuma counties must be transmitted electronically to the dispensing pharmacy. The only exception is for Medication Assisted Treatment (MAT) for substance use disorder, or if a waiver is granted to a prescriber (see below).

Beginning July 1, 2019, these same requirements go into effect in Greenlee, La Paz, Graham, Santa Cruz, Gila, Apache, Navajo, Cochise and Coconino counties.

Link to E-Prescribing Requirements in SB 1001 Bill Language

Take Action for Compliance
We urge you to assess your clinical practice capacities and determine if you are compliant with these impending opioid e-prescribing requirements to avoid and/or
minimize any disruption to your practice and patients.

It is important to note that e-prescribing controlled substances must satisfy the Drug Enforcement Administration’s Electronic Prescriptions for Controlled Substances (EPCS) system requirements and may cost more than basic e-prescribing. Many of the most common electronic health record vendors have both e-prescribing and EPCS capabilities so contact them for more information. To find out if your EHR vendor is EPCS-certified, you can also check the Surescripts website.

Request a Waiver, if Necessary
Pursuant to
Arizona Revised Statutes 36-2525 Q., the Arizona State Board of Pharmacy is required to grant waivers to medical practitioners who lack adequate access to broadband or face other hardships that prevent implementation of EPCS. The maximum duration for a waiver is up to one year.

If you determine you will be unable to meet the EPCS e-prescribing requirements, please submit a waiver using this link to the Arizona Board of Pharmacy as soon as possible: Waiver Form Link

DO NOT DELAY! The deadline to get a waiver to the Arizona Board of Pharmacy for consideration before 2019 is November 15, 2018. Once the waiver form is completely filled out, email the form to pmp@azpharmacy.gov.

Questions & Feedback?
If you have questions about EPCS, additional information is available on the Health Current website or you may contact them for phone-based support at 602-688-7200.

Tags:  Legislative  Opioid 

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AZ first probable WNV/SLE case

Posted By Administration, Friday, August 24, 2018

Society PA,

With monsoon season, mosquito activity is increased in Arizona. The year’s first probable West Nile virus (WNV)/St. Louis encephalitis virus (SLE) case in Arizona is under investigation.  Both of these flaviviruses are endemic in Arizona and have been detected in collected Culex mosquitos.

WNV and SLE are most commonly spread to people by the bite of an infected mosquito. In 2017, Arizona had 110 reported cases and 8 fatalities of WNV and 6 cases of SLE.

Healthcare providers are encouraged to consider WNV and SLE in patients presenting with:
  • Nonspecific signs of fever, headache, myalgia, arthralgia, rash, and weakness.
  • Meningitis, encephalitis, paralysis, or other acute signs of central or peripheral neurologic dysfunction.

The majority of WNV and SLE infections are asymptomatic; however, infections in the elderly and among immunocompromised individuals can result in neuroinvasive diseases that can be fatal.

Arizona clinicians should test serologically for both WNV and SLE if there is clinical suspicion for these mosquito-borne illnesses, with serum or cerebrospinal fluid collected after the first week from symptom onset. Providers should advise patients to prevent mosquito bites and they should contact local public health (https://www.azdhs.gov/preparedness/epidemiology-disease-control/index.php#resources-county ) regarding suspected WNV or SLE illnesses or questions on diagnostic testing.

 

For more information, visit:

https://www.azdhs.gov/preparedness/epidemiology-disease-control/mosquito-borne/index.php

https://www.azdhs.gov/preparedness/epidemiology-disease-control/index.php#idaz https://www.cdc.gov/westnile/healthcareproviders/index.html

https://www.cdc.gov/sle/technical/symptoms.html

Thank you,
Arizona Health Alert Network

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ASAPA 2018 Election Results

Posted By Administration, Friday, June 15, 2018
Updated: Thursday, June 14, 2018
The ASAPA 2018 election results are in!

The results are as follows:
President Elect: Kirsten Bonnin, PA-C
Secretary: Lynzi Warner, PA-C
Directors at Large: Carla Shamblen, PA-C and Elias Villarreal, PA-C
AAPA House of Delegates: Jamie Black, PA-C; Sarah Bolander, PA-C; Jacqueline Spiegel, PA-C

 

Returning Board Members:
President: Jennifer Feirstein, PA-C
Treasurer: Chris Davis, PA-C
Directors at Large: Sarah Bolander, PA-C and Amy Rust, PA-C
AAPA House of Delegates: Jennifer Feirstein, PA-C and Melinda Rawcliffe, PA-C

 

A big thank you to the candidates for their time and commitment to serve in their new roles starting in July!

