Pharmacists play major role in getting rural seniors vaccinated for pneumonia, but shots for the disease are less likely in rural areas

WebMD photo

By Melissa Patrick
Kentucky Health News

Pharmacists play a significant role in getting rural people vaccinated for pneumonia, and presumably other diseases, more so than in urban areas, according to a study by the Rural and Underserved Health Research Center at the University of Kentucky.

The study found pneumonia immunization is less common among seniors in rural areas, and pharmacists could play a major role in closing that gap, the owner of a small pharmacy chain told Kentucky Health News.

Rosemary Smith, a co-owner of six Jordan Drug stores in Eastern Kentucky, said in a telephone interview that the vaccination rate in rural areas is probably lower because they have fewer health-care providers and most of "our people" are not "wellness oriented" -- but almost every community has access to a pharmacist.

"The key is that we see these patients," Smith said. "They may go to their physician two or three times a year, but we see them two or three times a month sometimes. So we are very accessible to them,  especially independents."

The study notes that all 50 states and Washington, D.C. allow pharmacists to provide pneumonia vaccines, and that 93 percent of all Americans live within five miles of a community pharmacy.

Using 2014 data from the Medicare Physician and Other Supplier Public Use Files, the study looked at the rural and urban differences in pneumonia vaccine rates for people 65 and older, and then assessed the impact of pharmacies as an alternative to primary-care providers.

The study found that of the 1.4 million fee-for-service Medicare patients who had received a pneumonia vaccine, 72.5 percent got their vaccine from a primary-care provider and 22.2 percent got it from their pharmacist.

It also found that pharmacists delivered a "significantly greater proportion" of the pneumonia vaccines in rural areas than in urban ones: 29.4 percent and 21.1 percent, respectively. The results suggest that pharmacists could play a major role in increasing vaccination rates in rural areas, especially if they are actively encouraged to do so.

There is a need to do that. The study points out that vaccination rates for pneumonia are 40 percent lower in rural communities than in urban areas: 2.81 percent and 4.66 percent, respectively.

Kentucky's overall pneumonia vaccination rate for seniors was 3.8 percent, with 3.1 percent of the state's eligible population getting the vaccine in rural areas and 4.9 percent in urban areas.

The national rate was 4.26 percent, ranging from 6.3 percent in Colorado to 1.1 percent in Maine.

Why is it important for seniors to get vaccinated for pneumonia? The researchers note that the death rate from pneumonia for seniors doubles, from 20 percent to 40 percent, between the ages of 65 and 85, and despite the recommendation that everyone 65 and older get vaccinated for the disease, fewer than two-thirds do so.

In the interview, pharmacist Smith said patient education and encouragement are important in getting people vaccinated, noting that the Jordan Drug store that provides the most pneumonia vaccines is in a town where the physicians at the local clinic strongly recommend it to their patients.

"The opportunities are there to really move the needle on these vaccinations," said Smith, a founding member of the Kentucky Independent Pharmacist Alliance, which says it represents more than 500 independent pharmacists, with members in all 120 counties.

Smith said she thought pneumonia vaccination rates in pharmacies are likely higher than they were in 2014, since more pharmacies now offer them and people are getting used to the idea that they can go to the pharmacy for them, she said there is room to do more. Jordan Drug didn't start offering vaccinations until 2015.

"I had no idea there was such a difference in the vaccination rate between urban and rural," she said. "So I think we can do more and I think as an independent pharmacy group across the state, being the most accessible health care provider, that we will do more and we will take this study to heart."

Many local, independent pharmacies in Kentucky say they're at risk of closing because they are paid such low dispensing fees by pharmacy benefit managers hired by the managed-care organizations that handle Medicaid. A hard-fought bill to address this issue will go into effect July 1. The new law will put the state Medicaid department in charge of setting reimbursement rates for pharmacists, and require the  pharmacy benefit managers to be more accountable for how they spend the $1.7 billion a year they get to process prescriptions. The bill was sponsored by Sen. Max Wise, R-Campbellsville.

The UK study also measured county-level characteristics associated with pneumonia vaccination and found it more likely with "increasing age of residents, greater proportion of female residents, and availability of inpatient hospital services," and less likely in rural and poor areas.

"Given that over 50 percent of the nation’s primary-care health-professional shortage is in rural areas," the study said, limited access to primary-care providers may limit vaccinations, "resulting in a shift to service delivery in pharmacies, as shown in this study."

The study team was led by UK pharmacy professor Jeff Talbert, director of the UK College of Pharmacy's Institute for Pharmaceutical Outcomes and Policy and associate director of the UK Center for Clinical and Translational Science.

Tick season has arrived in Ky.; here are the most common ticks in our state and how to keep from getting the diseases they carry

By Melissa Patrick
Kentucky Health News

Kentuckians are finally heading outdoors to enjoy the warm weather, but the higher temperatures also means that it's tick season again, which lasts through August in Kentucky.

