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Conventus Case Study Practice Advice Hotline – Pain Management Real Time Advice

Conventus Case Study Practice Advice Hotline – Pain Management Real Time Advice
11/1/2017

Challenge.  

A member internal medicine physician was managing a long time patient, a 60-year-old disabled female with several co-morbidities, including but not limited to, fibromyalgia, tendonitis, back pain, and spondylolysis.  The patient requested a refill of Vicodin before the prescription renewal date.  The physician requested the patient come in for an office visit to evaluate her condition.  The physician took a urine sample, in accordance with New Jersey regulations requiring testing at least every 12 months.  The urine drug screen results were negative for Vicodin but positive for Xanax, and the physician suspected drug diversion.  He presented these results to the patient, who became extremely upset.  She admitted to taking Xanax and claimed her psychiatrist had prescribed this medication.  In addition, she was insistent that she had taken the Vicodin, although her pain had increased.  
Solutions
The member physician contacted the Conventus 24/7 Practice Advice Hotline, a free and confidential service that is always available to Conventus members and their practices. He was advised:
  • Check the New Jersey Prescription Monitoring Program (NJPMP) statewide database of prescription information to ascertain if the patient was obtaining opioid prescriptions from other physicians and/or “doctor shopping.”
  • Contact the patient’s psychiatrist to coordinate care and find out what medications were being prescribed.
  • Contact the lab regarding accuracy and sensitivity of the lab results.
  • Obtain signed Informed Consent and Pain Management Agreement forms to establish patient responsibilities and provider expectations.  Conventus sample templates were given to the physician in compliance with New Jersey law and regulation.
  • Evaluate the patient to determine why her pain had suddenly increased, including possible referral to specialists.
 
Result:
  • We assisted the physician in registering for the NJPMP. 
  • The physician contacted the patient’s psychiatrist, and the two physicians coordinated medication management. 
  • The physician referred the patient to orthopedic and pain management specialists.
  • The patient signed the Informed Consent and Pain Management Agreements, which also established consequences for diversion, addictive behavior, and/or receiving Schedule II Controlled Dangerous Substances from more than one provider.
  • The physician contacted the lab about the negative drug screen.  A lab representative indicated that the urine drug screen ordered by the physician was not sensitive for Vicodin.  Subsequently, the correct tests were ordered, which showed that the patient was taking the medication as prescribed.
  • The patient’s care and medication management was now coordinated between the specialists, the psychiatrist, and the member internal medicine physician.  There were no more incidents of early refills, and the patient obtained her pain medications from one source physician.
  • The member physician was now in compliance with NJPMP and NJ Opioid Laws and Regulations, and thus not in jeopardy of New Jersey Board of Medical Examiners disciplinary actions or sanctions.         Learn more today: https://www.conventusnj.com/contact.aspx