Comprehensive Care of an Injured Worker

By Stephen T. Woods, M.D., BWC Chief Medical Officer

When any group of individuals comes together with one common purpose, they can achieve what others believe is not possible. I got to see such a group at our recent Medical & Health Symposium, held in conjunction with BWC’s annual Safety Congress and Expo. In this case it was hundreds of providers with a shared passion for taking care of Ohio’s injured workers. Those of us at BWC share that passion and are dedicated to providing world-class care and coverage from Portsmouth to Ashtabula.

The Medical & Health Symposium was an excellent opportunity for providers to learn the latest best practices for the comprehensive care of an injured worker.

I was pleased that more than 400 providers attended. Our system often deals with people who are in their most vulnerable state – emotionally, medically and financially – after work-related injuries. The providers in attendance represented a broad range of disciplines, but all had the unique skills and the passion to pursue a virtuous cycle of continued improvement on behalf of their patients.

Those of us who serve injured workers do so knowing that we are choosing to be their advocates and understanding the complexities of their conditions and of our system.

That commitment is something we’re really focusing on at BWC. That includes being committed to holistic, comprehensive care that is patient-centered, minimizes the burden of injuries and avoids preventable disabilities. That focus on the customer also means that we have to understand the diverse needs of our customers and operate in a way that lets us quickly adapt to both their unique needs and the rapidly changing world around us.

Specifically, in BWC’s Medical & Health Division, we are continuing to push efforts to reduce the amount of bureaucracy our providers endure so they can spend more time managing the overall needs of the injured worker. Pharmacy management, better-designed fee schedules and treatment guidelines, access to non-medication options, and health behavior assessments are all areas we are exploring to make sure injured workers are better able to return to work and return to life.

Of course, no amount of effort on our part will make a difference without the partnership of our providers and other stakeholders. So, thanks to all of you for your commitment in providing comprehensive care for Ohio’s injured workers. You are all part of our world-class team.

Coping with pain

‘Visualize your way out of it,’ psychologist tells work comp audience

By Tony Gottschlich, BWC Public Information Officer

There’s another way to deal with chronic pain that doesn’t involve medications or surgery, a psychologist told an audience Friday at the 2017 Ohio Workers’ Compensation Medical & Health Symposium.

It’s called Cognitive Behavioral Therapy, and it’s not as complicated as it sounds. In fact, the techniques are rather simple, said Michael Coupland, medical director for Integrated Medical Case Solutions in West Palm Beach, Florida.

Cognitive Behavioral Therapy (CBT) is a widely accepted form of psychotherapy that is based on the cognitive model: the way that individuals perceive a situation is more closely connected to their reaction than the situation itself.

Coupland explained that we can condition our brains to control pain or banish it from our consciousness. But it takes practice, a daily repetition of mantras, deep breathing techniques, meditation and other mindfulness methods for it to take root and stick.

Thanks to neuroplasticity, the brain can reorganize or rewire itself, both physically and functionally, throughout your life in response to your environment, behavior, thinking and emotions.

“Exercise your neurons, visualize your way out of this,” he said. “I tell my patients, ‘Whether you believe in this or not, just humor me and do this every day for eight weeks.’ These techniques help stand down the body’s stress-arousal system.”

Coupland admitted it’s tough for most patients to accept this approach. Mindfulness, a state of active, open awareness of the present moment, and meditation are about “letting go,” but the American educational system teaches us to “hold on” to everything we learn.

Coupland shared with the audience a book he authored in the style of Dr. Seuss that illustrates the simplicity and effectiveness of CBT. It’s titled, “Up Pain, Down Pain, Good Brain, Bad Brain,” and can be found for free here.

For more on Coupland and his work, visit www.icms.us or www.cope-with-pain.com.

‘Wired for addiction’

Addiction specialist addresses work comp health symposium

By Tony Gottschlich, BWC Public Information Officer

Many believe drug addicts are weak-willed people of diminished moral character who choose drugs, getting high and even criminal behavior over a proper, law-abiding life.

And they would be wrong, a longtime psychiatrist and addiction specialist said Friday morning at the 2017 Ohio Workers’ Compensation Medical & Health Symposium.

