This session of CareOregon Pharmacy’s MEDS Ed program focuses on the intersection between psychological trauma and substance use disorders. Lydia Bartholow (DNP, PMHNP, CARN-AP) lays out the scope of the issues, highlights the most effective and lasting forms of engagement and treatment, and provides and in-depth review of the importance of trauma-informed care and patient-centered systems when engaging people experiencing substance use disorders.

Recorded on December 13, 2019 at CareOregon (Portland, Oregon).

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Key session takeaways (click the link to view a clip):

• Long-term consequences of cortisol end up becoming the biggest chronic conditions that impact our life expectancy. Part 2 - 25:50
• Much of what we know about the connection between trauma and substance use disorders is based on the ACEs study. Part 3 - 6:07
• A central nervous system that has experienced trauma will look for outside sources to soothe. Part 3 - 13:55
• The brain that has experienced trauma has lower dopamine levels, looking for things to engage with that help overcome perceived threats to survival. Part 3 - 19:07
• Physiological withdrawal symptoms can mirror the neuro-hormonal landscape of revisiting a traumatic experience. Part 3 - 37:41
• Key elements of trauma-informed care are promoting safety and control. Part 4 - 00:28

This session of CareOregon Pharmacy’s MEDS Ed program touches on the positive impact that focusing on goals of care can make on patient outcomes, successful strategies for deprescribing pill burdens and potentially inappropriate medications, and how leveraging the model of care shared by Housecall Providers and CareOregon can improve health outcomes and increase patient well-being, while reducing health care costs.

Recorded on November 21, 2019 at CareOregon (Portland, Oregon).

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Key session takeaways (click the link to view a clip):

• Palliative care patients are typically younger, in their 50s or 60s. In Oregon, if you have serious persistent mental illness, or if you’re experiencing homelessness, you die 20 years earlier than someone who doesn’t. Part 1 - 10:55
• Without relationships and security to help process trauma, people are left fragmented and held captive. Trusting relationships are the foundation of palliative work and most important therapeutic intervention. Part 1 - 15:53
• Focusing on positive aspects of a person’s past experiences and not just their past trauma can help strengthen engagement around goals of care. Part 2 - 24:30
• Pharmacist Leah Goeres shares her preferred method for deprescribing. Part 3 - 25:26
• Why is deprescribing so difficult? Part 3 - 33:05
• A guided tour of CareOregon’s Regional Care Teams structure. Part 4 - 24:50

This session of CareOregon Pharmacy’s MEDS Ed program focuses on clarifying sleep disorder screening and diagnosis, how to help patients through the challenges of CPAP usage and adherence and which medications pose greater risk for obstructive sleep apnea patients.

Recorded on July 26, 2019 at CareOregon (Portland, Oregon).

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Key session takeaways (click the link to view a clip):

• Prevalence is huge: 12% of the CareOregon population is impacted by sleep apnea. Part 1 - 11:40-12:15
• OSA treatment with CPAP has a major beneficial impact on comorbidities, quality of life and health outcomes, but to do so requires regular use (minimum four hours per night). Part 1 - 12:12-14:19 
• It can be very difficult for patients to adjust to using and maintaining sleep equipment (e.g., CPAP). Strong patient support exists. Without that support, patients are likely to closet their machines and give up. Part 2 - 33:58-35:23
• Drowsy driving is a significant public health concern — 4% of drivers are drowsy behind the wheel every day. 36% admit to falling asleep behind the wheel of a moving vehicle. Part 3 - 26:13 – 29:25
• Due to the significant numbers of people affected, specialists need to collaborate with primary care clinical champions on DME support to better address this epidemic together. Part 2 - 47:35 - 48:48

This session of CareOregon Pharmacy’s MEDS Ed program focuses on new simplified medication guidelines for treatment of COPD, effective demonstration of inhalers and DME supplies and insight into the role of the specialist and pulmonology referral in coordinating treatment.

Recorded on March 1, 2019 at CareOregon (Portland, Oregon).

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Key session takeaways:

• CareOregon has a new COPD treatment pathway that simplifies effective treatment based on the GOLD guidelines and covered formulary agents.
• Smoking cessation is an important component of long-term strategies for COPD. Use your teams, including behavioral health clinicians, to help with this (using trauma-informed approaches).
• Inhaler technique needs to be assessed regularly. Watch the video for inhaler demos and links to education videos to share with patients.
• Pulmonary rehabilitation programs are a covered non-pharmacological benefit that are effective in patients with COPD.
• There is a template to help guide when to refer a patient to a pulmonology specialist. Also, please contact our metro primary care innovation team if you are interested in help with implementation of templated referral workflows within your EMR and primary care teams.

This session of CareOregon Pharmacy’s MEDS Ed program focuses on the science and use of medications as best practice for the treatment of opioid and alcohol use disorders, distinguishing the barriers and myths about recovery treatment from evidence and effective treatment, Understanding the guidelines for effectively navigating high-risk patient referrals with a special focus on coordination between behavioral health and primary care and planning next steps to support further implementation and improved access of MAT in our network.

