Dr. Brian Irwin: Current state of opiate affairs

By Brian Irwin

By now, many of you are well aware that we have an opiate crisis in the state of New Hampshire. Overdoses from opiates or the combination of opiates and other medications are rising at staggering rates. Fatalities are becoming more and more common, as is addiction. We are seeing this penetrating all socioeconomic stratas, as well as all age groups. In response to this crisis, the New Hampshire Board of Medicine has passed new rules for the responsible prescribing of opiates. These rules went into effect on Jan. 1, 2017, and impact not only providers, but patients who take opiates.

So what's changed? The rules are deep and complex but in essence there are now expectations that prescribers must meet to comply. These include a documented history and physical, the use of a board-approved tool to determine the risks to patients taking opiates (these are not risk-free medications) and documentation of the rationale behind the prescription.

The rules go deeper, however. These include a treatment plan that considers non-opiate options, an informed consent document that outlines the risks and benefits of the opiate, and a mandatory inquiry into the N.H. Prescription Drug Monitoring Program. This program allows providers to see every single prescription that patients fill in New Hampshire as well as many other states.

These rules apply to all patients, even those taking opiates for a very short period of time — for example, for trauma or injury. For those taking opiates on an acute basis, a re-evaluation is mandatory if pain persists beyond 30 days. For those on chronic opiates, the rules also mandate a written treatment agreement that includes details on safe storage and disposal of medications, consent to random drug testing to ensure compliance and a requirement to only accept opiates from a single provider.

Chronic pain patients are handled differently than acute patients. This subgroup must be evaluated by the prescriber for referral to a pain clinic if the patient receives 100mg or more of morphine equivalent daily for a period of time greater than 90 days. Likewise, referral to a pain clinic is encouraged for those with a high risk for abuse or addiction or those with a co-morbid psychiatric disorder. The N.H. Prescription Drug Monitoring Program must be queried at least twice a year, and random urine drug testing is required at least annually.

These changes carry a degree of burden; however, it's the ongoing crisis in our state that has led to the implementation of these changes. Dealing with any epidemic, including an opiate epidemic, requires the community to pull together. While there may be a host of medical providers in this region, we all must work in a collaborative fashion to help stop this very dangerous pattern that is literally killing our children, our family members and our friends.

If you're on opiates, it may be worth discussing these changes with your provider as they affect us all, from providers who prescribe pain medications, to those patients who utilize them. Some may find these new rules frustrating or time consuming, but please realize the goal is to save lives. By working together in this community, we can all strive for a safer atmosphere for everyone in our town. And beyond.

Dr. Brian Irwin is a family physician at Tamworth Family Medicine, a division of Huggins Hospital.


  • Category: Health

Four more providers offering pre-registration at Memorial

Shauna Cameron is director of Primary Care at Memorial Hospital. (COURTESY PHOTO)

CONWAY — Nicole Stanley, Bill Martin, Lorinda MacDonald and Lynn Meehan are the latest Primary Care providers at Memorial Hospital to become part of the practice's pre-registration initiative, beginning this week.

In order to improve patient experience, Primary Care now uses a new process for central registration that aims to make the outpatient check-in process faster and easier, avoid delays, facilitate co-pay collection and decrease billing errors due to out-of-date insurance information. The process has been rolled out in stages over the last several months, and Stanley, Martin, MacDonald and Meehan are the latest offering this service for patients.

All Primary Care patients will receive an outbound registration phone call five days in advance of their appointment. Patients will be asked to confirm their demographic information (name and contact information) and insurance information. At that point they can confirm whatever co-pay will apply to their visit, and patients will be instructed to bring their payment in person. This call will also be a means of reminding patients of their appointments.

When patients arrive for their appointments, they can proceed directly to check-in at the practice, which will be greatly expedited by having previously registered by phone.

While it is Memorial's plan to talk to all patients personally by outbound call, those who can't be reached will be left a voice-mail message and be asked to call back to register for their appointment. It is critical that patients return the call in order for this process to work. Those who do not call back and do not pre-register will not be able to check in; rather they will be referred to the Registration Department (by phone or in person) to have their information verified before they can proceed to check in.

There are benefits to this new process for patients and the hospital alike:
• It will eliminate a bottleneck at the check-in desk as their information will have been confirmed in advance.
• It will allow for more accurate billing as patient insurance information will be confirmed for every appointment. Given the new insurance landscape and Medicaid expansion, there is much higher variability in coverage so it's more important than ever to confirm insurance each time.
• It will allow Memorial to accurately provide patients with co-pay requirements and to collect more consistently.
• It will decrease delays at appointments as patients are able to make it through the check-in process more quickly.
Practice Director Shauna Cameron also shared some other pointers for making your visit as smooth as possible: "Please bring with you all of your medications, your insurance card and co-pay, and the name and address of physicians you have previously seen," she said. "Be sure to complete any forms provided or mailed to you and present them upon arrival for your scheduled appointment. It is important that you arrive on time in order to complete the check-in process."
Other tips for a visit to Primary Care
• Please be aware that if you are late for your arrival time, you will need to reschedule.
• Arrival times are given to you by the person you talk to when you pre-register for your appointment.
• If you haven't already done so, ask to sign up for Memorial's Outpatient Medical Records Portal. It's where you can message your provider, view upcoming appointments and access certain parts of your medical record online. Read more about it and download the sign up form before your next appointment at tinyurl.com/memorialportal.