 

Sincerely,

Amber Herrick, PA-C
ASAPA Elections Chair

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Arizona Vaccine News from the AZ Dept. of Health Services

Posted By Administration, Tuesday, May 29, 2018

Society PA,

Please see the attached “Arizona Vaccine News.”

The intent of “Arizona Vaccine News” is to summarize local, national, and international vaccine information that affects Arizona. 

 

Thank you,
Arizona Department of Health Services

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Primary Care: PAs Need Vigilance with Herbals

Posted By Barbara Cortright, PA-C, Wednesday, April 4, 2018

With complementary and alternative medicine grabbing larger market share each year, physician assistants often increasingly find themselves learning more about herbal remedies from their patients before they hear about it in continuing-education courses.

But if a clinic’s patient panel includes a large number of Hispanic and Latino populations, the list of supplements can be substantial thanks to the increasing popularity of neighborhood herbal shops called yerberías that cater to this clientele.

Also known as botanicas, these retail stores sell herbs, creams, tinctures and teas. They may also carry talismans to ward off evil spirits and votive candles for events or ceremonies. Patients whose ancestral roots come from rural parts of Latin America may lean more heavily on the yerberías for help than the local pharmacy.

Many of these substances pose little threat to the patient’s overall health. Manzanilla, for example, is the Spanish word for “chamomile” and is often formulated into a soothing tea for bedtime. Other substances often focus on treating the common cold or aching joints. They may include extracts from creosote, arnica, and chiles (think modern medicine’s capsaicin cream), and anti-inflammatory extracts like turmeric, ginger, black pepper and nettle leaves.

However, products from yerberías lack FDA studies and approval. A 2013 study found that many of the substances patients receive from yerberías for the common cold may contain excessive amounts of lead, arsenic or mercury. 

And then there is the occasional rogue yerbería, like the one Mesa Police raided five years ago and found Viagra, Valium, amoxicillin and Pentrexyl, which are prescription-grade pharmaceuticals. (Pentrexyl contains ampicillin.)

PAs practicing in Arizona often ask for a list of all medications and supplements. But in the right patient, it’s also worth asking, “¿Cuál botanicas usa Usted?” or “Which botanicals do you use?”

– Barbara Cortright, PA-C

Tags:  botanicals  complimentary  herbal  supplements  yerberia 

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Call the New AZ Provider Opioid Assistance + Referral Line: 888-688-4222

Posted By Administration, Monday, April 2, 2018

Society PA,

OAR Line: Opioid Assistance + Referral Line for Arizona Providers: 1-888-688-4222

More than two Arizonans die every day from an opioid overdose.  The Arizona Department of Health Services recognizes that there are many patients at risk for an overdose – and those with complex high-impact chronic pain, on multiple medications, or struggling with opioid use disorder can be challenging for providers to manage. 

As a result, Arizona has now launched one of the nation’s first 24/7 hotlines providing free, real-time consultations for clinicians with complex patients with pain and opioid use disorders, staffed by experts at the Poison and Drug Information Centers in Arizona.

 This clinical service can assist providers with the management of:

  •   Patients taking high numbers of morphine milligram equivalents (MME)
  •   Patients that require an exit strategy from their current opioid regimen (including tapering)
  •   New patients on multiple controlled substances
  •   Challenging patients with pain and mental health/substance use comorbidities
  •   Patients with acute opioid overdose or toxicity
  •   Patients with acute opioid or benzodiazepine withdrawal
  •   Patients that require MAT (medication assisted treatment)
  •  Patients that require local referrals to behavioral health or substance use disorder treatment

 

Consistent with Poison Control protocols, these consultations will provide tailored, evidence-based (see Arizona Prescribing Guidelines 2018) real-time and follow-up services. 

 Call them today, overnight or tomorrow: 1-888-688-4222.

Additional Resources:

Arizona Opioid Prescribing Guidelines (2018)

Arizona Department of Health Services – Opioid Epidemic

Poison Control – Tucson

Poison Control – Phoenix

AHCCCS Treatment Resources Attached

Thank you,
Arizona Health Alert Network

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Mental Health: Vaping found to be safer than smoking

Posted By Adam Klawonn, PA-C, Tuesday, February 20, 2018

Electronic cigarette smokers had fewer chemicals and carcinogens in their systems than their traditional cigarette-smoking counterparts, according to a recent multinational study.