Mosquito Squad of Louisville graphic; click on it for larger version

“In tick-prone areas, check yourself, children and other family members every two hours, and very thoroughly after returning home from hikes and other outdoor activities,” Lee Townsend, extension entomologist in the University of Kentucky College of Agriculture, Food and Environment, said in a news release. “Common places to find ticks are behind the knees, around the waist, under arms, neck and head.”

Tick-prone areas include wooded areas; the boundaries between woods and fields; tall grass; low-hanging tree limbs; underneath leaves, plants, and ground cover; and around stone walls and woodpiles that are home to mice and other small mammals that have ticks.

The state health department recommends that Kentuckians remember four steps when it comes to protecting themselves from ticks: Protect, Check, Remove and Watch.

Protect: To protect yourself from tick bites, avoid tick-prone areas, but if you are going to be in those areas use a tick repellent that has 20 percent DEET,  picardin, IR3535 or lemon eucalyptus. Wear light-colored, long-sleeved shirts and pants tucked into socks. Use permethrin-based clothing sprays, unless you have cats, which find it toxic.

Check: After you've spent time outdoors, do a head-to toe check for ticks using a hand-held or full-length mirror. Parents should check children. It is also important to check your gear and pets for ticks. If possible, change your clothes and shower after going outdoors. To kill ticks on dry clothes, put them in a dryer on high heat for 10 minutes. If clothes require washing, use hot water.

CDC photo

Remove: Remove an embedded tick as soon as possible by grasping it as close to the skin as possible with tweezers and pulling straight out with gentle, even pressure. Do not jerk or twist the tick. Wash your hands with soap and water after the tick is removed. Apply an antiseptic to the bite site. Do not use alcohol, matches, liquid soap or petroleum jelly to remove a tick. Dispose of the tick by submersing it in alcohol, placing it in a sealed bag or container, wrapping it tightly in tape or flushing it down the toilet. Never crush a tick with your fingers.

Watch: Watch for symptoms of tick-borne illness, including sudden fever and rash, severe headache, muscle or joint aches, nausea, vomiting, and diarrhea. Symptoms can arise within several weeks of removing a tick. Contact your healthcare provider if symptoms occur.

Overall, the incidences of tick-borne diseases remain low in Kentucky, but that doesn't mean you shouldn't take precautions to protect yourself.

The most common tick species in Kentucky are the American dog tick and an aggressive biter called the lone star tick. Bites from these ticks typically just cause local irritation and itching, but a small percentage carry diseases.

In particular, the adult female lone star tick, which has a white spot on its back and is about the size of a pencil eraser, can carry erlichiosis, a Lyme-like disease that can cause fever, headache, chills, muscle pain and in some cases a rash. It can also cause some people to develop an allergy to red meat.

American dog ticks, which are reddish-brown with mottled white markings on their backs and also about the size of a pencil eraser, have the potential to carry Rocky Mountain spotted fever, which usually begins with a sudden onset of fever and headache that appears from two to 14 days after being bitten by an infected tick. The fever can be fatal if not treated correctly.

A much smaller tick that is becoming more common in Kentucky is the blacklegged tick, also known as the deer tick. It carries Lyme disease, symptoms of which can range from mild to severe, including fever, headache, fatigue and a skin rash that looks like a bull's-eye, although not everyone gets the rash.

In 2016, Kentucky had 16 confirmed cases of Lyme disease, and 17 probable cases, according to the federal Centers for Disease Control and Prevention.

The news release also notes a recent confirmation of tularemia, a bacterial disease that can be transmitted by tick bites, in a captive wild rabbit in Butler County. Tularemia can be life threatening, but most infections can be treated successfully with antibiotics, according to the CDC.

The state Cabinet for Health and Family Services is hosting a Facebook Live event to discuss tick awareness and prevention at 1 p.m. ET June 4. It can be found at facebook.com/kychfs. Questions can be emailed in advance to chfs.communications@ky.gov or posed in the comments section during the event.

Obese kids in rural Ky. are heavier than obese kids in urban Ky.

By Melissa Patrick
Kentucky Health News

LEXINGTON – Obese children and adolescents in rural Kentucky weigh more than their obese counterparts in the state's urban areas.

That was one of the research findings reported at the eighth annual Barnstable Brown Diabetes Center Research Day at the University of Kentucky, where researchers from UK and other regional institutions shared their latest research on obesity and diabetes.

Previous studies have found that obesity is more prevalent in rural areas. In the UK study of Kentucky children, the average weight in the rural group was nearly 186 pounds, with a body-mass index of 35.56. In urban areas, the average weight was nearly 166 pounds, with a BMI of 32.19.

BMI is a ratio of height to weight and is used as a screening tool to indicate whether a person is underweight, a healthy weight, overweight or obese. A healthy weight score ranges from 18.5 to 24.9, with higher figures considered overweight and 30 the threshold for obesity.