For more information, visit www.memorialhospitalnh.org.

  • Category: Health

Melody Nester named Community Relations and Development coordinator at Memorial

CONWAY — Memorial Hospital has welcomed Melody Nester to the position of Community Relations and Development coordinator.

Nester is a familiar name and face to many in the Mount Washington Valley. She worked 10 years in membership and marketing for Mount Washington Valley Chamber of Commerce and previously in marketing and development for Mount Washington Observatory.

Nester said she is excited to work with hospital staff and members of the community in her new role. "I look forward to working on the community relations and development team in support of Memorial Hospital's important mission to provide excellent and compassionate care in our community," she said.

Part of Nester's role will be to help organize Memorial Hospital Open Golf Tournament, taking place this summer on July 20 at Wentworth Golf Club in Jackson. "I welcome businesses and golfers interested in participating to contact our office now knowing that your participation will support health and wellness programs so vital for local children and other members of our community," she said.

Community Relations and Development Vice President Kathy Bennett said: "Melody really rounds our team and provides a strong foundation for our philanthropy efforts. We were so fortunate to be joined last year by Fryeburg's Rachel Damon, who is already doing great things here to reinforce the culture of philanthropy for our community hospital. Now with Melody in place, I know great things are in store for Memorial and our community in the coming years."

Damon said: "We are so fortunate to have Melody join us. She has a great work ethic, superior skills and is an all-round wonderful person. She will help us move forward with her daily vigor and enthusiasm."

For more information about Memorial Hospital's development efforts, go to www.memorialhospitalnh.org/foundation.


  • Category: Health

Accountability is essential for successful weight loss in 2017

By Marie L. Veselsky

Having a licensed, credentialed health-care provider weigh you on a consistent basis can help you be successful in achieving weight loss in 2017.
You need more than just one visit to be successful. You need ongoing accountability through weigh-ins, education, reinforcement and support.
Recent research indicates that a third of Americans are considered obese. Being significantly overweight can increase your risk for many chronic diseases and some cancers. The American College of Cardiology and the American Heart Association guidelines indicate that even a 3 percent weight loss among overweight and obese individuals can improve risk factors for chronic diseases such as high blood pressure, high cholesterol, coronary artery disease, stroke, osteoarthritis, sleep apnea and diabetes type 2.
As a registered dietitian who practices a more holistic approach, I am not a proponent of gastric bypass surgery unless the benefit far outweighs the risk. That said, there have been a lot of good studies that have come from data on gastric bypass patients. The American Medical Association Analysis of 136 gastric bypass studies where the patients lost significant weight indicates that 77 percent of participants eliminated their elevated blood sugars, 62 percent eliminated their high blood pressure, 70 percent eliminated their high cholesterol and 86 percent eliminated their sleep apnea. This shows weight loss is key in improving outcomes of many chronic illnesses.
The most successful weight loss treatments include elements of monitoring as a means to increase self-awareness. Especially powerful is having a licensed, credentialed health-care professional weigh you on a consistent basis, provide you with a diet that works and provide reinforcement.
Integrated Optimal Health's Choice Center for Nutrition and Choice Center for Diabetes and Weight will help you achieve your weight-loss goals through providing education, reinforcement, weigh-ins and ongoing support as well as group and individual exercise programs. It is easier than most people think. There is no "magic bullet" for weight loss, but knowing your individualized carb number for weight loss, which we determine for you, and getting the education and support you need is pretty close.
We provide yoga, exercise boot camps and movement programs, stress reduction programs, group support programs and individual appointments.
Many people do not realize that their health insurances covers preventative care. It is your health and your choice. Choose health.
Call 603-770-4856 or 888-444-1204 to find out about the group and individual programs. 24 Pleasant Street, Conway, NH. Most insurance accepted!
www.integratedoptimalhealth.com, www.choicecenterfordiabetes.com.

Marie L. Veselsky is owner of Integral Optimal Health at 24 Pleasant St. in Conway. She has a master's in education/nutrition and is a licensed registered dietitian and a board-certified advanced diabetes educator. Call (603) 770-4856 or (888) 444-1204 to find out about the group and individual programs, or visit www.integratedoptimalhealth.com or www.choicecenterfordiabetes.com.


  • Category: Health