Worcester Business Journal

wbjournal.com | November 26, 2018 | Worcester Business Journal 13 H E A L T H C A R E F O C U S Each client's situa on is different and results may vary from those presented here CLIENT: METAL MANUFACTURER This employer froze its pension plan and wanted to con nue providing excep onal employee benefits, so it simultaneously increased its 401(k) match. Knowing this decision could upset some long-term employees, the plan sponsor turned to H&H for assistance. Get the full story at hhconsultants.com/success Put our knowledgeable professionals to work for your business. We offer a full range of comprehensive actuarial, investment advisory and re rement plan consul ng services designed to iden fy, achieve and exceed each client's specific need. RETIREMENT EDUCATION TO FORGE AHEAD W ened when major hurricanes struck drug production facilities on Puerto Rico highlights the need to evaluate and plan for hazards that pose a threat to critical infrastructure for manufacturing pharmaceutical and medical products," AMA board member William Kobler said in the association's announcement in June. Despite concern about opioid ad- diction, they remain the most effective way to treat significant pain, especially compared to painkillers obtained over the counter. Injectable opioids begin working more quickly than opioids taken orally. A national shortage e shortage has been widespread, hitting hospitals across the country. In April, the American Society of Health-System Pharmacists surveyed more than 300 hospital pharmacists and found 98 percent had been affected by shortages of morphine, hydromorphone and fentanyl. In three out of four cases, doctors instead gave patients oral opioid medications, which can take longer to begin working effectively, or in nearly half of cases, they instead gave patients non-opioid injectable medications. Just over half of pharmacists in the survey said they prioritized patients based on clinical need because of the shortage. ree out of four respon- dents reported increased costs due to switching medications to something like intravenous acetaminophen or intrave- nous ibuprofen. Managing a shortage & an addiction crisis At the same time, doctors are pre- scribing opioids less oen, a result at least in part of an effort to curb rising opioid abuse cases. In 2012, doctors prescribed 81 opioids per 100 patients, according to the Cen- ters for Disease Control and Prevention. By 2017, that rate had fallen to 59 out of 100 patients. Still, that rate is three times higher than it was in 1999. Neil Gilchrist, the manager of phar- macy operations at UMass Memorial, said there's at least a slight correlation between the opioid abuse crisis and a lower production of prescription opi- oids, as health officials call for reducing how oen doctors turn to opioids to manage pain. Milford Regional Medical Center is similarly trying to move away from opioids when it can, said Susan Otocki, the hospital's pharmacy director. "We're doing that on purpose to avoid the use of opioids, not because of the shortage but because it's better for the patient," Otocki said. Overdose deaths involving prescrip- tion opioids were five times higher in 2016 than in 1999, according to a study published in March in the American Journal of Public Health. While the state Department of Public Health doesn't break out prescription opioid overdoses, more than 1,500 total fatal opioid over- doses this year were recorded through the end of September. ose figures are consistent with opi- oid death totals in recent years, leaving the public health issue as a major source of fatalities despite so much attention to the issue in Massachusetts. Not every hospital is still feeling the pinch as much. Heywood Hospital in Gardner experienced a shortage from the summer of 2017 through early 2018, said Martin Goldberg, Heywood's direc- tor of pharmacy. "However, the crisis level started to abate in March/April of this year," Goldberg said, "and while there are still some pockets of shortages, the supply that we have now is sufficient to meet our patients' needs." Avoiding dire problems Central Massachusetts hospitals are responding to the broader drug shortage by planning well in advance. At MetroWest Medical Center, the staff has been turning, when it can, to non-opioids like ibuprofen or topical creams, or using opioids in pill form in- stead of through injections. e supply has gotten better since the beginning of the year, said Daisy Burroughs, the hospital's public relations manager. At Milford Regional Medical Center, drug inventory issues are mentioned in each shi's unit meeting, Otocki said. Common drug shortages like IV fluids are broadcast to the whole medical staff by email, and specific departments are alerted to shortages in drugs they're more likely to use. "It's a chronic problem," Otocki said. "You kind of almost have to take it day-by-day because you're not sure what you're going to be able to obtain." Like other hospitals, Milford works to find other drugs to fit a patient, such as oral opioids instead of injectable ones, or Tylenol, Motrin or Advil when the pain isn't too severe. In certain cases, opioids will be used occasionally to supplement those more common drugs instead of being taken, say, every six or eight hours. In most cases with patients, Bercume Roland Bercume, senior director of pharmacy at UMass Memorial Medical Center, manages the opioid shortage. said, UMass can find an alternative medication as effective as what might initially be prescribed. e hospital issues a notice to providers each week to update them on which supplies are running low so they can give medica- tions accordingly. "Talking to other organizations, we're all managing on a week-to-week basis," Bercume said. "It gets pretty dire at some points." The shortage's impact The American Society of Health-System Pharmacists surveyed more than 300 members in April to gauge how they've been affected by injectable opioid shortages. Among its findings: 98% Said their hospital has been affected by the injectable opioid shortage 82% Have had to buy vial sizes or concentrations they don't normally stock 74% Converted patients to oral opioid medications instead 73% Reported increased costs associated with other therapies, such as intravenous acetamenophen 68% Said the shortage has been severe 56% Implemented restriction protocols on injectable opioids 48% Converted patients to non-opioid injectable medications Source: American Society of Health-System Pharmacists

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