Other studies have shown that pediatric obesity is higher among low-income families, and nearly one-fourth of Kentucky's children live below the poverty line in rural areas and the Appalachian region, noted Dr. Aurelia Radulescu, medical director of the Kentucky Children's Hospital Pediatric High BMI Clinic.

Nearly one in three Americans from age 10 through 17 is overweight or obese, according to the State of Obesity report. Kentucky's rate of 33.5 percent ranks it 14th among the states.

The study looked at 629 Kentucky children, 2 to 18, with a BMI greater than or equal to the BMI of 95 percent of those of the same age and sex.

The study found that the rural children had higher lipid profile, or cholesterol, levels and higher liver-enzyme levels than the urban children, which Radulescu said put them at a higher risk of heart disease and fatty liver disease, respectively.

The researchers also reported that "a high proportion" of the obese youth had pre-diabetes and were short of vitamin D, which facilitates the body's absorption of certain minerals.

Radulescu said the results are important because they support early screening for these "metabolic abnormalities," which can provide an important tool to discuss the effects of obesity and weight gain in children, and be used as a way to motivate families to change lifestyles that lead to obesity.

Radulescu noted that the study did not consider family history or other social determinants of health. Other researchers in the study were Dr. Hong Huang, Mary Killian, Dr. Carmel Wallace and Dr. Henrietta Bada.

Poll: 72% of Ky. adults had problems paying for health care last year; lawmakers show bipartisan agreement on some approaches

By Melissa Patrick
Kentucky Health News

LEXINGTON – After learning that nearly three-fourths of Kentucky adults reported having had one or more problems affording health care in the past year, two Democrats and one Republican in the legislature found they had much to agree on when it came to finding ways to address this problem.

Rep. Kim Moser, Rep. Wilson Stone, Sen. Morgan McGarvey
and Sheila Schuster (L-R) at the May 14 forum:, titled "The
 State of (Un)Affordable Healthcare in Kentucky" 

The lawmakers were part of a legislative panel at a Kentucky Voices for Health forum to discuss the results of the new health-care affordability survey  The forum was held May 14 in Lexington, with nearly 50 health advocates in attendance.

When the legislators were asked what they'd do if they could wave a magic wand to improve Kentucky health care, Sen. Morgan McGarvey, D-Louisville, said he would have raised the cigarette tax $1, not the 50-cent hike that passed in the last legislative session.

He noted that research indicates a 50-cent increase will not significantly reduce the state's smoking rate or have any impact on the its health because cigarette companies will offer rebates to make up the difference. McGarvey said he knew a House member who has already received a 50 cent rebate in the mail, though the increase hasn't taken effect.

Rep. Wilson Stone, D-Scottsville, offered several ways to improve the health of Kentuckians by making it more affordable, including stabilizing the individual market; improving "high-quality job procurement," meaning skilled, high-paying jobs that offer good health insurance; allowing health coverage across state lines; and allowing associations to offer group health plans.

The only Republican on the panel, Rep. Kim Moser of Taylor Mill said, "I don't disagree with either of my colleagues here."

Moser, who is also the director of the Northern Kentucky Office of Drug Control Policy, added that it's important to address the many issues around addiction in Kentucky.

"Until we really invest in early childhood learning, early prevention, and early identification of those individuals who are at risk, whether it's because of a mental health issue or their family situation -- whatever it is that places them at risk -- I think we need to really hone in on that," she said.

Survey finds "deep bipartisan support for change"

The panel's bipartisan agreement was supported by the affordability survey, which found "deep bipartisan support for change," according to Lynn Quincy, an official of Altarum, the company that conducted the study.

For example, 74 percent of participants said they agreed with the statement, "The U.S. health-care system needs to change," there was little difference among Republicans, Democrats and those who said they identified with neither party.

And when asked about the "major reasons" for the high cost of care, such as drug makers, hospitals and insurance companies charging too much money, or support for specific changes such as making it easier to switch insurers if your health plan drops your doctor, there was also bipartisan agreement.

One attendee suggested a #WeAgree campaign to inform people that when it comes to health-care affordability burdens and solutions, there is little partisan divide. Quincy agreed.

"We need to agree and come together as consumers to counteract extremely powerful stakeholders elsewhere in the system," Quincy said. "We've got to give our elected representatives cover, and I think with this false narrative of division they don't have that cover."

Emily Beauregard, executive director for Kentucky Voices for Health, charged the policymakers to find ways to align the state's health-care system with the needs of Kentuckians.

"As health advocates, we believe that it is critical that Kentucky policy makers understand the high cost on their constituents and work toward policy solutions that will bring relief," she said.

Insurance and care are expensive; collection agencies contacted 1/4 in poll

The survey also found that the 72 percent of Kentucky adults who struggled to pay for health care in the past year reported that their affordability issues largely centered around not being able to afford insurance, delaying or foregoing care because of cost, and struggling to pay medical bills. One in four participants said they had been contacted by a collection agency.