“Addiction is not about the drugs or the behavior, it’s all about the brain,” said Dr. Susan K. Blank, co-founder and chief medical officer for The Atlanta Healing Center, an outpatient treatment recovery program. “This is a genetically inherited brain disease.”

Blank, speaking to a capacity audience at the Greater Columbus Convention Center, spoke for an hour on the topic, “The Perfect Storm: Pathophysiology of Controlled Substance Misuse and Addiction.” Her presentation was the first continuing education session on the final day of the two-day symposium for health care professionals.

Blank explained there are three key forces behind addiction, and choice has little, if anything, to do with it. They include:

  • Genetics. Our brains are hardwired for addiction because of our genes. Some of us inherit malfunctioning “dopamine feedback loops.” When we experience pleasure, whether from food, drugs or sex, it’s because our brains are releasing the feel-good neurotransmitter dopamine. In addicts, that feedback mechanism doesn’t shut down and they just want more and more, regardless of the consequences. “It’s never enough,” Blank said. This is particularly hard to overcome if the addiction started in one’s youth. That’s because drug and alcohol abuse can damage the prefrontal cortex, our brain’s impulse-control center, which is still developing into our mid 20s.

Worried your children might be future addicts? Look for the thrill-seeking child who thrives on adrenaline, the child who’s the first to take a dare. These are behaviors that demonstrate he or she is seeking a dopamine release, Blank said.

  • Exposure. Growing up around addicts increases the likelihood of addiction.
  • Environment. There must be an environmental trigger or stressor – loss of a job or loved one, for instance – that keeps the addiction cycle going.

“You have to have all three legs of that stool for addiction to manifest itself in your life,” said Blank, who is also president of the Georgia Society of Addiction Medicine. Genes alone won’t doom you.

Addictions often start through prescription drugs, she said, and can’t stop without outside help. They lead to brain changes that can’t be undone. “Our rational brain is gone.”

Drug overdose is the leading cause of accidental death in the United States in recent years, fueled by powerful opioids, heroin especially. Ohio is the nation’s overdose death capital, with 3,050 OD deaths in 2015, or more than eight per day, according to state-by-state statistics compiled by the Henry J. Kaiser Family Foundation.

Blank noted that addictions aren’t limited to painkillers and street drugs, of course. People can be addicted to sugar, sex, tobacco and other dopamine triggers, too. It’s all about the dopamine. (Surprising fact to nonsmokers: “Nicotine is better than food, sex and morphine,” Blank said.)

Blank provided a number of sobering facts and statistics, including this one: “This is a chronic disease and there is no cure.”

But there is hope, she said. Addictions can be managed, and many addicts go on to live long, productive and healthy lives. Nationwide, opioid prescriptions are falling and there’s a growing awareness and understanding that addiction is a disease.

She concluded her remarks with a warning: “If you can’t escape addiction, choose yours carefully.”

The health symposium concluded Friday. It was held in conjunction with the 2017 Ohio Safety Congress & Expo, the Ohio Bureau of Workers’ Compensation’s annual safety, health and workers’ compensation conference.

Comprehensive care for injured workers, innovative employers highlight busy day 2 at #OSC17 and #BWCmhs, much more to come

Welcome back to the Columbus Convention Center, home of the Ohio Safety Congress & Expo and the Ohio Workers’ Compensation Medical & Health Symposium!

We have a lot in store before we bid farewell this afternoon but first, here’s a rundown of yesterday’s activities.

The second day of OSC17 was the first day of the Medical & Health Symposium. This is the second year of the symposium, which filled to capacity weeks ago. BWC sponsors this conference for health-care professionals who treat Ohio injured workers to hear from leading national and state experts. This year, our theme is “Comprehensive care for the injured worker.”

BWC Medical Director Dr. Stephen Woods welcomed participants and kicked off the event. The day featured several intriguing sessions on various topics related to the care of injured workers. One session covered how the aging workforce challenges the workers’ comp industry. Read a detailed blog on that topic here.

Over at OSC17, we got the day started with the Safety Innovation Awards. ICP Adhesives from the Akron area took first place, and Holloway, Henderson & Martin LLC of Pickerington snagged the People’s Choice Award.