Researchers from several institutions, including University College London and US Centers for Disease Control, found that saliva, urine and breath samples from 181 current and former smokers had fewer traces of nitrosamines – a deadly component of inhaled nicotine – and volatile organic compounds if they were using e-cigarettes only versus their counterparts who used both cigarettes and vape products.

The limited study, which was published in Annals of Internal Medicine, is being hailed as a "landmark" study. A brief summary can be found on the US National Library of Medicine's website.

However, the study did not look at whether vaping can help traditional cigarette smokers quit smoking altogether. Researchers found that serum nicotine levels were roughly the same whether participants smoked or vaped.

That question is further complicated by recent news on the vaping products themselves. First, new research shows vaping can increasingly lure teenagers 

to take up smoking traditional cigarettes, and in fact, vaping among children in grades 8 through 12 is on the rise.

Secondly, there is no consistency in the amount of nicotine present in various vaping products, according to a recent study in Journal of Addiction Medicine. E-cigarette users often look at the doses of nicotine marketed on vape packaging to develop a weaning process to kick the habit completely. But researchers found that samples of e-cigarette products contained as much as 35 percent less or 52 percent more nicotine than marketed.

 

--Adam Klawonn, PA-C

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Mental Health: Mindfulness gains attention for stress, addiction

Posted By Adam Klawonn, PA-C, Thursday, February 15, 2018
Updated: Thursday, February 15, 2018

Brief periods of inwardly focused meditation can reduce one's systolic blood pressure by 20 percent and cortisol levels by up to 50 percent, according to a recent study from Carnegie Mellon.

Researchers at the Pittsburgh-based university found that 144 stressed-out adults who participated in 20-minute mindfulness exercises using a mobile app did best when they were trained to "monitor the present moment with acceptance" before being exposed to known stressful situations. The study, published in Psychoneuroendocrinology, was funded by yoga, meditation and psychology groups.

This follows numerous other studies revealing the beneficial uses of mindfulness, or "mindfulness cognitive behavioral therapy" (MCBT), for other mental heatlh issues, such as addiction, depression, impulsivity and ADHD.

Looking for a mindfulness app you can recommend to patients? Check out this lineup from Marie Claire, and note that last year the apps Headspace, Calm and Mindbody had the highest ratings from iPhone App Store users.

--Adam Klawonn, PA-C

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Mental Health: Tech insiders rebel over smartphones

Posted By Adam Klawonn, PA-C, Friday, February 9, 2018
Software engineers and investors who helped birth the world's most addicting technology are joining forces to break the hold these devices have on the developing brains of children and adolescents.

Specialists who once worked for or invested in Google and Apple are concerned portable devices like the iPhone, Android phones, and smart tablets are negatively impacting the focus and mood of children. In a story posted earlier this month in the New York Times, early Facebook investor Roger McNamee said, "This is an opportunity for me to correct a wrong."

A series of moves is expected to shed more light on mobile devices and the neurodevelopmental stages of children, whose neuronal connections experts say do not solidify until their early twenties. Anti-tech addiction interests are forming the Center for Humane Technology and launching a public advertising campaign worth at least $7 million dubbed "The Truth About Tech."

This follows the outcry from pediatricians and mental health experts in January, who called on Facebook to abandon its development for a messenging feature for children as young as 6 years old.

--Adam Klawonn, PA-C

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Flu slams Arizona this winter

Posted By Administration, Wednesday, January 10, 2018

Influenza affected roughly 10 times the number of Arizonans over the past year and the end of December versus the same periods in 2016, according to state health officials.

New data from the Arizona Department of Health Services shows Arizona registered 7,978 flu cases this year versus just 834 last year. During the final week of December, hospitals and clinics logged a whopping 2,453 cases versus just 282 cases during the same period in 2016.

Officials are advising all health care providers to practice good hand hygiene, cough or sneeze into one's forearm or elbow, and – perhaps the bane of hard-working physician assistants everywhere – burn up a sick day or two and stay home to avoid spreading the flu to co-workers and patients.

ADHS Director Dr. Cara Christ recommends fluids, rest and other-the-counter medications to help with symptoms.

Here is a full list of populations that are most vulnerable to the flu:

  • Children younger than 5 years old
  • Adults aged 65 and older
  • People with chronic disease, especially heart and lung disease
  • People with immunosuppression, including that caused by medications or by HIV infection
  • Women who are pregnant or postpartum (within 2 weeks after delivery)
  • People younger than 19 years who are receiving long-term aspirin therapy
  • American Indians/Alaska Natives
  • People with extreme obesity
  • Residents of nursing homes and other chronic-care facilities

Weekly RSV and flu reports from ADHS can be found here.

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