The regional results showed that 80 percent of adults in Eastern Kentucky said they had had affordability burdens in the past year, the highest rate of any region.

Kentucky adults worry about their health care; 71 percent said they worried that they will be unable to afford medical costs when they become elderly; 69 percent worried about the cost of a serious illness or accident; and 59 percent worried about the cost of prescription drugs.

Real stories about health-care costs

The forum also included a panel of four Kentuckians who told about how they or their small businesses had struggled with health-care costs.

Kristi Roberts said she works for a small business that has provided health insurance for its employees since 1948. She told the group that their health-coverage costs have been increasing yearly for some time, but that this year's 27 percent increase has put them in danger of dropping insurance.

Debbie McAfee, who has been diagnosed with multiple sclerosis and works as an advocate for those with the disease, said the cost of treatment has jumped from $8,000 per year to upwards of $90,000 a year, between 1993 and 2017, with no major modifications to the drug.

Jane Harrod, a Lexington farmer, said she didn't have health insurance when she suffered an accident that required emergency surgery, but she was able to find a surgeon who offered a discount and allowed her to pay out of pocket. She said that since she's been off work she's been on Medicaid, but after she goes back to work she'll be without insurance again because she won't be able to afford it.

Megan Naseman of Berea said she had been recently hospitalized for sepsis and had paid $4,500 for medical expenses since January. She told about her choice to delay emergency room care at 2 a.m. for what could have been a recurrence of the disease because the Anthem nurse couldn't promise her that the visit would be covered if she went to the emergency room.

"What would it be like if when you get sick you just have to worry about getting well?" she asked. "If you didn't have to worry about what is this going to cost me."

The survey, taken Feb. 7 to Feb. 23, included more than 900 Kentucky adults and was conducted by Altarum Healthcare Value Hub, with support from the Robert Wood Johnson Foundation.
__________

OTHER COMMENTS FROM LEGISLATORS

Stone noted some of the largely bipartisan measures the legislature has passed in recent years, such as expanding the scope of care by advanced-practice registered nurses, pharmacists, physical therapists and physician assistants; increasing access to colon and breast cancer screenings; requiring insurers to cover autism; and funding major research with funds from the 1998 settlement with cigarette makers.

"When you expand the availability of health care you just by definition make it certainly more available and hopefully more affordable," Stone said.

McGarvey said, "I think when you talk about it as cost, we do ourselves a disservice, because it's not a cost when you talk about health care; at a basic level you are talking about justice or injustice. . . . You shouldn't be threatened with your home, with your life because you did everything right and the hospital didn't tell you in advance that the doctor working that day wouldn't be covered by your insurance, even though you thought they would. It's not rich or poor, smart or dumb. I don't know the person who could figure that out in real time at that moment. Or have any choice about it."

Referring to the state's changes in Medicaid, McGarvey said, "We had the best model for delivering healthcare in the country, and since it wasn't broke we decided to fix it. There is absolutely nothing that shows a costs savings in real dollars. In particular, in human costs and justice to people. . . . I'm seeing a little bit more bipartisanship in some of these conversations when we talk about data and research and take the politics out of it."

Moser said of the changes, "I think it's very important to put things in place that don't create barriers for individuals to get treatment, but at the same time we do need to find a sustainable model. We can't just keep paying for things that don't necessarily work."

She noted a bill that recently became law that focuses on addiction treatment and bases payment on following best-practice standards to get paid. "We're really paying attention to what works and what we can afford," she said, "because we have to do both."

As hepatitis A outbreak continues in Kentucky, health officials say vaccine is best way to protect yourself; and wash those hands!

By Melissa Patrick
Kentucky Health News

Since state officials declared an outbreak of hepatitis A in November, Kentucky has had 577 confirmed cases of it. That's almost 30 times the state's average of about 20 cases a year, and five of those 577 people have died from the liver disease.

The most common prescription for preventing hepatitis is hand washing, but the absolute best way to avoid the highly contagious disease is vaccination, which requires two shots, six months apart.

The first dose provides more than 90 percent immunity, but getting both shots offers lifelong protection, Louisville health officials told Darcy Costello of the Louisville Courier Journal.

State health officials have advised anyone living in Jefferson, Bullitt, Hardin, Greenup, Carter and Boyd counties, where the outbreak has been concentrated, to get a vaccination.

Officials also advise shots for anyone at high risk for getting the disease, including people who use illegal drugs, people who are homeless or have unstable housing, men who have sex with men, people recently in jail or prison and people with underlying liver disease.

Boyd County residents have responded well to the call, Erin Crace, nurse supervisor at the Ashland-Boyd County Health Department, told Kentucky Health News in a telephone interview. She said the agency vaccinated more than 100 patients a day in mid-April, and the number has dwindled to about 10 to 15 per day.

The department has also reached out to food-service workers to get them vaccinated. As of May 15, six Boyd County food workers have been diagnosed with the disease, the Lexington Herald-Leader reports.

