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N. Borden



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    OS08 - Patients as True Partners in Care (ID 12)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Executive
    • Presentations: 1
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      OS08.01 - Addressing the Opioid Crisis with Technology (ID 174)

      N. Borden, Drug Informaton System, Nova Scotia Department of Health and Wellness; Halifax/CA

      • Abstract
      • Slides

      Purpose/Objectives: *Objectives*: The province’s objective is to use technology to provide anonymous access to naloxone and to improve prescribing/monitoring practices by establishing morphine-to-opioid equivalency.

      Methodology/Approach: *Approaches*: The provincial strategy calls for widespread access to naloxone to prevent overdoses. Free naloxone kits will be available through pharmacies and to support this distribution an electronic process is being implemented to submit claims to reimburse pharmacies. The electronic billing process requires dispenses of naloxone kits to be recorded in pharmacy software and submitted to the DIS, like other device dispenses. The challenge is that naloxone kits cannot be associated with an identifiable patient; to address this requirement, a patient profile only for free naloxone kit dispenses has been setup in the Client Registry. To ensure this profile is used exclusively for naloxone dispenses, a new business rule that will be sufficiently flexible to account for future changes will be implemented in the DIS to restrict dispenses on that patient profile to naloxone products only. Morphine equivalency addresses the lack of a standard potency measurement across all opioids making it difficult to identify high risk opioid doses leading to overdose. A tool that allows for comparison of opioid doses has been developed to equate the different opioids into one standard value based on morphine, referred to as morphine milligram equivalents (MME) or morphine equivalent doses (MED). MME is a value assigned to opioids representing their relative strength in terms of morphine. MME is determined by using an equivalency factor to calculate a morphine dose equivalent to the ordered opioid. Daily MED is the sum of the MME of all opioids a patient is likely to take within 24 hours; that total is used to determine if the patient is nearing a dangerous threshold. The province is working with its DIS vendor to determine if its product could support calculating and displaying daily MED for prescriptions and dispenses. This equivalency would provide clinicians with Morphine Equivalent information for opioids so they can make educated decisions on the appropriate therapy of opioid drugs for patients. The implementation of Morphine Equivalence will be a multi-phased approach based on the timing and availability of reliable ME data from FDB and determining messaging requirements. The implementation’s first phase will address two capabilities with respect to Morphine Equivalence (ME): capturing and storing ME using a simple file structure and communicating ME information for a specific drug to clinicians accessing the DIS. A second phase will include support for ME data once it is available from FDB and the third phase will build on the available FDB data and provide maintenance of ME thresholds, business rule development, and reporting on patient opioid use.

      Finding/Results: *Results*: At the time of writing, both these projects were in the initiation stage; however, it is expected that by May 2018, they will be sufficiently advanced to report on successes and obstacles.

      Conclusion/Implications/Recommendations: *Recommendations*: The province recommends seeking innovative ways of utilizing technology to further serve the public and, especially as in this case, to save lives.

      140 Character Summary: A province’s use of digital methods – enabling naloxone access and establishing morphine equivalency – to address opioid misuse.

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