Wyoming Care Coordination Network Mountain-Pacific Quality Health December 13, 2018
Who’s in the Room? 2
Get to Know Each Other • Which organization are you representing? • How many Americans over 65 suffer from depression? a) 1 million b) 3 million c) 6 million d) 7 million 3
Mountain-Pacific Chronic Care Management (CCM) Support Provide care Engage patients and coordinators with empower them for long- targeted educational term continued program tools and resources to participation distribute to patients • Focus on 20-minute monthly interventions 4
Mountain-Pacific CCM Support • Disease-specific information Vaccines Nutrition Safety • Medication safety tools Medication disposal Medication bags Pill planners Adherence and health literacy • Plus MORE, visit our website frequently for new tools and resources 5
Calendar of Events • October 11: Kickoff! Polypharmacy and medication adherence Community resource discussion: patient safety in harsh weather • November 15: Nutrition The right diet for your health Community resource discussion: How to find fruits and vegetables in the winter • December 13: Stress and Loneliness in Winter Combating seasonal affective disorder and social isolation Community resource discussion: Community events to connect and socialize • January 10: Revisiting the Care Plan Incorporating patient goals and priorities in wellness Community resource discussion: How to keep moving in the winter 6
Mountain-Pacific CCM Support What you can expect: • Monthly newsletter Timely tools and resources • Monthly education event • Community resource review • Case studies and troubleshooting • Resources from Mountain-Pacific 7
Mountain-Pacific CCM Support What we are asking in return: • Participate in live events Encourage group learning • Complete brief surveys following learning events • Complete evaluations sent with tools and resources • Share your knowledge and experiences • Help guide our discussions and content 8
Medication Minute Traveling and Medication What you need to know…. 9
What Do I Need to Bring With Me? • Prescription medicines you usually • Over-the-counter medicines take Antidiarrheal medication Including medications you just need Antihistamine and/or Decongestant sometimes, like rescue inhalers or Anti-motion sickness medication allergy medications Medicine for pain or fever (such as • Special prescriptions for the trip acetaminophen, aspirin, or Antibiotic prescribed by your doctor ibuprofen) Mild laxative for self-treatment of moderate to severe diarrhea Cough suppressant/expectorant Medication to prevent altitude Cough drops sickness Antacid Nausea medication Antifungal and antibacterial ointments or creams 1% hydrocortisone cream
Where and How Should My Medication Travel? • Put your medicines in your • If your travel plans take you carry-on luggage across one or more time zones, Bring enough medicine to last you may need to change the time you take your medications your whole trip, plus a little extra in case of delays each day during your trip. Talk Carry all of your medication — with your doctor and create a even vitamins and supplements dosage schedule. — in their original containers or packaging in a clear plastic bag in carry on luggage ▪ Ensure all prescription medications are clearly labeled with your full name, doctor’s name, medication name, and dosage
TSA Medication Travel Tips • You don’t need to to notify an officer about any medication you are traveling with unless it is in liquid form. • Liquid medication more than 3.4 ounces is allowed in carry-on bags. You are not required to place medically required liquids in a zip-top bag. However, you must tell the officer that you have medically necessary liquids at the start of the security screening. Medically required liquids could receive additional screening that could include being asked to open the container. • You can bring your medication in pill or solid form in unlimited amounts as long as it is screened. • You can travel with your medication in both carry-on and checked baggage. You should place keep your medication in your carry-on in case you need to access them immediately. • TSA does not require passengers to have medications in prescription bottles, but states have individual laws regarding the labeling of prescription medication. • Medication is usually screened by X-ray; however, if you do not want a medication X-rayed, you can request an inspection instead. • Nitroglycerin tablets and spray (used to treat episodes of angina in people who have coronary artery disease) are permitted and have never been prohibited. TSA Travel Tips – Traveling with Medication. September 5, 2014. Available from: https://www.tsa.gov/blog/2014/09/05/tsa-travel-tips-traveling-medication
What About Traveling Abroad? • Pack a note on letterhead • Check with the country you stationery from the are traveling to, to insure all prescribing doctor medications are legal in that (preferably translated into country and that you meet the language understood at local requirements for your destination) including: labeling All prescribed medications, information on their active ingredients and the purpose of the medication Controlled substances, such as marijuana, and injectable medicines, such as EpiPens and insulin.
Combatting Seasonal Affective Disorder and Social Isolation 14
What is Seasonal Affective Disorder (SAD)? • A type of depression • A mood disorder subset in which people who have normal mental health throughout most of the year exhibit depressive symptoms at the same time of each year, most commonly in the winter. • Full Remittance during other seasons • 2 Years of continuing pattern 15
Who it affects • 4-6 % of people in the United States • More common the farther from the equator • Onset is typically in 20 – 30 years of age • More common in females 16
Causes • Circadian Rhythm – body’s natural 24 hour clock • Serotonin - a compound present in blood platelets and serum that constricts the blood vessels and acts as a neurotransmitter. • Melatonin levels - a hormone secreted by the pineal gland that inhibits melanin formation and is thought to be concerned with regulating the reproductive cycle. 17
Risk factors Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression. Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions. Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months. Sex. Females are more likely than males to suffer from SAD. 18
Signs and symptoms of SAD • Feeling depressed most of the day, nearly every day • Losing interest in activities you once enjoyed • Having low energy • Having problems with sleeping • Experiencing changes in your appetite or weight • Feeling sluggish or agitated • Having difficulty concentrating • Feeling hopeless, worthless or guilty • Having frequent thoughts of death or suicide 19
Diagnosis • Physical exam • Lab tests • Psychological evaluation • DSM-5 criteria (F33.9) 20
Treatment • Light Therapy • Cognitive Behavior Therapy • Medications • Increase Melatonin • Increase Serotonin • General Health • Diet, Exercise, Regular Sleep, Social 21
National Suicide Rate 22
WY 2007-2016 Ten Year Age-Adjusted Suicide Rate 35 30 25 20 15 10 5 0 STATE Big Horn Campbell Crook Fremont Hot Springs Natrona Niobrara Park Sweetwater Washakie 23
WY 2016 Suicides by Means 100 87 90 80 70 60 50 40 28 30 21 20 10 7 0 Poisioning Hanging Firearm Other 24
Risk Factors for Suicide • Female • Living Alone • Widowed • Poor Social Support • Poor Health • Stressful Life Events 25
Let’s have a critical conversation • Patients may not be forthcoming with information • Older patients tend to complain less about being “sad” • Males are less likely to self-report depression 26
So, what can you do? • Approach with openness and frankness •Ask “Have things become so bad that you consider hurting yourself?” •Ask “Have you ever felt life is not worth living?” • Ask about plans, means and methods 27
Resources • Depression Zone Tool Https://www.mpqhf.org/QIO/wp- content/uploads/2018/11/Depression-for-Zone-Tool-508.pdf • S:\Wyoming\CCM Project\2018-12-13 Wyoming Care Coordination Network\Things to do to wave off holiday blues.docx 28
• SAMHSA’s National Helpline: https://findtreatment.samhsa.gov, 1-800-662-HELP (4357) 1-800-487-4889 (TTY) • NAMI (National Alliance on Mental Illness) • www.nami.org: 800-950-6264 • IN A CRISIS? TEXT NAMI TO 741741 • National Suicide Prevention Helpline: 1-800-273-8255 (TALK), https://suicidepreventionlifeline.org • Wyoming Behavioral Health Division: 1-800-535-4006 • Wyoming Mental Health Ombudsman: 1-888-857-1942 29
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