All of the finalists were impressive!  Here’s the final list of award winners along with links to videos highlighting their innovations:

  • 1st place ($6,000 award): ICP Adhesives and Sealants, Norton (Video )
  • 2nd place ($4,000 award): C&K Industrial Services Inc., Cleveland (Video)
  • 3rd place ($3,000 award): Holloway, Henderson & Martin LLC, Pickerington (Video)
  • Honorable Mention ($1,500 award): Suburban Steel Supply Company, Gahanna (Video)
  • Honorable Mention ($1,500 award): Ames Arboreal Group, Columbus (Video)

And our very own Dr. Abe Tarawneh, superintendent of the BWC Division of Safety and Hygiene delivered a presentation on the role of safety leaders in building and executing strategic direction for occupational safety and health programs. Abe advised attendees that the mission of a safety leader is simple: elevate safety as a core value for the organization. If it is not a core value, make it one.

We’re not done yet! Our final day will feature more informative sessions at OSC and the symposium.

See OSC17 and symposium schedules here, in the event guide or on the mobile app. Follow @OhioBWC on Twitter and keep an eye on hashtags #OSC17 and
#BWCmhs for coverage.

Stay tuned for a wrap of the day as we bring the curtain down on another successful OSC17 and M&HS.

Aging workforce challenges work comp industry

By Tony Gottschlich, BWC Public Information Officer

Americans are living longer and they’re working longer, which presents a particular set of health care challenges for the injured worker, as well as economic challenges for the workers’ compensation industry, a longtime nurse and work comp veteran said Thursday morning at the 2017 Ohio Workers’ Compensation Medical & Health Symposium.

“Many of us don’t want to retire or we can’t retire, and that’s changing how we look at individuals in the workforce before they have an injury and how we manage their care after an injury,” said Kevin T. Glennon, vice president of clinical services for One Call Care Management in Jacksonville, Florida.

Glennon, speaking to a capacity audience at the Greater Columbus Convention Center, spoke for roughly 50 minutes on the topic, “Managing the Changing Needs of the Aging Injured Worker.” The session was one of 13 continuing education classes offered at the two-day symposium for health care professionals. The symposium continues Friday in conjunction with the 2017 Ohio Safety Congress & Expo, the Ohio Bureau of Workers’ Compensation annual safety, health and workers’ compensation conference.

Glennon pointed to U.S. Bureau of Labor Statistics indicating that older workers are less likely to get injured on the job, but when they do, it’s almost always worse than when a younger person is injured.

“When a 25-year-old worker falls on the job, she might get a bruise, but for a 75-year-old worker, it’s a broken hip,” he said.

While applauding people who want to work past the typical retirement age, Glennon noted the risks for doing so. Older workers typically have decreasing strength, endurance and reflexes, as well as diminished vision, hearing and mental acuity. And when injured, their recovery might be compromised by other existing health problems, such as diabetes, as well as medications that are contraindicated and an increasing susceptibility to infectious diseases.

The list goes on. All of which becomes even more complicated and costly if injured, aging workers have no family at home to help with their recovery.

Glennon told the audience to be proactive in managing work comp cases involving the elderly, even for cases where the worker was injured decades ago.

“I have one patient who is 80 who was injured at 22,” he said. “I’m a firm believer that when you have these older injuries, check up on these patients at least once a year.”

In any case involving the elderly, Glennon said to make sure the patient’s needs are being met, that they’re receiving proper vaccinations and routine medical checkups. Look for red flags —untreated wounds, recent ER visits — that could lead to a downward spiral of health problems. “And whatever we can do to keep the respiratory system healthy is money well spent,” he said.

Glennon added that technology, while expensive, can be more cost effective in the long run for the aging patient. Self-operated lifts to help the patient get out of bed, for example, or a wheelchair that helps a patient stand upright is likely cheaper than the costs of a home health aide over months and years.

As he wrapped up his presentation, Glennon said the aging workforce has caused employers to adjust their approach to risk management and workplace health and safety. Today the focus is on wellness and prevention — smoking cessation and weight management, for example — as well as modifying job tasks to better suit the worker.

Ohio prescription drug monitoring program showing positive outcomes

By Nick Trego, BWC Clinical Operations Manager

Established in 2006, the Ohio Automated RX Reporting System (OARRS) is Ohio’s state wide prescription drug monitoring program. OARRS collects information on all controlled substance prescriptions written by Ohio licensed prescribers and dispensed by pharmacies across the state.