Hepatitis A is found in the feces of people with the disease and is most frequently transmitted by eating or drinking something that has been contaminated with fecal matter -- typically because the food or beverage has been handled by someone with the virus who hasn't properly washed their hands after going to the toilet or changing a diaper. It can also be spread when someone with the virus shares a cigarette, drink or towel, or through sex, drinking contaminated water, and illicit drug use.

So far, most of the state's cases have been among the homeless and drug users, according to the Kentucky Department for Public Health.

A person can get the hepatitis A vaccine in a number of places, including health departments, pharmacies and primary-care providers, but Crace recommends calling first to make sure they have the vaccine in stock before you go.

Because of rules for storing and handling the vaccine, which expires, many primary-care providers, especially in low-risk counties, don't always have the vaccine on hand, and pharmacies might be more likely to have it, Crace said.

She added that the supply of vaccines will also vary among health departments, but the health departments in Boyd, Carter and Greenup counties were well stocked.

Crace said the Ashland-Boyd County department is able to vaccinate children and most people with insurance as well as those who are uninsured or under-insured. It can also offer the vaccine for a cash price. It offers a walk-in clinic between 8 a.m. and 9 a.m., and appointments as available for the rest of the day. It is open Monday through Friday.

A new state regulation requires students to have had the two-dose hepatitis A vaccine by the first day of school, but Crace said the department hasn't vaccinated many children recently, because many of them have already received it; it is offered at 12 months of age and older.

The most common symptoms of hepatitis A are fatigue, low-grade fever, loss of appetite, joint pain, sudden nausea and vomiting, yellow eyes or skin, abdominal pain, pale stools and dark urine, according to the Centers for Disease Control and Prevention. A person with the virus is contagious for up to two weeks before showing symptoms. Symptoms usually last less than two months, but 10 percent to 15 percent of victims remain sick for up to six months.

Another report on the upsurge of methamphetamine in Kentucky, this time from an eastern county: Johnson

Methamphetamine image from Drug Enforcement Administration

While most of Kentucky's focus has been on finding ways to combat the state's heroin and prescription drug epidemic, another drug that had captured headlines just a few years ago is on the rise -- methamphetamine.

Meth use has long been mostly prevalent in Western Kentucky, but is moving east.

“We’re completely eat up with it around here,” Paintsville Police Chief Mike Roe told Aaron K. Nelson of The Paintsville Herald. “It’s an epidemic.”

Nelson reports that according to the Johnson County Judicial Center, meth production is on the decline in Johnson County, but possession and trafficking of the drug is on the rise.

"The numbers for first-offense meth possession started with a handful of charges in 2008. They slowed down in 2012, but have skyrocketed since, peaking with 80 charges in 2017," he writes. And as of early May, Nelson reports that there have already been 26 charges in the county.

Nelson adds that first-offense manufacturing of methamphetamine peaked in 2013 and 2014, with 20 cases each year, compared to just one case in 2016, one in 2017, and zero so far in 2018. But at the same time, trafficking of the drug has increased, reporting that "first-offense trafficking meth cases in 2017 were the highest on record," with those numbers having been tied or exceeded already in 2018.

“A few years ago, you had manufacturing here. A lot of shake-and-bake,” Roe told Nelson, referring to the relatively easy — and dangerous — method for making low-quality methamphetamine in small, portable labs. “Now, it’s coming in from Detroit, Louisville, Huntington … everywhere.”

Beth Warren of the Louisville Courier Journal has reported a similar meth surge in Louisville, and Dave Thompson of The Paducah Sun has reported that methamphetamine is now the "drug of choice" in Western Kentucky and Southern Illinois.

"Meth-related deaths in Kentucky more than tripled from 2013 to 2016, when 252 people died, according to the Kentucky Injury Prevention and Research Center. More than a third of those deaths were in Jefferson County," Warren wrote. "Police across Kentucky intercepted more than triple the amount of meth last year than they did in 2013, according to a recent state police report. Nearly 11,000 drug seizures submitted to the state crime lab last year were meth — more than heroin, cocaine and fentanyl combined."

“I would say trafficking is our top priority,” Roe said. “Busting these dealers.”

Bevin names Adam Meier, who as his deputy staff chief oversaw Medicaid change, to head Cabinet for Health and Family Services

Adam Meier (picture provided
to the Cincinnati Enquirer) 

Gov. Matt Bevin has appointed Adam Meier secretary of the Cabinet for Health and Family Services, the state's largest cabinet, with more than 7,000 employees and an annual budget of more than $12 billion.

Meier, a lawyer from Fort Thomas, was Bevin's deputy chief of staff for policy, and in that position was responsible for overseeing the new Medicaid plan, called Kentucky HEALTH (for "Helping to Engage and Achieve Long Term Health"), authorized by a federal waiver.

