Understanding the Health
Professionals Services Program
James Alexander, R. Ph. MN Pharmacists Association MN Pharmacists Recovery Network HPSP Advisory Committee S. Bruce Benson, R. Ph., Ph.D. College of Pharmacy, University of Minnesota HPSP Advisory Committee Monica Feider, MSW, LICSW HPSP Program ManagerPurpose of this presentation is to
enable the participant to:
zDiscuss the development and growth of the HPSP zDiscuss the mission, operation and benefits of HPSP zDescribe the impact of HPSP on Minnesota pharmacy zDescribe the impact of HPSP on public health in Minnesota zDescribe results of surveying state programs that monitor pharmacists with illnessesFirst, a bit of History
The Backstory 1980 to 1994
zMinnesota Board of Pharmacy concerns
zSpecial MSPhA Committee responds
zPharmacists Aiding Pharmacists, Inc.
Backstory (con’t)
zPharmacist Support Group
zUniv. of Utah School Pharmacy Section
zPRN/MN replaces PAP, Inc.
zHPSP created by Legislature
Backstory (con’t)
zBoards’ controlled monitoring of clients
zAdvisory Committee has input to HPSP
zAlternative to disciplinary action
zSafety of Public Health Practices
Overview of Minnesota’s
Health Professionals
Services Program (HPSP)
Health Professional Services Program
HPSP is a state of Minnesota program of the health‐ licensing boards that provides monitoring services to health professionals with illnesses that may impact their ability to practice. HPSP implements monitoring plans to ensure that the health professionals obtain adequate treatment and do not cause patient harm. As of June 30, 2009, a total of 33 persons regulated by the Minnesota Board of Pharmacy were among the 566 persons enrolled in HPSP.Mission
The mission of HPSP is to enhance
public safety in health care.
HPSP’s goals are to promote early intervention, diagnosis and treatment for impaired health professionals and provide monitoring services as an alternative to board discipline.
HPSP Legislation
z1994: Legislation created HPSP “to protect the public from persons regulated by the boards who are unable to practice with reasonable skill and safety by reason of illness, use of alcohol, drugs, chemicals…or as a result of any mental, physical, or psychological condition.” (Minn.Stat. 214.31) z2000: Legislation requiring all health licensing boards and 3 programs administered by the Dep. Of Health to Participate in HPSP by July 1, 2001. z2006: Legislation passed requiring participation by Hearing Aide Dispensers, Speech Lang. Therapists, OccupationalStructure
The following are statutorily required:
zProgram Committee (board representatives)
zAdvisory Committee (assoc. representatives)
zAdministering Board (Board of Dentistry)
HPSP also meets informally with board staff to
review program processes and address any
questions or concerns that may arise.
Participating Boards
9Nursing 9Medical Practice 9Pharmacy 9Dentistry 9Chiropractic 9Social Work 9Behavioral Health & Therapy 9EMSRB 9Physical Therapy 9Psychology 9Veterinary Medicine 9Podiatric Medicine 9Optometry 9Nursing Home Administrators 9Dietetics and Nutritionists 9Marriage & FamilyTherapy
9Dept. of Health (Speech Therapists, Hearing Aide Dispensers, Occupational Therapists and Assistants)
Benefits
zHealth professionals can report illness to HPSP in
lieu of licensing board
zIndividuals reporting impaired health professionals
have legislative permission, confidentiality and immunity
zProtects public by monitoring and restricting
practice of those impaired
zEnsures licensees receive appropriate level of
Unique Characteristics
•
Primary focus is patient safety
•
Provides services to persons with
substance, psychiatric & medical disorders
•
Eliminates the duplication of services:
•
Offers a single point of contact for all regulated health professionals, providers, and employers•
Allows all boards to access the same servicesPharmacist Participation in
the Minnesota’s Health
Professionals Services
