An Innovative Collaboration at CALTCM’s 2018 Fall Meeting

by Deborah Wolff-Baker MSN, ACHPN, FNP-BC, GS-C

The November 3rd CALTCM Fall Meeting, Reducing Readmissions Through Better Transitions,  was held at the Betty Irene Moore School of Nursing at UC Davis. This was a unique day in CALTCM history, highlighting not only ways to reduce readmissions through better transitions, but a blooming partnership between CALTCM and the Northern California Chapter of the Gerontological Advanced Practice Nurses Association (NCCGAPNA).

The day began with a keynote talk by Dr. Terry Hill on the hidden burdens of community long-term care provided by family caregivers.  The rest of the morning was packed full of information to educate and inform attendees about issues associated with community discharges and transitions of care with an emphasis on upstream thinking to prevent avoidable hospital readmissions. This information was presented in symposium style with 5 expert Nurse Practitioner members of NCCGAPNA speaking from the perspective of home-based palliative and primary care providers who provide medical care to patients discharged from Skilled Facilities into the community.

Appeals Court Affirms EOLOA Remains in Effect

by Karl Steinberg, MD, CMD, HMDC

On November 27, a California Court of Appeals basically upheld the End of Life Option Act, which had been ruled invalid by a Riverside trial court judge.  The original lawsuit, Ahn v. Hestrin, alleged that the law was not passed through proper channels, and the judge agreed. The law, which allows medical aid in dying for terminally ill patients, was briefly invalidated in May 2018 before this Appeals Court stayed the ruling.  Now, after deliberation, the Court has determined that the original lawsuit was invalid because the plaintiffs lacked standing to bring a lawsuit, since they did not actually have a stake in whether the law existed or not. Since participation is completely voluntary for both patients and physicians, it was felt that they simply did not have any basis to oppose the law.  The dissenting judge went even farther, opining that the original law was passed by appropriate means and there was no basis for the original lawsuit at all.

A Review: Unhealthy Alcohol Use in Primary Care - The Elephant in the Examination Room

by Dan Osterweil, MD, FACP, CMD

Unhealthy Alcohol Use in Primary Care—The Elephant in the Examination Room, by Jennifer Edelman, MD, MHS; Jeanette M. Tetrault, MD, raises the important distinction between alcohol use disorder and unhealthy drinking associated with health status. CALTCM has been on the vanguard of this notion, collaborating with researchers from UCLA and Harvard, offering a CME program aimed at educating primary care physicians in identifying elders at risk for alcohol-related/associated health problems. The program is interactive and a fun way to learn about the subject. It focuses on knowledge and skills required in the primary care office to identify individuals who should be screened and counseled versus those who should be referred to addiction specialists or  psychiatrists.

Call for Posters for Annual CALTCM Meeting!

I have found one of the most educational and enjoyable aspects of our annual meeting to be taking in the individual research projects that are completed and presented in “poster” form during our annual meeting. The presenters in the past have been very diverse: from distinguished academic researchers to medical students; from DONs to CNAs; from PharmDs to pharmacy students.

How does one go about creating and presenting a poster at our meeting? Since I really wanted to become further involved with this process, I asked for and received a “mentor”; someone who has much experience in this realm, and can help “walk me through” the particulars.

I would encourage anyone who has any interest in sharing a “best practice” or a research project to reach out to the CALTCM board; we will be delighted to set you up with a mentor to help you go about presenting it!

It is only through sharing of our clinical knowledge and experience that we can continue to improve the quality of care for our residents!

Click here to learn about the Poster Session guidelines and abstract needs. 

The “Death Certificate Project”

by Flora Y. Bessey, Pharm.D., BCGP

As many members may recall, since 2013 the Medical Board of California (MBC) and the California Department of Public Health have been working with various state legislature subcommittees to try and address the issue of opioid “overprescribing.” One initiative of this project is now known as the “Death Certificate Project.” 

This Project is a good faith effort to address the crisis of accidental deaths due to prescription opioid overdoses. To very briefly recap: the MBC has obtained data from the CDPH for 2012 and 2013 related to opioid prescriptions. These data used codes that the CDPH uses to identify underlying AND “contributing” causes of death in order to identify opioid-“related” deaths. The MBC began to examine these data in 2015, cross-referencing them with the California Controlled Substance Utilization Review and Evaluation System (CURES) database to determine who was prescribing to these individuals, and also looked at the prescribing habits of the attending physician, or the physician who certified death. These data were then sent to “experts” to evaluate whether there might have been inappropriate prescribing.

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