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Featured speakers:

• Paul Lewis, MD, MPH: Multnomah County Health Officer
• Andrew Mendenhall, MD, DABAM, DABFM: Senior Medical Director, Substance Use Disorder Services, Central City Concern
• Alison Noice, MA, CADC III: Deputy Director, CODA
• Amy Jo Cook: Community Paramedic, Clackamas Fire District #1
• Dan Hall: Community Paramedic, AMR
• Anthony Cheng, MD: OHSU South Waterfront
• Stacie Andoniadis: Primary Care Innovations Specialist, CareOregon
• Tanya Kapka, MD, MPH: Metro Medical Director, Network and Clinical Support, CareOregon

This session of CareOregon Pharmacy’s MEDS Ed program features interactive discussions on diagnosis, assessment and management of chronic liver disease from the physician and nurse perspectives, as well as a review of medications used to treat hepatitis C and manage complications of cirrhosis.

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Featured speakers:

• Atif Zaman, MD, MPH: Professor of Medicine, Oregon Health & Science University
• Karista Peabody RN, BS CMSRN: Hepatology Patient Care Coordinator, OHSU Hepatology
• Maddie Fry, PharmD: Post-graduate year 2 Pharmacist Resident, CareOregon

This session of CareOregon Pharmacy’s MEDS Ed program focuses on empowering learners with tools to apply in clinical environments to improve the experience of transgender patients and medical management of gender transition.

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Featured speakers:

• Amy Penkin, LCSW: Program Supervisor, OHSU Transgender Health Program (she/her)
• Jess Guerriero, MSW, MA: Social Worker, OHSU Transgender Health Program (they/them)
• Christina Milano, MD: OHSU Clinical Associate Professor of Family Medicine and cofounder of the OHSU Transgender Health Program (she/her)

This session of CareOregon Pharmacy’s MEDS Ed program focuses on recent discoveries and lessons learned across transitional care environments, including hospital discharge, skilled nursing and Meds-to-Beds.

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Featured speakers:

• Jane Duck, RN, BSN: High Risk Populations Program Manager, CareOregon
• Mariah Alford, PharmD, BCPS: Pharmacy Clinical Supervisor, CareOregon 
• Mai Tran, PharmD, BCACP, BCGP: CareOregon
• Anthony Neises, PharmD: Legacy Health
• Nate Semm, CSWA: Legacy Health
• Elizabeth Decker: RN Case Manager, Legacy Health
• Carlo De Gregorio: Health Assistant, Pioneers Care Team, Central City Concern
• Meryl Manley, RN, PCCN: Post-Acute Care Manager, Prestige Care
• Elizabeth Whitworth, MPH: PreManage Project Manager, CareOregon

This session of CareOregon Pharmacy’s MEDS Ed program on pain management for health care professionals goes beyond pharmacological guidelines to examine the neurophysiology and language of pain as well as trauma-informed perspectives on challenging patient conversations.

Content from Pharmacy Resident Cassandra Miller from CareOregon explains current trends in opioid utilization, benefit criteria and non-opioid alternatives.

Content from Nora Stern, from the Providence Persistent Pain Project, focuses on the relationship between pain and trauma, how pain changes the nervous system and how education can act as a treatment intervention.

Content from Lydia Anne M Bartholow, from Central City Concern’s Old Town Clinic, reviews trauma-informed care, care plans, patient and provider challenges when discussing pain, as well as techniques to improve these difficult conversations.

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Featured speakers:

• Lydia Anne M Bartholow, DNP, PMHNP, CARN-AP: Old Town Clinic, Central City Concern
• Nora Stern, MSPT: Providence Persistent Pain Project
• Cassandra Miller, PharmD, MS PGY-1: Managed Care Pharmacy Resident, CareOregon

This session of CareOregon Pharmacy’s MEDS Ed program for health care professionals focuses on treating hypertension, providing a multidisciplinary approach to effectively treating this complex disease state.

Content from Jose Rueda, from OHSU's Comprehensive Hypertension Center, reviews hypertension treatment trials and evidence-based guidelines, as well as causes of secondary hypertension.

Content from Pharmacist Christopher Blem, from Legacy Health Systems, focuses on medications and how they work, as well as ways to improve adherence.

Content from Dietician Julia Hanfling, from 3 Peaches Nutrition and Diabetes Coaching, explores who is at risk for hypertension, the role of sodium in high blood pressure, three main dietary recommendations and the importance of lifestyle factors.

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Featured speakers:

• Jose Rueda, MD: Director Comprehensive Hypertension Clinic, Division of Nephrology and Hypertension, OHSU
• Chris Blem, PharmD, BCACP: Legacy Medical Group, Emanuel
• Julia Hanfling, RD, CDE: 3 Peaches Nutrition and Diabetes Coaching

This session of CareOregon Pharmacy’s MEDS Ed program for health care professionals introduces the new diabetes treatment pathway, a more effective approach to diabetes management created in partnership with area diabetes experts.

Content from Dr. Andrew Ahmann focuses on advancing therapy in Type 2 Diabetes to reduce A1C and improve complications. Use of GLP-1 agonists is featured in this segment.