“For much of the past two years, he has been focused on health-care policy in Kentucky, and his empathy for people, combined with his legal background and working knowledge of human services programs at the state and federal level, make him an ideal choice to lead this important cabinet," Bevin said in a news release.

Bevin also named Kristi Putnam as a deputy secretary for the health cabinet. Most recently, Putnam, has served as the program manager for Kentucky HEALTH.

The new Medicaid plan adds new rules for many in the program, including a deductible account, which is like a health savings account; a rewards account that allows beneficiaries to earn credits for dental and vision care, which were once basic benefits; reporting requirements and penalties; and new premiums and co-payments.

The controversial "community engagement" requirements that require beneficiaries to work, volunteer or attend school or job training at least 80 hours a month will be phased in for most counties over the next year. These requirements will largely affect "able-bodied" adults without dependents who have gained Medicaid coverage through the 2014 expansion to people in households with incomes up to 138 percent of the federal poverty level.

Medicaid covers about 1.4 million Kentuckians, nearly 500,000 through the expansion.

“With the innovative changes coming with the Kentucky HEALTH waiver and the increased financial resources and legislative support for improving Kentucky’s child welfare, foster care, and adoption systems, I am honored and humbled at the responsibility Gov. Bevin has entrusted me with to lead the cabinet at this pivotal time," Meier said in the news release.

Meier succeeds Vickie Yates Brown Glisson, who left the office at the end of January to run against Democratic Rep. John Yarmuth in Louisville's 3rd Congressional District. The acting secretary has been Scott Brinkman, secretary of the Governor's Executive Cabinet.

New law to encourage safe disposal of unused painkillers takes effect in July; similar initiatives across state are already in motion

A new law to encourage the safe disposal of unused painkillers, and to make it easier to do so properly will take effect in mid-July.

Sen. Alice Forgy Kerr

Senate Bill 6, sponsored by Sen. Alice Forgy Kerr, R-Lexington, passed with overwhelming bipartisan support, with only one senator, Sen.Wil Schroder, R-Wilder, voting against the final version. Gov. Matt Bevin allowed the bill to become law without his signature.

The new law will require pharmacists to tell customers how to safely dispose of unused opioids and other controlled substances, and either provide or offer to sell them a product designed to neutralize drugs for disposal -- or provide on-site disposal.

Kerr told Kentucky Health News in March that shifting to a mindset of immediately getting rid of any unused pain medications will require a "cultural shift," much like when we had to learn to put our seat-belts on: "It took us a while."

The law adds to several other efforts to decrease the misuse of prescription drugs in the state, Michon Lindstrom reports for Spectrum News.

In August, Attorney General Andy Beshear announced creation of a pilot program called the Kentucky Opioid Disposal Program to provide drug deactivation pouches to people living in Floyd, Henderson, McCracken and Perry counties -- four that have struggled with opioid addiction.

And in March, he announced a partnership with CVS Health to launch a new medication-disposal program that involved the placement of in-store disposal units in nine of the company's 24-hour pharmacies. Click here for a list of the CVS locations with medication deposit boxes.

While announcing the CVS partnership, Lindstrom reported that Beshear said most heroin addiction begins with an addiction to opioids.

“That’s pretty profound,” said Beshear. “What that tells us is that 80 percent of people using heroin right now didn’t go out and actively make the decision to buy a street level drug until they were already actively addicted. For 70 percent of the people out there abusing prescription pills, they aren’t their pills, they are from a friend or family member. It tells us that the most dangerous place in each and everyone of our homes, the most likely place to cause addiction in our kids and our grandkids, is the medicine cabinet.”

Reps. Addia Wuchner, R-Florence, and Kim Moser, R-Taylor Mill, also introduced an initiative called the Spring Clean Northern Kentucky in March 2017 that brought safe drug disposal pouches to more than 30 locations in Boone, Kenton and Campbell Counties.

While presenting the initiative, Lindstrom reports that Wuchner and Moser stressed the importance of removing un-used drugs from the house to prevent others from misusing the medication and forming an addiction.

“These are potentially dangerous, they are dangerous when they are used and abused and the fact that we have medications that are still unused in our medicine cabinets, especially opioids we are at risk for a neighbor, for a visiting child, for a visiting young person, for our own children to get their hands on those medications.” said Wucher.

“It is important to reduce the supply of controlled substances, especially on the street, and that does start with getting them out of the medicine cabinets and really educating our families about exactly what it is they can do,” said Moser.

UK gets contract that will let it expand to rural Kentucky a program to get or keep pregnant women off opioids

Women with opioid-dependence problems during and after pregnancy will get more help from the University of Kentucky through a $4.9 million contract from the Patient-Centered Outcomes Research Institute, created by the Patient Protection and Affordable Care Act of 2010.

The contract will boost the Perinatal Assistance and Treatment Home (PATHways) program, now based in Lexington, which helps pregnant women with medication, peer support and health services to reduce the number of babies born with an opioid addiction. After delivery, they get peer counseling and health services.