Program (HPSP)
Examples of How HPSP Protects the
Public
z
Employers report practitioners to HPSP
for:
–Stealing narcotics – suspicion or caught
–Showing up to work intoxicated
–Appearing manic or psychotic
–Concerns about dementia and cognitive functioning
Examples of How HPSP Protects the
Public
•
Health professionals contact HPSP when they: – Have been caught stealing drugs– Have been terminated or put on LOA due to mania, psychosis, cognitive
impairment or other medical disorders – Are in treatment for substance abuse or
psychiatric reasons
How HPSP Responds
z
HPSP may ask practitioners to refrain
from practice if their illness is active
z
HPSP requests that practitioners obtain
assessments or evaluations (substance,
psychiatric and/or medical)
z
HPSP utilizes the above to determine if
monitoring is appropriate, and if so, to
implements monitoring plans that
protect the public and foster recovery
How HPSP Responds ‐ Intake
zIntake
–Tennesen Warning –Program Described –Eligibility Determined –Brief social, vocational, medical, psychiatric and substance histories gatheredHow HPSP Responds ‐ Intake
zRequest for evaluations
zRecords gathered
zDevelop Participation Agreement and
Monitoring Plan
–Standard conditions –Individualized conditionsWhy HPSP Develops Monitoring Plans on
a Case by Case Basis
Increase Practice Restrictions Standard Monitoring Refrain From Practice Increase Therapeutic Requirements Potential for Harm Considerations: -Profession -Specialty -Access to drugs -Supervision -Patient interaction Illness Considerations: -Insight -Tx compliance -Symptoms -Response to tx -Diversion -Illness history -Length sober or stablePharmacist Referrals by
First Referral Source: 2004‐2010
Total Pharmacist Referrals
‐BY FIRST REFERRAL SOURCE‐
‐as of 8/25/2010‐
66% not referred by the Board
70% of those referred with discipline had prior involvement in HPSP
Total Pharmacists Illnesses Monitored
‐ALL pharmacists referred as of 8/25/10‐ ‐no duplicates of persons referred more than once‐ z90% with substance disorders
–38% with a comorbid psychiatric disorder –7% with a comorbid medical disorder z48% total with psychiatric disorders but only
10% without a comorbid substance disorder
z9% with medical disorders, but only 1% without
a comorbid substance or psych disorder
Total Pharmacist Substances of Choice
‐as of 8/25/2010‐ 73% list a prescription medication as a substance of choiceSubstances of Abuse by Profession
Substance of Abuse Pharmacist Physician Nurse
Alcohol 25% 54% 43% Illicit 2% 1% 9% Opiate 42% 29% 20% Other Prescription 8% 5% 3% Polysubstance 23% 11% 25% Total Rx 73% 45% 48% For the purpose of this document, polysubstance represents a prescription medication and at least one other substance. Pharmacist data is from all pharmacists monitored by HPSP through 8/25/10 Physician data is from physicians monitored on 6/16/2010 Nurse data is from nurses monitored on 7/14/2010
Total Pharmacists ‐ Discharges
‐as of 8/25/2010‐MONITORED
74%
NOT Monitored
26%
% of monitored % of not monitored
Completed 64% No Contact 18% Non‐Compliance 25% Non‐Cooperation 47% Ineligible 5% Ineligible 21% Voluntarily Withdrew 5% No illness to monitor (non‐jurisdictional) 15% Deceased 1%
Comparing Referral Sources by Profession
Profession Self Third Party Board Voluntary Board Discipline Total Referred Pharmacist 39% 29% 16% 16% 69 Physician 54% 16% 23% 6% 281 Dentist 27% 24% 45% 4% 55 Based on referrals from 1/1/2005 to 6/30/2010
HPSP survey of state
programs that monitor
pharmacists with illness
Survey
HPSP developed a comprehensive survey to identify similarities and differences among state monitoring programs for pharmacists with illness. The surveys were mailed to all United States programs on the national Pharmacists Recovery Network website and distributed at the University of Utah’s School on Alcoholism and Other Drug Dependencies (2009), with seventeen responses being received.