Content from Dr. Leonard Bertheau examines managing complicated patient cases using new, impactful guidelines for this challenging disease state.

Content from Pharmacy Resident Sierra Fung dives into practical tips for navigating diabetic supplies and prescription coverage.

Recorded on September 20, 2017 at CareOregon (Portland, Oregon).

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Featured speakers:

• Andrew Ahmann, MD: Director of OHSU's Harold Schnitzer Diabetes Health Center
• Leonard Bertheau, DO: Diabetes and Endocrine Center, Adventist Health
• Sierra Fung, PharmD: Pharmacy Managed Care Resident, CareOregon

This session of CareOregon Pharmacy’s MEDS Ed program for health care professionals focuses on heart failure, a disease of epidemic proportions. Approximately 5.7 million Americans are currently living with heart failure, with approximately one million hospitalized each year.

Content from Jayne Mitchell include types of heart failure, signs and symptoms, self-care and disease progression.

Recorded on April 20, 2017 at CareOregon (Portland, Oregon).

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Featured speakers:

• Jayne Mitchell, ANP-BC, CHFN: OHSU Heart Failure Program
• Pamela Chukwuleta, PharmD: Pharmacy Resident, CareOregon
• Kelly Hayes, AIC RN: CareOregon
• Laura Macias, RN-CHPN: Clinical Manager OPPC, Adventist Health Homecare Services

An interprofessional speaker panel — CareOregon Training and Development Specialist Paul Carson and Adventist Health Nurse Care Manager Erin Lemon lead an interactive workshop on the fundamentals of motivational interviewing (MI). Attendees learned how to effectively incorporate MI techniques into a nurse’s busy workflow, while gaining an understanding of MI’s effectiveness in eliciting behavior change and improving communication with patients who experience a background of trauma.

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Featured speakers:

• Paul Carson, BA: Training and Development Specialist, CareOregon
• Erin Lemon, BSN, RN, CCDS: Adventist Health

Clinicians discuss treating chronic pain and ways to talk with patients about their pain management regimens. They describe how to screen, recognize and triage high-risk symptoms associated with pain medications.

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Featured speakers:

• Dr. Rachel Solotaroff: Medical Director, Central City Concern Chair, CareOregon Metro Chronic Pain/Chemical Dependency Task Force
• Tara Berkson, PharmD: MEDS Ed Coordinator, CareOregon
• Nadejda Razi-Robertson, LCSW: Behavioral Health Consultant

Psychiatrist John K. Bischof, MD, discusses the disease and therapy options for patients coping with depression. We get the patient perspective from David Lee Greenlee, and Bridget Bradley from Pacific University School of Pharmacy gives a medication review.

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Featured speakers:

• John K. Bischof, MD: Psychiatric Medical Director, Old Town Recovery Center, Central City Concern
• David Lee Greenlee
• Bridget Bradley, PharmD, BCPP: Pacific University School of Pharmacy, Virginia Garcia Memorial Health Center

An interprofessional speaker panel — Adventist Health Diabetologist Dr. Leonard Bertheau and Tara Berkson, PharmD lead interactive discussions on navigating the latest best practices when caring for complex and high-risk patients with diabetes. Certified Diabetes Educator and RN Cheryl Ortner shares her insights on educating patients about lifestyle modifications and medication use.

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Featured speakers:

• Leonard Bertheau, DO: Diabetes and Endocrine Center, Adventist Health
• Tara Berkson, PharmD: MEDS Ed Coordinator, CareOregon
• Cheryl Ortner, RN, MSN, CDE: Diabetes and Endocrine Center, Adventist Health

This session of CareOregon Pharmacy’s MEDS Ed program focuses on managing children’s complex health conditions, including the impact of parental trauma, behavioral health integration, high-risk medications, improving family engagement and follow-through, and population data highlighting high-risk children.
Recorded on May 21st as a remote web-cast in Portland, OR.

Key session takeaways (click the link to view a clip):

• Parental Trauma can have an impact on a child’s developmental delays and social-emotional risk. Part 1 – 2:38
• Parents have new brain growth in the first six months after their child’s birth…UNLESS they are experiencing stress, which impairs frontal cortex development. Part 1 – 9:33
• A child whose parent has a high ACE score will have increased odds for behavioral and emotional problems. Part 1 – 22:45
• Positive relationships with providers help build resilience. Part 1 – 31:50

• Providers only see a small glimpse of the greater social complexity that creates barriers to engagement.  Part 2 – 12:40
• The context of social determinants of health, inequities, and bad experiences with the healthcare system must be kept in mind when engaging with families, along with the perceptions and assumptions we have as providers. Part 2 – 55:52
• The top questions to ask to help improve family follow-through and engagement.  Part 2 – 1:04:35

• Patients and families often feel more comfortable and trusting of primary care providers, which can help reduce stigma. Part 3 – 2:00
• Which disorders cause PCPs to contact child psychiatric resources? Part 3 – 7:00
• What are the criteria for improving clinical practice? Part 3 – 27:45