The program has been successful. "Between 2014 and spring 2017, more than 150 women received treatment through PATHways. Of those, 77 percent were admitted to labor and delivery without any illicit drugs in their systems," Linda Blackford reports for the Lexington Herald-Leader. "Women who participate in the pilot will be required to find a local physician to prescribe medication assisted therapy, and the program will help them find this support if they don't already have it."

Blackford notes, "Kentucky has one of the highest rates in the nation of babies born with neonatal abstinence syndrome, a rate that has climbed from 46 babies in 2001 to 1,115 in 2016, according to hospital discharge data collected annually by the Kentucky Cabinet for Health and Family Services."

Read more here: http://www.kentucky.com/news/state/article210626234.html#storylink=cpy

The contract will fund a study in which one group of rural women will attend pregnancy and parenting support and education groups led by a trained nurse and a peer support specialist every other week. The other group will have meetings via telemedicine with specialists in high-risk pregnancy, addiction care, pediatrics or substance counseling. "The goal is for women to receive enhanced substance abuse care in their home communities, which is especially important to patients living in rural areas," a UK press release said.

The program was developed by the UK medical college's Department of Obstetrics and Gynecology and Department of Psychiatry, and the College of Nursing.

Medicaid work requirements to begin in Northern Kentucky this summer, with all but eight counties to be involved by Dec. 1

Kentucky's new work requirements for "able-bodied" Medicaid recipients will be phased in slowly, with the three main Northern Kentucky counties leading the way. Campbell County will be the first to instigate the new "community engagement" requirements on July 1, followed by Boone County on Aug. 1 and Kenton County on Sept. 1.

After that, large groups of counties are to be rolled into the program each month until the last scheduled counties are added Dec. 1.

Whitley, Knox, Bell, Clay, Leslie, Harlan, Perry and Letcher counties will be exempt from the community engagement requirements until December 2019, apparently because that area is part of a pilot project to help people in the Supplemental Nutrition Assistance Program (formerly called food stamps) find jobs.

Medicaid's new "community engagement" requirements are part of an overhaul of the program, part of which will require "able bodied" Kentuckians to participate in an approved community engagement or work activity 80 hours a month, and document their hours monthly, to keep their Medicaid coverage. Officials call the program PATH, for Partnering to Advance Training and Health.

The rest of the Medicaid benefit changes will start July 1 for all counties, according to the health cabinet. Those are the deductible account, which is like a health-savings account; the My Rewards account, which allows a person to earn credits for dental and vision care; the reporting and lock-out requirements; and the premium and co-payment requirements, etc.

A county-by-county spreadsheet of enrollment in Medicaid, as of January 2018, is at http://www.uky.edu/comminfostudies/irjci/MedicaidbycountyJan2018.xlsx.

Kristi Putnam, program manager for the changes in Medicaid, told attendees of a recent stakeholder forum in Frankfort, “Volunteering, care giving, job training, enrolling in classes and working are all qualifying activities," Darla Carter of Insider Louisville reports.

The changes will largely affect "able-bodied" Kentuckians without dependents who have gained Medicaid coverage through the 2014 expansion to people in households with incomes up to 138 percent of the federal poverty level.

Pregnant women, those who are deemed medically frail, primary caregivers of a dependent, full-time students, former foster youth up to age 26 and the chronically homeless will be exempt from the requirements.

Kentuckians who qualify for the program will get a notice in the mail about the community engagement requirements, as well as the address of a Kentucky Career Center to aid them.

“We’ve been partnering with our library system,” Putnam said. “We’ve been working with our federally qualified health care centers to find other locations and other places where career coaches can go and actually provide services, so job assessments, job placement services, connection to training and education programs, so this is intended to not be a you have to come to the career center. It’s very much intended to be a we will come to where you are.”

Putnam added that the slow rollout is designed to help the state troubleshot and allow for weekly meetings to discuss any issues that arise, Carter reports.

The state recently rejected a request by a consumer advocacy group that has voiced concerns about the changes, Kentucky Voices for Health, to create a stakeholders advisory council to help with the implementation of the program, Carter reports. (KVH has created two "explainers" about the changes, one in two pages, and a more detailed version in four pages.)

WFPL, a public radio station in Louisville, has also created an interactive tool called "Kentucky Medicaid Waiver Calculator," to help Medicaid enrollees and others figure out how it will affect the, based on family size, income and other factors. The state does not support its use.

Instead, the Cabinet for Health and Family Services has opted to continue with its current approach, which includes holding forums and sending beneficiaries notices in the mail, Carter writes.

The next forum is scheduled for June 7 at 1 p.m. at the Kentucky Career Center, 1324 Madison Ave. in Covington.

In addition, the state offers its own overview that includes answers to frequently asked questions; it is online at
https://kentuckyhealth.ky.gov/SiteCollectionDocuments/Kentucky%20HEALTH%20General%20Information%20Quick%20Print.pdf.

