Changing Trends to Improve Life Chances
SafeRx Santa Cruz County
During July’s HIP Council meeting, Bill Morris, MD from Janus of Santa Cruz and Palo Alto Medical Foundation and Jen Hastings, MD, physician consultant at HIP presented on SafeRx Santa Cruz County, our local opioid safety coalition. SafeRx is a broad-sector coalition that relies on partners in social services, government, and healthcare working together to influence change and accelerate existing efforts to promote opioid safety. The coalition is divided into three work groups, who are managed and supported by the Steering Committee. The Change Package Development work group focuses on supporting safe prescribing practices, expanding access to Medication Assisted Treatment, and increasing access to Naloxone, an emergency treatment for opioid overdose. The Metrics work group develops a community dashboard with accurate, relevant, and easily tracked data. Lastly, the Community Engagement and Education work group focuses on developing and publicizing patient and community education messaging around prescription medication.
Compared to state averages, Santa Cruz County has consistently high rates of prescription opioid deaths, non-fatal opioid-related emergency department visits, opioid prescriptions, yearly opioid dosage per resident, residents on high opioid doses, and residents on opioids for long periods of time. From 2010-2013 Santa Cruz County had an average of 12.72 deaths from prescription opioids per 100,000 residents—the highest among all Bay Area counties. Santa Cruz County has dangerous opioid prescription numbers; enough opioids are prescribed for every man, woman, and child to medicate themselves around the clock for 6 weeks of each year in Santa Cruz County. In 2015, this equated to 720.4 opioid prescriptions per 1,000 residents (excluding buprenorphine) compared to 619.2 for the rest of the state.
SafeRx was formed to address this peril in Santa Cruz County. The coalition has established a definition of opioid failure that involves four components. A patient has experienced opioid failure if they (1) have side effects that are potentially fatal or unmanageable, (2) develop an addiction or opioid disorder, (3) their diagnosis is an inappropriate use of opioids, or (4) the prescribed opioids are not treating the diagnosis. In this definition, SafeRx emphasizes that opioid failure means that opioids have failed the patient, rather than implying the failure is the fault of the patient. The SafeRx team identified several aspects of Opioid Failure Management including provider competency and safe prescribing practices, tapering plans to wean patients off opioids, as well as access to supplementary treatment such as behavioral health treatment, physical therapy, addiction specialty treatment, and complementary therapies.
With the support of its partners, SafeRx is taking concrete steps to benefit the community. Santa Cruz Community Health Centers, a partner of SafeRx, is piloting newly-developed Pain Management Guidelines that integrate opioid failure into primary care guidelines. During the pilot, clinicians are giving feedback to the Change Packet work group to measure which practices within the guidelines are effective. Another partner, Janus of Santa Cruz, operates the Janus SCOPE Program which is aimed to increase access to Naloxone. The program has distributed 1,400 Naloxone kits and trained 800 individuals to administer them, resulting in over 200 opioid overdose reversals. The Community Engagement work group has developed a public service announcement and a patient education brochure to educate the community about opioid safety. SafeRx is also hosting a community event on Sunday, October 1st from 12-4 pm with various booths and demonstrations along with keynote speaker, Bill Morris.
Nurse Family Partnership
Following the SafeRx presentation, Anita Alvarez, Director of Nursing and Director of Maternal Child Adolescent Health, and Jen Herrera, Health Services Manager and MCAH Coordinator, from the Santa Cruz County Department of Public Health presented about the Nurse Family Partnership (NFP), a program recently launched in Santa Cruz County. NFP is a nationally recognized, evidence-based community health program to support low-income, first-time mothers in Santa Cruz County by arranging home-visits and case management from personal nurses throughout the mother’s pregnancy and two years thereafter. The program serves 551 counties among 43 states and tribes in the USA. By providing first-time mothers with a trustworthy resource with a clinical skill set, the program aims to improve pregnancy outcomes, child health and development, and the economic self-sustainability of the parent. The home-visit format is designed to provide physical assessments of the client’s home that informs the individualized education the client receives. The nurses’ role in NFP is not only to educate the mother on child health and development, but to provide mentorship and model a relationship of support and availability.
The NFP in Santa Cruz is entirely locally funded and relies on referrals from community partners. The only requirements for enrollment are that the mother is low-income (determined by Medi-Cal eligibility), having their first child, residing in Santa Cruz County, and is participating in the program voluntarily. According to data based on population of children ages 0-5 living poverty, Santa Cruz County has a 96% unmet need for home-visit services and ranks in the bottom third of California counties. In both 2014 and 2015, 41% of all births were to first-time mothers and at least 50% of births had Medi-Cal as the payer source. The program has the capacity to take on one hundred cases between four public health nurses in the next two years; 20 families have been enrolled to date.