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Successful Future of Healthcare Conference addresses gun violence and opioid epidemic

Tuesday, May 22, 2018   (0 Comments)
Posted by: DCMS
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Gun violence and the opioid epidemic are critical topics that impact healthcare and delivery of care in Northeast Florida. The Duval County Medical Society (DCMS) Foundation's 2018 Future of Healthcare Conference not only addressed these issues, but also looked at solutions to improve them throughout the community.

Hundreds of healthcare providers, community leaders, local legislators, and representatives from local non-profit organizations gathered at the Prime Osborn Convention Center for the two-day Conference focused on improving healthcare in Northeast Florida.

On Monday evening, May 21, DCMS Foundation President and Conference Chairman Dr. Sunil Joshi welcomed participants and shared some history about how the Conference first came to be.

There are many reasons why Jacksonville and Northeast Florida are great places to live and work: amazing weather, clean beaches, a growing art scene, and a diverse population, Dr. Joshi shared. However, he noted that there also remains a "great divide in Jacksonville."

"There are many issues related to socio-economic status, education, access to healthcare, health insurance, and unemployment that contribute to the health of a region," he explained.

When the DCMS Foundation Conference first created the Future of Healthcare Conference in 2017, Duval County was ranked as 55th of 67 Florida Counties in terms of overall health by the Robert Wood Johnson Foundation. In just one year, the county has risen 13 spots to 42nd.

To make these significant healthcare improvements takes effort from more than just healthcare providers. That's why the Future of Healthcare Conference brings together community members from all fields and walks of life.

Registered participants at the 2018 Conference were from Baptist Health, Mayo Clinic, UF Health, Memorial Hospital, St. Vincent's HealthCare, the Florida Department of Health in Duval and Nassau Counties, Visit Jacksonville, University of North Florida, Jacksonville University, the Sulzbacher Center, United Way of Northeast Florida, YMCA of Florida's First Coast, and many more local organizations.

In his presentation Monday evening, Florida Medical Association President Dr. John Katapodis provided a "state of the state" of medicine in Florida. He shared why physicians need to come together as one voice in medicine to ensure that they have a hand in any Florida law that might impact the delivery of healthcare.

A recent example is a new opioid prescribing law that will go into effect on July 1 in Florida to reduce the amount of opioid pills prescribed while using state dollars to fund addiction recovery and treatment programs. Organized medicine groups such as the Florida Medical Association and Duval County Medical Society had a firsthand impact on the wording of the final version of the bill. 

Dr. Katopodis also addressed the significant impact of burnout on physicians in Florida and across the country. Organized medicine groups across the country including the DCMS have created Physician Wellness programs to ensure their physician members have a confidential outlet for seeking help without any impact to their medical license.

In American Medical Association (AMA) President-elect Dr. Barbara McAneny's keynote speech on "A Vision for the Future of Healthcare in America," she explained some of the major challenges currently facing the healthcare industry.

"Healthcare in America is unsustainable in it's current state," Dr. McAneny shared.

The cost of care in the United States is currently higher per capita than other Organisation for Economic Co-operation and Development (OECD) countries. This high cost impacts access to healthcare for many U.S. residents.

"What patients want is not actually more healthcare, they want health," she said.

About half of all primary care visits in the U.S. are related to the management of chronic disease, Dr. McAneny explained.

"Done right, a value-based payment system would allow for better delivery."

Dr. McAneny also addressed payment issues that healthcare providers face on a daily basis. She shared how the AMA is working to decrease administrative burdens and cut through the red tape that currently binds physicians.

The AMA is also working to provide regulatory relief by improving the usability of electronic health records and making efforts to eliminate, streamline and simplify many federal rules and other regulations that are faced by healthcare providers, according to Dr. McAneny.

She also touched on the opioid epidemic issue which continued as a major topic of the Conference on Tuesday. Dr. McAneny noted that recently more people have died of opioids than have died in military actions.

She admitted that physicians played a role in this issue when the demand for these medications first came on the market.

"When the drug companies said they were not addictive medicines, we believed them."

The opioid epidemic discussion continued on Tuesday with a variety of speakers from the local and state level. 

Dr. Kelli Wells, Medical Director for the Florida Department of Health, provided current data regarding the impact of the opioid epidemic in Jacksonville. She shared that in 2017, the Jacksonville Fire Rescure Department responded to 3686 opioid overdoses. From January to April 2018, JFRD responded to 530 overdoses. She explained that many of these patients are also people who have previously overdosed. Dr. Wells also noted that in the first quarter of 2018, the Medical Examiner reported 198 deaths from opioid overdoses.


Former Jacksonville dentist Dr. Leon Smith perhaps gave the most impactful talk of the day. Choked up from the begining, Dr. Smith bravely shared about the devastating impact of the opioid epidemic on his own family.


As he explained, the first and only time he ever traveled to Las Vegas was after his son, Andrew Smith, overdosed. Dr. Smith arrived at the airport and learned that instead of visiting his son in the hospital, he would be going to identify the body. He describes it as the most "horrific" thing he's ever had to do and still remembers vividly the nurse explaining the struggle to bring Andrew back to life. 


Andrew was born at St. Vincent's high school, grew up and attended high school in Jacksonville. He was a smart boy that went on to attend college at Stetson University.


"He's our son. He was born in this town." 


Dr. Smith explained that his son was good at hiding his addiction, and admits that his family, like the families of many addicts, assisted in the addiction.


"Very few addicts can maintain their addiction on their own," he shared, explaining that families often give their loved ones money, post bail, pay for lawyers, and they let them back into their homes again and again.


In response to the devastating loss of his son, Dr. Smith now advocates for more research and data on opioid abuse and addiction, data that could make a difference in the way the epidemic is treated.