The OARRS data base can be accessed by pharmacists, prescribers and law enforcement. Pharmacists use the database to review all controlled substance prescriptions being taken by a patient. OARRS allows the pharmacist to see the details of those prescriptions for an individual patient.

Prescribers access the database to ensure the appropriate treatment for patients and to assess compliance with prescribed medication regimens.

Law enforcement officials can review OARRS reports when legal issues emerge surrounding controlled substance use.

The OARRS database promotes the use of best practices when prescribing opioids, benzodiazepines and other medications that can have dangerous side effects if used inappropriately.

A recent report published by the Ohio Board of Pharmacy on opioid prescribing between 2012 and 2016 shows encouraging outcomes including:

  • 4% (162 million dose) decrease in the total number of opioids doses dispensed
  • 20% (2.5 million) decrease in number of opioid prescriptions
  • 5% (43 million) decrease in the total number of benzodiazepine doses dispensed
  • 2% decrease in the number of individuals who see multiple prescribers to obtain controlled substances illicitly (“doctor shopping”)
  • 11 million requests for OARRS reports in 2016

Ohio BWC statistics, likewise, show a decline in opioid prescribing over the same time period. During this period BWC has encouraged the use of best clinical practice guidelines and a state of the art closed formulary to provide medication management. Ohio BWC is the first state agency to establish a prior authorization (PA) process where clinical nursing staff reviews each medication request. The successes of the closed formulary, best practice guidelines and clinical nursing staff PA processes are listed below:

  • 5% decrease in opioid doses achieved by BWC
  • With less than 1% of the opioids receiving population in Ohio, BWC accounted for 9% of the reported decline in doses dispensed

These statistics leave no doubt that the OARRS database is having a positive influence on prescribing and dispensing controlled substances. Increased safety to patients in the state of Ohio and reducing the chances for opioid/benzodiazepine abuse and misuse are valuable benefits provided by OARRS.

Opioid education: the dangers of addiction and dependence

By Nick Trego, BWC Clinical Operations Manager

Opioid analgesics are potent pain relieving medications that can cause numerous side effects that range from itching to chronic constipation to hormone deficiencies.

The United States Drug Enforcement Administration (DEA) considers opioid analgesics to be dangerous drugs with a high potential for abuse and with use potentially leading to severe psychological or physical dependence.

Prior to initiating therapy with opioid analgesics, patient education surrounding the risks and benefits of these medications is essential to understanding and developing realistic expectations of treatment outcomes.

Due to the addictive nature of these medications, the Ohio BWC is also taking additional steps to prevent addiction, including collaborating with other organizations to develop fact sheets to help providers, employers and injured workers better understand the potential risks of excessive opioid use.

A few statistics show the importance of understanding the impact opioids are having in Ohio and across the United States:

  • Prescription opioids are associated with more fatal overdoses than any other prescription or illegal drug including cocaine and heroin.1
  • In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills.2
  • Unintentional drug overdose continued to be the leading cause of injury-related death in Ohio in 2015, ahead of motor vehicle traffic crashes – a trend which began in 2007.3
  • Unintentional drug overdoses caused the deaths of 3,050 Ohio residents in 2015, the highest number on record, compared to 2,531 in 2014. The number of overdose deaths increased 20.5 percent from 2014 to 2015, which is similar to the increase from 2013 to 2014.4

Increased understanding of the safety and risks associated with the use of opioids will benefit those seeking the best possible medical treatment without facing the consequences of dependence or addiction.

We invite you to review these new educational materials and share them with your colleagues, family and friends.

The fact sheets can be found on BWC’s website:

BWC’s medical director, Dr. Stephen Woods, addressed the importance of balancing short term pain management and the longer term risk of addiction in an earlier blog post

For more information, email Pharmacy.Benefits@bwc.state.oh.us.

 

1 Ohio’s Opiate Epidemic, Mental Health & Recovery Board – Erie and Ottawa Counties, Alcohol and Other Drugs (AOD) Committee

2 CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016

3, 4  2015 Ohio Drug Overdose Data: General Findings, Governor’s Cabinet Opioid Action Team