December 2019, Volume XXXIII, No 9

  CAPSULES

HealthPartners to close retail pharmacies

HealthPartners will close all of its Minnesota and western Wisconsin retail pharmacies in 2020. The move affects 30 retail pharmacies located within HealthPartners, Park Nicollet, Central Minnesota, and Stillwater Medical Group clinics. The organization’s mail-order pharmacy operations will also cease.

Some 300 positions, including 100 pharmacists, will be eliminated as a result of the closures. HealthPartners’ specialty, infusion, and hospital pharmacies will continue to operate, along with health plan pharmacy management and medication therapy management services.

Sarah Derr, PharmD, executive director of the Minnesota Pharmacists Association, said that the action reflects a national decline in the retail pharmacy industry that has included closures of many rural independent outlets. The National Community Pharmacists Association predicts that up to 58% of pharmacies nationwide could close in the next two years. Despite this trend, she is hopeful that the pharmacy industry will be able to restructure the way it is reimbursed for services and open new outlets in coming years.

The closures begin Jan. 20, 2020, and are expected to be completed by April 1, 2020.

Medical cannabis program to add qualifying conditions

The Minnesota Department of Health (MDH) will add chronic pain and age-related macular degeneration as new qualifying conditions for the state’s medical cannabis program. Under state law, the new conditions will take effect in August 2020.

MDH also approved two new delivery methods: water-soluble cannabinoid multi-particulates (for example, granules, powders, and sprinkles), and orally dissolvable products such as lozenges, gums, mints, buccal tablets, and sublingual tablets.

The program’s two medical cannabis manufacturers will double the number of patient cannabis treatment centers in accordance with legislation passed during the 2019 Minnesota legislative session. These new sites will mean greater access to cannabis treatment centers.

As in years past, MDH used a formal petitioning process to solicit public input on potential qualifying conditions. Throughout June and July, Minnesotans submitted petitions to add qualifying conditions. Following this petition period, the process included public comments and a citizens’ review panel. MDH staff also prepared a set of documents summarizing the available research pertaining to the use of medical cannabis for each prospective condition.

Improved outcomes for ventilated hospital patients

Delta Dental of Minnesota Foundation has partnered with the Minnesota Hospital Association (MHA) to work with hospitals and health systems across Minnesota to improve oral health for patients on ventilators. With support from a $400,000 grant from the foundation, MHA created a best-practices toolkit for treating the oral health of ventilator patients and to pilot with local hospitals to improve overall health outcomes.

Poor oral health has been linked to hospital-acquired pneumonia and to ventilator-associated pneumonia (VAP), the focus of this project. More than a quarter million people in the United States receive mechanical ventilation each year, making them vulnerable to serious health complications such as acute lung injury and respiratory distress syndrome, as well as increased risk of mortality related to pneumonia. VAP occurs in 8% to 28% of these patients, which leads to an additional $41,000 in health care costs, a 14-day increase in the length of hospitalization, and, for 9% to 13% of patients, mortality.

The MHA-led project contributes to the goal of reaching a 20% reduction in ventilator-associated events as called for by the Centers for Medicare & Medicaid Services. Research shows that oral hygiene is an important intervention, in combination with other strategies, to prevent VAP. With Delta Dental support, MHA and oral health experts from across the state identified specific steps hospital care team members can take to help maintain oral health for ventilated patients.

Successful steps include raising awareness of oral health for ventilated patients by identifying a designated coordinator or including oral health on a list of topics to review for each patient. Care team members brushed patients’ teeth or swabbed or rinsed patients’ mouths every two to four hours. Documenting each oral health intervention—brushing, swabbing or rinsing—in the patient’s chart was critical to maintaining oral health as a priority.

Grants to support people with dementia, caregivers

Help is on the way for patients with Alzheimer’s disease and other forms of dementia—and those who care for them—under a package of $750,000 in grants appropriated by the Legislature and awarded by the Minnesota Board on Aging.

Planned activities include memory screenings, collaborations with health care providers to improve referrals, and culturally responsive trainings. Several organizations are offering Dementia Friends training, designed to change the way community members think, act, and talk about dementia.

“These funds support not only people with Alzheimer’s and other forms of dementia but their family and friends, who play such a critical role in caregiving,” said Kari Benson, executive director of the Minnesota Board on Aging. “Alzheimer’s alone impacts some 91,000 Minnesotans over age 65, a number that continues to grow, and more than 254,000 people who provide care informally.”

Initiative Designed to Help Stop Abuse of Adults with Disabilities

“Treat People Like People—Abuse Stops with Us,” a new campaign designed to raise awareness of abuse of adults with disabilities, was recently initiated by the Minnesota Office of Ombudsman for Mental Health and Developmental Disabilities (OMHDD) and the Governor’s Council on Developmental Disabilities (GCDD). The Department of Human Services (DHS) will also be joining as a partner and funder of the campaign.