Survey Topics
zProgram Administration zFunding zStaffing zIllnesses Monitored zMonitoring zReporting zRestrictions zMutual Support Groups zToxicology Screening zGeneral QuestionsProgram Administration
How are programs administered:
zLicensing Board: 24%
zProfessional Association: 24%
zPrivate: 28%
zOther: 24%
Program Administration
Is monitoring confidential from board?
zYes: 53%
zNo: 12%
zVaries/Case by Case: 35%
zPrograms are in State Statute 76%
Funding
Funding Sources:
–Board 88% –Grant 6% –Professional Association 6% Annual Budget Average: –$180,000Funding
Participants charged for service:
Yes: 58%
No: 42%
Average charge: $88.00/month
Staffing
Current pharmacist enrollees average: 51
Treatment Provided
Yes: 6%
No: 94%
Mutual Support Groups
Average weekly frequency of required
attendance
Year 1 3.2
Year 2 2.8
Year 3
2.6
Year 4 2.6
Year 5 2.4
Toxicology Screening
Average Monthly Frequency of Required Screens Year 1 2.6 Year 2 2.3 Year 3 1.8 Year 4 1.8 Year 5 1.6 Days per week participants are required to be available = 6Illnesses Monitored
•
Substance Disorders: 100%
•
Psychiatric Disorders w/out comorbid
substance disorders: 53%
•
Psychiatric Disorders with comorbid substance
disorders : 94%
•
Medical Disorders w/out comorbid substance
disorders : 44%
•
Medical Disorders with comorbid substance
disorders: 88%
Illnesses Monitored
•
Medical Disorders with comorbid
psychiatric disorders : 50%
•
Medical Disorders without comorbid
psychiatric disorders : 38%
•
Competency Issues: 18%
(violations of practice act)•
Boundary Violations : 28%
•
Behavioral Problems : 12%
Monitoring
Monitors persons who have been sober for
one to four years (at time of referral)
Years of Reported Sobriety upon initial contact Would Monitor Case by Case Average Length of Monitoring 1 65% 29% 5 years 2 65% 29% 4.8 years 3 64% 18% 4.7 years 4 64% 12% 4.8 yearsReporting
Relapses reported to licensing board
–Yes 40% –No 7% –Determined Case by Case 53%Reporting
Participants discharged for positive screen Yes: 6% No: 75% Determined case by case: 19% Participants discharged for relapsing once Yes: 6% No: 65% Determined case by case 29% Participants discharged for multiple relapses Yes: 12% No: 299 Determined case by case: 59%Restrictions: Practice While On
Medication
Prescribed Narcotics Yes 18% No 23 Determined case by case 59% Methadone Yes 19% No 50% Determined case by case 31% Buprenorphene Yes 25% No 31% Determined case by case 44%Biggest Issues Facing Monitoring
Programs
1. Funding Issues
2. Use of Prescription Drugs (narcotics, or
other prescription drugs that can be
abused)
Measuring Success
zPublic safety.
zContinuing sobriety and safe return to
practice identified as success by most
programs.
Survey Conclusion
zState Monitoring Programs are important professional adjuncts for small numbers of U.S. pharmacists. zResults indicate that there are both similarities and differences between the 17 responding state monitoring programs for pharmacists. Among them, three out of five monitoring programs report they are in state statute, most are funded by a health licensing board, most do not provide treatment, and the most common illness monitored is substance abuse (all respondents).Survey Conclusion cont.
zConversely, results demonstrate variation among monitoring programs in several areas. Results also indicate that HPSP’s practices generally are consistent with the national norms. zThe survey results obtained should be of value to state monitoring programs in the United States as they assess and try to improve their respective services.Closing Statements
zWhy HPSP works:
–Board support –Professional association support –Confidential participation –Easy reporting –Statutory mandateClosing Statements
z
What you can do:
–Address concerns as they occur
–Ensure policies are in place