Senator Lizbeth Benacquisto is one of many lawmakers currently working to address the opioid epidemic that took the life of Andrew Smith. She authored Senate Bill 8, the opioid prescribing law mentioned earlier that will go into effect in July.


Her cousin's daughter was also a victim of the epidemic. At age 29 with two young daughters, that family member became a victim of heroin.


"It ripped her family apart."


Senator Benaquisto spoke directly to Dr. Smith, recognizing his pain.


"Your loss of Andrew is unbearable and something you will never overcome," she said, explaining that it's stories like these that led her to author SB 8.


"Every person who enters the realm of getting too much of these drugs is our responsibility."


With the law now just weeks from going into effect, educating physicians and healthcare providers on the new rules is critical. Drs. Alan Miller and Ferdinand Formoso of Coastal Spine & Pain Center were proponents of the new regulations and are now working to educate providers on safe opioid prescribing.


According to Dr. Formoso, as of 2008, opioids became the gateway drug for youth in the U.S. surpassing marijuana. He noted that opioids are more addictive than cannibas with a higher possibility of dying of overdose.


For this and other reasons, the two colleagues spent a lot of time in Tallahassee during the most recent Florida Legislative Session. They supported the new acute pain restriction, and as Dr. Formoso shared, prescriptions for acute pain often offer far too many pills, more than are needed by the typical patient.


Dr. Miller took some time during the Conference to explain the CDC guidelines regarding opioid prescriptions, highlighting two key points.


The first is understanding the maximum recommended doses of narcotics such as oxycodone, hydrocodone, fentanyl patch, and others. Secondly, Dr. Miller addressed benzodiazepines, sharing that he highly recommends against prescribing benyzadyames together with opioids.


There are ongoing efforts in the city of Jacksonville to treat addiction and one novel effort is taking place in partnership with St. Vincent's HealthCare and the City of Jacksonville. Project Save Lives is a pilot project that provides targeted services that include, but are not limited to stabilization and treatment for withdraw, connection to a peer, medication assisted therapy and seamless transfer to residential and/or outpatient treatment.

 Dr. Frank Huson Gilberstadt, Chief Clinical Officer for Ascension St. Vincent's, explained, that the project has created a culture change in the emergency department.


"We're using lots of different types of medications in small doses," he said of when they send these patients home following an overdose. "The patients are still comfortable with their pain and going home with smaller amounts of medication."


To qualify for the pilot study, the patient must be 18 years or older and willing to participate. Those selected were overdose patients when entering the St. Vincent's Emergecy Department and NARCAN responsive and/or were opioid/fentanyl-positive.


The pilot has only been underway for just over a year, but Dr. Gilberstadt is satisfied with the progress thus far.


"There are a lot of eyes on this project," he said.

Tuesday's agenda also focused on gun violence as a public health issue. Jacksonville Sheriff Mike Williams shared research that has been underway in Jacksonville since he took his office just over two years ago.

Sheriff Williams explained that in many parts of the country there is a small number of people that drive a significant portion of the violence within the community, and the same was found to be true in Jacksonville.

In many cases, he shared that it is less than one percent of the population causing up to 50 percent of crime in a community.

The Sheriff's Office is now working with community members on numerous strategies including one called "focused deterrence" where they reach out to potential offenders on a one-on-one basis to explain the serious consequences of criminal activity. 

Williams noted that these community teams focus on reaching potential offenders that are on the peripheral of some of the groups that have already been in trouble with the law.

"We focus on the young men that are around some of those groups that may make a decision that could impact the rest of their lives," he said. "But that could also make a decision that could impact the rest of their lives in a positive way."

Dr. Marie Crandall, Professor of Surgery at the University of Florida College of Medicine - Jacksonville, shared a variety of recent research regarding firearm-related trauma injuries. One recent study looked at the number of firearms in homes by state and found a higher proportion of firearms in the home correlated with a higher rate of homicide. Dr. Crandall also highlighted another study which noted a 7-40% reduction in firearm related fatalities and injuries in states with stricter licensing. 

How does the research apply in Jacksonville? Dr. Crandall cited research on firearm injuries that has taken place over the past 20 years at the University of Florida Health - Jacksonville trauma center. She noted that while the exact number of injuries changed from year to year, the neighborhood didn't change. 

"Year after year it was our neighborhood that was the most distressed," she said.

The neighborhood around UF Health - Jacksonville is "socially distressed," as she described. It tends to be an area with food deserts, and housing, education, and employment issues.

To improve outcomes in these areas, Dr. Crandall encouraged voters to voice their concerns and push for change. She suggested urging lawmakers to pass sensible licensing laws with minimum age of purchase and universal background checks. 

Tuesday also included a look back at the 2017 Conference and an update on the progress that has been made since that time. Conference participants agreed to address Food Deserts after wrapping up the 2017 discussion. Since then, committees have worked vigorously to develop public policy solutions for food deserts in Duval County. The United States Department of Agriculture defines food deserts as "parts of the country vapid of fresh fruit, vegetables, and other healthful whole foods, usually found in impoverished areas."


Dr. Lauri Wright of the Hunger Network of Northeast Florida shared extensive research that has been completed during the past year, including the development of a hunger map that really gets to the core of food availability and cost in food desert areas. As Wright noted, the committees have also looked at potential solutions at both the local and national level. Federally, the committee could push for an increase in SNAP benefits. Locally, committee members are looking at ways to incentivize grocery stores to move into food desert areas and ways to incentivize corner markets to carry healthier foods. 


For the 2018 Conference, participants will be receiving a follow-up from staff as the process begins to find an actionable outcome for the year ahead. Staff members will be reviewing all of the comment cards turned in by participants and forming a coalition of volunteers to begin researching the chosen issue on a local level and looking at potential solutions.