From 2012 through 2016, there was an increase of more than 2,000 maltreatment reports of vulnerable adults in the state, according to DHS. During this same period, reports of neglect increased 38% among people with disabilities, and abuse grew by 26 percent.

In response to these trends,

OMHDD and GCDD have developed a plan to raise awareness of abuse and mistreatment and to educate people with disabilities, their families and guardians, mandated reporters, and the general public on how to identify and report instances of abuse. An overarching goal of the initiative was to show that individuals living with disabilities are valuable, unique human beings deserving of respect and inclusion. People with disabilities shared, in their own voices, their experiences and stories.

Videos, tools, and resources for direct care providers, vulnerable Minnesotans, their families, and the public are available online at https://treatpeoplelikepeople.org.

Heart attack risk may be elevated in middle-aged adults with BPD

Middle-aged adults who show symptoms of borderline personality disorder may be at greater risk for a heart attack, as they show more physical signs of worsening cardiovascular health than other adults, according to research published by the American Psychological Association.

“Although borderline personality disorder is well studied for its relationship to psychological and social impairments, recent research has suggested it may also contribute to physical health risks,” said Whitney Ringwald, MSW, MS, of the University of Pittsburgh, lead author of the study.

Borderline personality disorder is characterized by intense mood swings, impulsive behaviors, and extreme emotional reactions. This inability to manage emotions often makes it hard for patients to finish school, keep a job, or maintain stable, healthy relationships. According to the National Institute of Mental Health, 1.4% of adults have BPD, but that number does not include those with less severe symptoms.

Researchers looked at self-reported basic personality traits, as well as those reported by up to two of the participants’ friends or family members, and self-reported symptoms of depression. By combining several physical health measurements, including blood pressure, body mass index, and the levels of insulin, glucose, cholesterol, and other compounds in the blood after a 12-hour fast, the researchers established a relative cardiovascular risk score for each participant, along with a significant association between borderline personality traits and increased cardiovascular risk.

The researchers said their findings have important implications for primary care doctors and mental health professionals who treat patients with BPD.

Healing center for moms with depression, anxiety breaks ground

Hennepin Healthcare recently started construction on its Redleaf Center for Family Healing for Twin Cities moms, babies, and families.

About one in seven mothers experience depression and anxiety during and after pregnancy, according to Helen Kim, MD, medical director for the Mother-Baby Program and co-founder of the Redleaf Center. Without treatment, the impact on a mother’s mental health can be devastating—and sometimes fatal, affecting the entire family as well as future generations.

The Redleaf Center will expand on the space and services of Hennepin Healthcare’s Mother-Baby Program, Minnesota’s first intensive mental health program for pregnant and postpartum moms. It will support families through services that nurture the mind, body, and spirit—from comprehensive mental health and relationship support to onsite childcare, integrative medicine, a teaching kitchen, gathering space, and more.

The groundbreaking ceremony drew leaders from health care, the community, and local government, including Hennepin County Commissioner Marion Greene (District 3). Families who have benefited from the Mother-Baby Program also attended the ceremony.

The $30 million endeavor was initiated by a $10 million donation from the Lynne & Andrew Redleaf Foundation. The ceremony also recognized a new gift of $2.25 million from the Pohlad family.

Construction is slated to be completed in November 2020 

  Medicus

Nathan Chomilo, MD, will serve as medical director for the Department of Human Services’ health care programs, beginning in January. A pediatrician and internist, Dr. Chomilo is a founding member of Minnesota Doctors for Health Equity, a statewide coalition of physicians, and serves as medical director for Reach Out and Read.

Conor Ryan, MD, has joined the pediatric neurology team at Noran Neurological Clinic. Dr. Ryan’s clinical interests include general child neurology, pediatric neuromuscular medicine, electromyography (EMG), and developing medical devices. He is board-certified by the American Board of Psychiatry and Neurology, and holds a special qualification in child neurology.

Andrew Haak, PhD, from Mayo Clinic in Minnesota, has been named to a new American Lung Association research team, part of the organization’s Airways Clinical Research Center (ACRC) Network and its Awards & Grants program. Dr. Haak was given the Catalyst Award for his research project, titled “Catecholamine Signaling Regulates Pulmonary Fibrosis.”

Maricela Schnur, MD, has joined St. Luke’s Interventional Pain Management program in Duluth. Dr. Schnur treats numerous areas of chronic pain utilizing medical management, interventional injections, and surgical options such as spinal cord stimulation and peripheral nerve stimulation. Her interests include myofascial pain, chronic low back pain, peripheral neuropathies, and joint pain.

Jason Howard, DO, an anesthesiologist, has joined the Essentia Health–St. Joseph’s Medical Center in Brainerd. Dr. Howard earned a medical degree from A.T. Still University in Kirksville, Missouri, and completed a residency in anesthesiology at the University of Florida College of Medicine in Gainesville, Florida. He is board-certified by the American Board of Anesthesiology.

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Construction is slated to be completed in November 2020