May 3, 2019
Chapter Action Brief
Call for Abstracts. . . Buffalo Board Review Course. . . Deprescribing. . . DEIP. . . Measles. . . and More
Attention NYACP Residents and Medical Students: Call for Abstracts
The Chapter is now accepting abstracts online for the NYACP Annual Scientific Meeting poster competition on Saturday, October 12, 2019 at the Westchester Hilton Hotel in Rye Brook, NY.
The deadline to submit your abstract is Friday, July 12, 2019
If you have worked on a research project or have an interesting clinical case, submit your abstract for a chance to present in the following categories:
- Clinical Vignette
Residents/Fellows and Medical Students will be combined in the following category:
- Quality, Advocacy and Public Policy Category
Click on each category to learn more: ****Please note: we no longer require a username and password when submitting an abstract
Program/Clerkship Directors will be notified of competition results the week of September 2, 2019.
NYACP staff DOES NOT notify individuals of the results.
Submit Your Abstract Here
Weekend Board Review Course Buffalo
Earn up to 27 AMA PRA Category I credits- and 27 MOC Points!
In case you missed the Weekend Board Review in Rochester- you still have the opportunity to see Dr's Conrad Fischer, Chris Paras and Niket Sonpal in Buffalo. The weekend program is for residents who are preparing for the ABIM IM Board Exam in August and for Chapter members who are preparing to take the exam for Board Recertification. Register Here
Why Choose NYACP Weekend Board Review Course?
- Case Based Questions and comprehensive learning environment
- Earn up to 27 AMA PRA category 1 CME credits!
- It's Resident - Budget Friendly
- We provide the most up to date-high yield information!
- Excellent resource if you're planning to recertify!
- Earn up to 27 MOC points!
June 14-16, 2019
University at Buffalo
Jacobs School of Medicine and Biomedical Sciences
955 Main Street • Buffalo, NY 14203
This three-day course will cover pertinent topics you need to review for the upcoming exams. The topics will include:
8:30 am - 5:30 pm
8:00 am - 6:00 pm
8:00 am-6:00 pm
- Infectious Disease
- General Internal Medicine
- GI Hepatology
Read More Here • Register Online
NYACP and the CDC Address the Measles Epidemic
The Chapter is working hard to address the fast growing measles epidemic in New York State. During a recent conference call between NYACP and CDC representatives, information was shared about their immediate needs in New York to address the alarming number of measles cases - over 700 to date. All agreed that misinformation about vaccinations needs to be replaced with the wide circulation of accurate immunization messaging.
The Chapter is working with the Medical Society of the State of NY (MSSNY) as part of a coalition of stakeholders to engage the public to vaccinate. A press conference with all stakeholders, Senator Hoylman and Assemblyman Dinowitz, sponsors of legislation to limit vaccination exemptions, is planned for May 6, 2019.
A special thanks to the following NYACP representatives who participated in the April 19 conference call with the CDC: Louis Snitkoff MD FACP – Chapter President, Linda Efferen MD MACP- Chair, Health and Public Policy Committee, Rabbi Aaron E. Glatt, MD, FACP and NYACP Staff.
Measles Outbreak Throughout New York State: What Physicians Can Do
Recent outbreaks of measles in Rockland County, Orange County, and New York City have contributed to the largest measles outbreak in New York State since the elimination of measles in the US in the year 2000. Over 390 cases of measles outbreaks have been reported in Brooklyn and Queens alone.
Multiple studies have shown how impactful a state’s nonmedical vaccination exemption policies can be to the risk of an outbreak of a contagious disease. One recent publication in the journal of Academic Pediatrics found that “a state with easy nonmedical vaccine exemption policies is 140% and 190% more likely to experience a measles outbreak compared with states with medium or difficult policies, respectively.” The same report found that the magnitude of outbreaks decrease in half when there are fewer exemptions.
NYACP is supporting legislative efforts to address the measles outbreak, including support for NYS Bill S.2994 (Hoylman)/A.2371 (Dinowitz), which would eliminate non-medical vaccination exemptions for children. In addition, The Chapter has made available resources with the help of our members to help communicate with patients and physicians the importance of vaccinations. Here are a few:
From the DOH:
To read more, please view the Measles Page here.
*A special thanks to Rabbi Aaron Glatt, MD, FACP, for developing and producing this information to share.
Deprescription, The New Fashion in Prescribing!
This is the first in an ongoing series highlighting issues faced by geriatricians and their patients
TS Dharmarajan MD, MACP, AGSF, FRCPE
Vice Chairman, Department of Medicine; Clinical Director, Geriatrics; Program Director, Geriatric Medicine Fellowship Program
Montefiore Medical Center (Wakefield Campus)
Professor of Medicine, Albert Einstein College of Medicine
Deprescription or Deprescribing is a relatively new term referring to the “appropriate and safe reduction in number or dosage of medications prescribed to an individual”; the process is intended to withdraw unwanted, ineffective medications.1 Deprescribing is not enforced, rather, is voluntary and carried out following discussions between provider and patient and/or caregiver, including acceptance by the latter. Following deprescribing the patient is followed for unexpected consequences that may warrant re-introduction of the medication.
An aging population with associated co-morbidity has resulted in the prescribing of numerous medications to older individuals. The redundant, excessive and inappropriate use of medications is termed “polypharmacy.” Definition of polypharmacy varies, ranging from three to five or more medications prescribed on a continued basis.2,3 Polypharmacy, in conjunction with over-the-counter medications and supplement use leads to adverse drug events (ADEs) and poor outcomes, including hospitalization. Examples of ADEs include falls, fractures, delirium, syncope, organ dysfunction and more. Sometimes, as exception, patients are appropriately on six or more essential medications, as with chronic kidney disease or heart failure. Seniors also visit multiple providers, each adding medications to the list; additionally, many elders also consume over-the-counter supplements.