The state also offers a website, citizenconnect.ky.gov, where Medicaid beneficiaries can go to report and check in on their benefits, track their monthly program requirements and earn or spend their rewards from their My Rewards account.

The changes are being challenged in federal court in Washington by 16 Kentuckians on Medicaid who say the waiver approved by the Trump administration violates several federal laws. They also argue that the waiver risks the health care of tens of thousands of low-income families.

The administration of Gov. Matt Bevin has estimated that in five years, the Medicaid rolls would have 95,000 fewer people with the changes than without them, partly because of non-compliance. The program covers about 1.4 million Kentuckians.

Rural Health Journalism Workshop in North Carolina June 8; deadline to apply for travel stipend is May 23

The Association of Health Care Journalists is hosting a free one-day workshop on covering health on June 8 in Research Triangle Park, N.C.

The conference is free for AHCJ members, but registration is required by May 25. Members who need financial assistance should apply for one of the limited travel stipends by the May 23 deadline.

The keynote speaker will be Hannah Koch, a research and technical assistance associate for mental health at the Western Interstate Commission for Higher Education. Koch is tentatively scheduld to discuss key behavioral health issues in rural communities.

Five workshops will cover a variety of topics, including "What reporters should know about rural residents and rural health," featuring Alan Morgan, chief executive officer of the National Rural Health Association and Dr. Jeffrey Heck, president and chief executive officer of the Mountain Area Health Education Center.

Another workshop, "Will your local hospital survive?" will include George Pink, deputy director of the North Carolina Rural Health Research Program and Dana Weston, president of the University of North Carolina Rockingham Health Center.

"Addressing rural health workforce hurdles" will be a workshop with Mark Holmes, director of the North Carolina Rural Health Research and Policy Analysis Center and the director of the Cecil G. Sheps Center for Health Services Research, and Dr. Robert Bashford, associate dean for the Office of Rural Initiatives at the University of North Carolina School of Medicine.

The "Rural opioid crisis: Access to treatment and harm reduction" workshop will include Regina LaBelle, visiting fellow, Duke-Margolis Center for Health Policy and a former chief of staff in the White House Office of National Drug Control Policy, and Donald McDonald, executive director of the Addiction Professionals of North Carolina.

Wrapping up the day will be a workshop titled, "Can telemedicine transform health care in rural communities?" featuring Latoya Thomas, policy director for the American Telemedicine Association.

To register for the workshop, click here. To request a travel stipend click here, or send an e-mail to membership coordinator Tina England: Tina@healthjournalism.org.

Polk maintains he quit for health reasons, denies knowing he had been placed on 'special leave' amid allegation of drinking on job

By Melissa Patrick
Kentucky Health News

Former state health commissioner Hiram Polk told Kentucky Health News at the end of April that he left his position in September "strictly" over a disagreement with "middle management" over lack of funding for an early-childhood anti-drug program that he had championed, and because of his health.

But records in the internationally renowned surgeon's state personnel file show he had been placed on "special leave" to allow the Cabinet for Health and Family Services time to "investigate allegations of misconduct; i.e., the consumption and possession of alcohol during work hours while on Cabinet premises."

Dr. Hiram Polk

Polk denied knowledge of such an investigation and said "I did not know" that the special-leave notice had been placed in his file.

Asked if the charge was true or not, Polk said, "You are the first person I heard from about it. I have no knowledge of either possession or use."

He also said, "I am not aware now or then" that he had been accused of drinking on the job. Later, he said he had never seen his personnel file, and "It never occurred to me to do so."

Noting that the documents indicated that the leave notice was hand-delivered to him, he said he remembered Deputy Secretary Tim Feeley delivering a letter and suggesting "I ought to take this leave," but "I don't remember what was in the letter or anything else. . . . I told you as much about this as I know and you are talking from a document about me that I have never seen."

Doug Hogan, a spokesman for the cabinet, confirmed in an e-mail that the "special investigation leave action" was hand-delivered to Polk.

Hogan was asked about the timeline of documents in the file. He said Polk's resignation letter was dated Sunday, Sept. 17, but was not transmitted to the cabinet until after he had worked Sept. 18 and part of Sept. 19 -- the date of the  "special leave" notification letter was delivered.

Polk said it was his decision to resign. "I resigned because I was having medical trouble and had been told that I ought to have a pacemaker for a very slow heartbeat and that is not a minor thing in somebody my age," he said. He is 82.

Asked if there was anything else he wanted to say, Polk said he wanted to clarify that his disagreements with the cabinet had to do with "middle management" and had nothing to do with former Secretary Vickie Yates Brown Glisson, who resigned from her position in late January to run for Congress in Louisville.

In the earlier interview, Polk said, “The middle management people were essentially Vickie Glisson, and she's middle management – the whole thing is. So she did not agree with the expenditure of the money.” Glisson declined to comment.