Filtered by category: The CALTCM WAVE 2019 Clear Filter

Beers 2019

by Vanessa Mandal, MD, MS, CMD

Adverse drug reactions are the 4th leading cause of death ahead of diabetes, pulmonary disease and accidents, with 350,000 events occurring annually in nursing home residents.(1) These events are potentially preventable up to 50 percent of the time and common serious manifestations include falls, orthostatic hypotension, heart failure, and delirium. The American Geriatric Society (AGS) updated Beers Criteria is a useful toolbox for physicians in addressing medication appropriateness, identifying potentially inappropriate medications and de-prescribing to reduce avoidable adverse drug events. AGS has assumed responsibility for the criteria in 2011 with updates on the 3 year cycle since 2012, with the most recent occurring in January 2019. The interdisciplinary expert panel was comprised of 13 clinicians – physicians, pharmacists and nurses, experts with experience in ambulatory care, home care, acute hospital care, skilled nursing facility and long-term care. The Panel reviewed 1,422 articles, and abstracted 377 into evidence tables.  The abstracted evidence included 29 controlled clinical trials, 281 observational studies and 67 systematic meta-analyses and/or reviews. The primary target is practicing clinicians and the criteria are intended for use in adults age 65 and older in ambulatory, acute and institutionalized settings. The overarching goal is to improve medication selection; educate clinicians and patients; reduce adverse drug events; serve as a tool for evaluating quality of care, cost and patterns of drug use of older adults. Five types of criteria from the 2015 updates were retained in the 2019 update.

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PDPM at CALTCM’s Summit for Excellence

by Michael Wasserman, MD, CMD

The Patient Driven Payment Model, or PDPM, will go into effect on October 1, 2019.  It is far and away the biggest change to hit post acute care since Prospective Payment in the 1990’s.  Anyone who was around then should recall that most of the publicly traded nursing home chains went into bankruptcy.  That could happen again!

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Remembering Dr. Wing Mar, CAMD, and CALTCM

by Frank Randolph, MD, CMD and Terry Hill, MD, CMD, FACP

Dr. Wing Mar invited me to join CAMD (California Association of Medical Directors, which was CALTCM’s former name) in 1985 when we met at a California Medical Association Long Term Care Committee meeting. Dr. Mar helped to establish CAMD in 1977.  For the sake of temporal context, the American Medical Directors Association (AMDA) was formed in 1976.

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NARCAN in the Post-Acute World

by Flora Bessey, Pharm.D., BCGP

As the world of post-acute care continues to evolve, and we are faced with a quickly evolving landscape of new challenges, perhaps an especially unexpected (and unwelcome) one is the increasing prevalence of opioid drug use (and abuse) in our residents. This issue is one is of keen interest in the non-LTC world, so it is no surprise that it has now become a point of contention for us.

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Update: California Dementia Partnership to Improve Dementia Care

by Timothy Gieseke, MD, CMD

On December 4th, 2018 our dementia partnership sponsored a webinar by Dr. Maureen Nash, a nationally recognized Gero-psychiatrist who presented the PowerPoint presentation (handout provided below) on “Helping those with Serious Mental Illness who now live in a LTC setting”. She advocated for use of best practices for persons with serious mental illness who require institutional care, most commonly because of their very high risk for cognitive impairment.  CMS’s campaign to improve dementia care by reduce antipsychotics at times may seem to compromise known best practice. She recommended following the American Psychiatric Association’s free best practice guidelines for treating: Major Depressive DO, Bipoloar DO, PTSD, OCD, Schizophrenia, and dementia persons with agitation and aggression. In these guidelines, recommendations for use of antipsychotics (many have FDA approval) represent best practice even though they may not be recognized in the excluded category by the CMS campaign.  

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Are you Prescribing Too much Insulin for Persons with Type 2 Diabetes?

by Timothy Gieseke, MD, CMD

In the October 4, 2018 issue of Diabetes Care, the ADA and EASD (European Association for the Study of Diabetes) published their consensus report for Management of Type 2 Diabetes, 2018.  Both organizations now favor the use of Incretin Receptor Agonists or SLG2 Inhibitors for persons with established macrovascular disease (or high risk for Cardiovascular Disease), for improving glycemic control, if metformin alone isn’t adequate or not appropriate.  

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2018 at a Glance

CALTCM Members and Friends,

As we greet 2019 with fresh ideas and educational programs, offering you the best one can offer in professional education and training for California’s post-acute and long-term care (PALTC) arena, I am proud to share with you our accomplishments in 2018.

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Poor Sleep and Inflamed Gums – What do they have in common?

by Jay Luxenberg, MD

Recently, both poor sleep and inflamed gums have been implicated in the pathophysiology of Alzheimer’s disease. But before we discuss that, I’d like to remind you of the free resource “Alzforum” – www.alzforum.org – where the latest papers and meeting presentations are presented along with active discussion by many of the leading researchers in the field. I do not know of any other field where such a central repository has been maintained over a long period of time. It’s common for colleagues, patients and even family members to ask me about “the latest breakthrough” that they hear about on the news or read about in the lay press. I find Alzforum the best place for me to get a balanced view of the research that triggered the news report.

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