Polypharmacy and associated ADEs result from drug-drug, drug-nutrient or drug-disease interactions. An ADE is “harm resulting from use of a drug, including all adverse drug reactions.”4 Failure to recognize an ADE leads to evaluation, additional prescribing and more poor outcomes. A new geriatric syndrome must be viewed as potentially drug related, prior to needless, expensive testing.
Who owns responsibility for addressing the burden of polypharmacy? In large part, it is the primary provider or geriatrician, whose onus it is to coordinate care for patients who visit multiple providers of care. Medication reconciliation and opportunity for deprescribing exist at every patient encounter. Periodically, a patient feels overburdened by the number of medications and initiates a request for deprescribing. Unfortunately, there is no incentive for providers to engage patients into long-drawn discussions to assess and withdraw medications which may contribute to the reluctance for providers to attempt deprescribing!
At times, reduction in the dose or drug withdrawal results in negative consequences, as with beta blockers, benzodiazepines and antidepressants. In such cases the drug must be promptly re-introduced. Options always exist. Is a non-drug (life style) approach available? Is the patient on another medication that suffices? Is there any benefit at all from the drug, considering co-morbidity and life expectancy? Has harm resulted from the drug, e.g. renal dysfunction, a fall or hyperkalemia? Several drug classes are always considerations for deprescribing: analgesics, anti-histamines, anti-psychotics, H2 blockers, proton pump inhibitors, vitamins, supplements and sedative hypnotics. In addition to improving outcomes, deprescribing reduces medication costs to patients and participating facilities.5
Ethical aspects may warrant consideration. One must factor comorbidity, life expectancy, quality of life and importantly, opinion of the patient with capacity (or that of caregiver should capacity be lacking). Properly utilized, safe deprescribing is a boon to older adults and results in better healthcare!
- Sivagnanam G. Deprescription: the prescription metabolism. J Pharmacol Pharmacother. 2016;7(3):133-37
- Rambhade S, Chakraborty A, Shrivastava A et al. A survey on polypharmacy and use of inappropriate medications. Toxicol Int. 2012;19(1): 68-73.
- Heuberger R. Polypharmacy and food-drug interactions among older persons: a review. J Nutr Gerontol Geriatr. 2012;31(4): 325-403.
- Nebeker JR, Barach P,Samore MH. Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting. Ann Intern Med. 2004;140:795-801.
- Page AT, Clifford RM, Potter K et al. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82(3): 583-623
Funding Still Available: Health Information Exchange Adoption is Now Easier with the DEIP
The New York State Department of Health (DOH), with support from Centers for Medicare & Medicaid Services (CMS), has established the Data Exchange Incentive Program (DEIP) to increase Health Information Exchange (HIE) adoption across the state for Medicaid providers.
Participating organizations are incentivized to contribute a pre-defined set of data elements to the SHIN-NY through a QE. This program is designed to help defray the cost for an organization when connecting to their local QE.
Still not connected? New York eHealth Collaborative is coordinating the rollout of the program and the incentive payments on behalf of the State Department of Health. Limited funding is still available.
Eligible practices may receive up to $13,000 in incentives to offset the cost and efforts of health information exchange adoption. In order to receive funding, all milestones must be completed by September 30, 2020 as long as funding is not exhausted before this time.
To be eligible for enrollment in DEIP, an organization must:
- Have at least one provider that accepts Medicaid (Fee-For-Service, Medicaid Managed Care, or HARP); AND
- Have at least one provider that has attested to and been paid under Medicare or Medicaid MU (any year, any stage)
You can learn more about DEIP here or you can contact your local Qualified Entity (QE) to get started.
NY Department of Health Influenza Surveillance
The New York State Department of Health (NYSDOH) collects, compiles, and analyzes information on influenza and produces a weekly report during the influenza season (October through the following May).
During the week ending April 20, 2019:
- There were 1,991 laboratory-confirmed influenza reports, a 40% decrease over the previous week.
- Of the 2,420 specimens submitted to NYS WHO/NREVSS laboratories, 336 (19.22%) were positive for influenza. 319 were for influenza A, and 17 were influenza B.
- Of the 197 specimens submitted to the Wadsworth Center, 139 were positve for influenza. 54 were influenza A (H1), 84 were influenza A (H3), and 1 was influenza A (Not Subtyped)
- Reports of percent of patient visits or influenza-like illness (ILI3) from ILINet providers was 1,76%, which is below the regional baseline of 3.10%.
- The number of patients hospitalized with laboratory-confirmed influenza was 363, a 38% decrease over last week.
- There were no influenza-associated pediatric deaths reported this week, and six influenza-related pediatric deaths so far this season.
Read the entire report here.
Nassau District Event
Screening Your Older Patients for Risk of Financial Exploitation
Earn up to 1 AMA PRA Category 1 CME Credits
Wednesday, May 22, 2019
Registration: 6:00 PM • Dinner and Educational Event: 6:30 PM
Thyme Restaurant • 8 Tower Place • Roslyn, NY 11576
Register Online • View the Online Flyer
NYACP Annual Scientific Meeting
Saturday, October 12, 2019
Hilton Westchester Hotel
699 Westchester Ave • Rye Brook, NY 10573
More information will be available soon!
NYACP Co-Sponsored Meetings & Events
Co-Sponsored with the NYU School of Medicine
Advances in Cardiovascular Risk Reductions:
Improving Treatment for Patients with Diabetes
Offering 7.5 Hours of AMA PRA Category I Credits™
Thursday, May 9, 2019 • 7:45am - 4:30pm
NYU Langone Health
Alumni Hall • 550 First Avenue • New York, NY 10016
Event Flyer • Online Registration