Super Huddle – Wishing You Health & Wellness   IPA held its final Super Huddle meeting for 2018 at ‘Imiloa on December 6. Over 125 providers and staff attended to network, learn about how to lessen their stress during the holidays and visit information booths. Some attendees even received chair massages from Vive Institute Spa. Many thanks to the exhibitors and staff who organized activities, shared information and donated giveaways on short notice. Participants played bingo by visiting exhibit tables to win gift baskets and VISA cards. Attached are photos taken at the event! Please see attached for the list of exhibitors and Kevin Larkin, IPA Behavioral Health Manager’s presentation on reducing holiday stress.

Ask the EHI Pharmacist   Depression in adults age 60 and older is often under-recognized and under-treated and may be mislabeled as aging, grief, dementia, etc. Psychotherapy is first-line in mild depression, and socialization and exercise should be suggested to all patients. If an antidepressant is needed in the elderly, tailor based on comorbidities, side effects, interactions, and the Beers Criteria of high-risk meds. First-line therapy is SSRIs (sertraline, etc.) which have the best evidence in older patients with depression, including after a heart attack or stroke and are also a good choice in patients who have dementia or Parkinson’s disease. SNRI’s, mirtazapine, or bupropion is also first-line.

Look for one antidepressant to serve two purposes:

  • Such as, Duloxetine or Venlafaxine in neuropathic pain

  • Mirtazapine to help with insomnia or promote weight gain

  • Bupropion is useful in patients with fatigue or erectile dysfunction, but try to avoid it in anxiety, as it is more activating

  • Older patients are more likely to develop hyponatremia with an SSRI, SNRI, or mirtazapine. Sodium levels should be monitored, especially with other risk factors such as heart failure or use of diuretics

  • Antidepressants are linked to fall risk and SSRIs are on the Beers Criteria for patients with a history of falls or fractures.

Monitor for symptoms of increased risk: sedation, blurred vision, fatigue, forgetfulness, etc. Antidepressants may seem less effective in older adults, but it is often because of inadequate doses or durations. Double therapy can be considered with bupropion or mirtazapine + SSRI or SNRI for patients who partially respond to optimal doses of one med.

HMSA Payment Transformation

Quality Performance Update – We prepared spreadsheets showing progress to date for each office. If you did not receive your spreadsheet, please contact Joyce at jvitales@ehiipa.com. The IPA will give year-end performance incentives to high performers.

Annual Provider Survey – Please complete and submit this survey online before December 31, 2018. Access the link here. HMSA funding to the IPA depends upon your completion of this survey.

Ecosystem Referrals – NOW AVAILABLE to submit attestation on Coreo. Requirement for compliance is confirmation & description of referrals to programs in the community submitted via an attestation form in Coreo by the end of the measurement year (12/31/18). Each PCP needs to identify which program patients were referred to, then estimate the number of members they referred to those programs. We complained that all of the programs listed with check boxes are on Oahu and not on Hawaii Island. To receive credit for this, please check “other” and list the programs that you refer patients to. See screenshot here.

KTA Diabetes Prevention Program (DPP)   KTA Pharmacy will begin offering a Diabetes Prevention Program beginning January 10, 2019. They are  looking for patients with pre-diabetes who are willing to attend their year-long program. There is no referral required; all they need is their most recent A1c or fasting blood glucose test that shows that they have pre-diabetes. During the program, patients will learn how to make necessary lifestyle changes to lower their risk of developing Type 2 diabetes. Contact KTA Pharmacy at 959-2888 to enroll your patients!

Announcements:

  • FREE Tobacco Cessation Classes – Hui Mālama Ola Nā ‘Ōiwi office, December 7, 2:00-4:00 PM. Call Judy at (808) 854-0016 or Hui Mālama at (808) 969-9220 to sign up your patients.

  • Hilo + Puna Community Medical Center Rat Lungworm Disease Support Group – December 12, 4:00-6:00 PM at the Kea‘au Community Center. Flyer attached.

  • Beacon Health – PCP Referral for Behavioral Health Support – Beacon Health offers behavioral health services for HMSA patients. Attached is the referral form (here), the overview of services (here), and the WHO-5 Well-Being index tool (here).

  • Advance Health Care Directive Fill-out at ADRC – November-March dates attached.

  • UPDATED Aging & Disability Resource Center (ADRC) Referral Form – Please use the attached referral form to refer patients to their programs. Also attached is a list of Kupuna Care services.

  • Ola Hou I Ka Hula: Hula & Hypertension – Refer your patients to this culturally-based program for those seeking healing from health problems! Mondays & Wednesdays, 5:30-6:30 PM. Flyer attached.

  • Hilo Medical Center Diabetes Support Group – “Carbs You Can Count On.” Flyers attached here. Will continue every first Tuesday of the month from 4:00-5:00 PM for the rest of 2018.

  • Aloha Kidney 2019 Classes – Dates available. Flyer attached.