Thursday, January 24, 2008
Since there is so much going on at the American Academy of Hospice & Palliative Medicine and the Hospice and Palliative Nurses Association Annual Assembly I will just cover some of the highlights of each day.
Previous posts for 2008 Annual Assembly:
AAHPM Pre-Conferences Wed Jan 30th
HPNA Pre-Conferences Wed Jan 30th
AAHPM/HPNA Annual Assembly Thu Jan 31st
Friday, February 1
The ICF and Decision Support in Hospice and Palliative Care
by Harry Feliciano, MD MPH
The speaker is from the Palmetto GBA and will be speaking on a new approach to verifying appropriateness for hospice. What is Palmetto GBA you ask? It is a Regional Hospice and Home Care Intermediary that helps verify Medicare claims for hospices mostly in the Southeast, although I am not sure of their entire coverage area. Apparently they have developed a new system with the WHO's International Classification of Functioning Disability and Health. While this talk is likely to be oriented to policy makers and organizational/administrative levels, it is probably good for many clinicians to begin to understand new ways we may have to justify appropriateness for hospice Medicare benefits. I would be really interested if anyone who attends this would be willing to write up a review for Pallimed after the conference.
There are a lot of FAAHPM speakers in this next session, with the three novel topics presented. Intravenous Methadone by Dr. Bridges (Alive Hospice) should give some comfort and caution to hospice clinicians working with this effective medication for pain relief in the IV(subcutaneous is also available) form. I am very glad for my palliative medicine fellowship with Dick Stephenson and Hospice and Palliative CareCenter in Winston-Salem, NC for allowing me to become familiar with prescribing it in the hospice population. Palliative Care for Patients with Developmental Disabilities by Ellison & Shabanowitz (Geisenger) is a great topic for an underserved population with unique challenges. The difficulty is probably in taking such a broad range of disabilities and applying general principles, but they should have some good insight. Filling out the session is Ira Byock (Dartmouth) covering responding to Requests for Hastened Death, as well as some more administrative issues, specifically Long Term Care, Research, and Legislation.
Wyeth sponsors the luncheon covering Opioid Bowel Dysfunction (hint: methylnaltrexone). I usually like the lunch time to meet with colleagues and network, and you usually have to preregister for this anyway.
The Program Planning Cmte (Christine Ritchie and MaryJo Prince-Paul) did a good job of splitting up the areas covered with each section. Evidence Based Ventilator Withdrawal with Campbell (Wayne State), Full-Time Palliative Care in a Rural Area with Pile (Hospice of Southwest Virginia) and Smusz (Carilion New River Valley), Physician Order for Life-Sustaining Treatment (POLST) implementation with Briggs (Gundersen Lutheran), and PTSD in Veterans at End of Life with Cutson and Sease (Duke). All great topics. (Do you think the AAHPM should have a POLST full-day pre-con next year? Might be good synergy?)
The one session I would highlight here is What's New in Analgesic Pharmacotherapy because 1) it is presented by pharmacists, which is nice because pharmacy is more involved with palliative training, and 2) it is presented by a University of Maryland School of Pharmacy faculty member, Dr. McPherson. I have to commend the University of Maryland School of Pharmacy for being so active at the AAHPM these last several years I have been. They always have several posters and one or two presenters. More palliative pharmacists please.
There is a lot of talks in this time slot not including the two paper sessions. And you have a lot of competing well-known speakers: Quill, Crossno, Casarett, Cleary, Arnold, Tulsky. Where to go? The most interesting topic but likely the one with the smallest proximal clinical impact is the session on the Patients' Rights and Public Policy in the Wake of the Abigail Alliance. For some reason this did not seem to hit the news cycle very long, but this is an important issue for the medical field. The Assembly is also experimenting with some limited registration workshops during this time which include Pain Management and Breaking Bad News, highly suggested for the new palliative care clinician without access to a lot of formal training resources.
Following the other workshops is a Symptom Management Skill Building session with Twaddle (Midwest PHCC). Two great topics during this time are Sarah Freibert (Akron Children's) instructing us how to Create a Palette of Care: Implementing a Full Service Pediatric Palliative Care Program. Hopefully we will have enough pediatric palliative care programs in the next few years to sustain more training programs in this needed area. Cuyegkeng and Scott (Kaiser Permanente) review a possibly overlooked area for hospice and palliative care: Medical Error and Patient Safety. A recent Fast Facts just came out about medical errors and I think there are a number of reasons this issue has not come up in hospice much before so this should provide a good framework. And congratulations to Irene Higginson from King's College London on her AAHPM Award for Excellence in Scientific Research.
And don't forget the 6-7pm Service of Remembrance and Celebration. No other meeting has something like this so if you have not participated before I highly encourage it.
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