Bits and Pieces in the News

The privatization of Iowa Medicaid can go live April 1, 2016, according to the Centers for Medicare and Medicaid Services (CMS). According to a news report, a new Iowa legislator committee will be in charge of oversight of the managed care organizations. Oversight will be critically important moving forward, especially in light of the report by Dr. E. Fuller Torrey and others about the fraud, waste, and excess profits in public mental health services (see p. 43 of the report).

There’s an update to the Mindfulness programs at Iowa announcement from Bev Klug:

Living Mindfully with Chronic Medical Conditions – Continuing and open to new members
Note: The first offering of this group just ended and the group members decided they would like to continue, meet monthly, and open the group up to new members.
Being present with and accepting of current-moment experiences can be challenging, even in times of ease. Living with a chronic medical condition/s can add layers of challenge to this intention through physical discomfort; worries about the future and possible progression of the illness; fear of the unknown; past and current losses; the inevitable, unpredictably appearing, not new but somehow still unexpected (!) symptoms associated – or new symptoms unassociated – with progressive diseases; and dealing with days of essentially feeling “undone” for some time. Because these conditions aren’t always visible to others and the person experiencing them may be going about their life working, parenting, etc., even while hurting or feeling sick, it’s common for the suffering they experience to go unacknowledged or misunderstood by others, thus contributing to them feeling or becoming isolated. When the condition flares periodically, the ensuing limitations may impact their ability to work, maintain social and familial relationships, while also creating uncertainty and possible losses. The practice of mindfulness – opening to what is here with compassion, kindness and wise discernment, can serve as a trusted guide in living as fully as possible, even with this. Let’s explore together and see what your experience is.

The format of this group will be a combination of practice, reading and discussion. There are some mindfulness-based books and other resources written by people who live with chronic conditions that we will draw from, including a variety of practices.

This group is appropriate for people who want to address, through the lens of mindfulness, some of the challenges associated with chronic medical conditions that are not predicted to substantially improve, including, but not limited to: Inflammatory Bowel Disease (IBD); Multiple Sclerosis (MS); fibromyalgia; Systemic Exertion Intolerance Disease (formerly Chronic Fatigue Syndrome); chronic pain; cancer; autoimmune and other inflammatory illnesses and/or medical symptoms that are unexplainable.

Schedule: Monthly Mondays, 3/21, 4/18, 5/9, 6/13, 7/18 Deadline: March 14, 2016
Time: 5:30-6:30pm
Location: UI Hospitals and Clinics
Instructor: Bev Klug, M.A., LMFT
Fee: $90 (Pay at first class – may be reimbursed by UI flex spending)
Registration: Email and we will send you specific directions, confirmation of your registration and suggested readings

Incidentally, I noticed a new study on mindfulness for chronic back pain in older adult published in JAMA recently, in which a Mindfulness Based Stress Reduction (MBSR) intervention was compared to a control group for older patients with chronic back pain. While the intervention group fared better following completion of the 8 week program, there was no difference from the control group at 6 month followup. Although I get it that there were monthly booster sessions for MBSR (which seemed poorly attended) I wondered whether the MBSR group members actually followed a daily practice. It was difficult for me to tell from reading the study. While the intent is to do so following the program at Iowa (which I completed in the summer of 2014 and still sustain a daily practice), it’s difficult to maintain and could make a difference in results:

Morone, N. E., et al. (2016). “A mind-body program for older adults with chronic low back pain: A randomized clinical trial.” JAMA Internal Medicine.
Importance  Treatment of chronic low back pain (LBP) in older adults is limited by the adverse effects of analgesics. Effective nonpharmacologic treatment options are needed.Objective  To determine the effectiveness of a mind-body program at increasing function and reducing pain in older adults with chronic LBP.Design, Setting, and Participants  This single-blind, randomized clinical trial compared a mind-body program (n = 140) with a health education program (n = 142). Community-dwelling older adults residing within the Pittsburgh metropolitan area were recruited from February 14, 2011, to June 30, 2014, with 6-month follow-up completed by April 9, 2015. Eligible participants were 65 years or older with functional limitations owing to their chronic LBP (≥11 points on the Roland and Morris Disability Questionnaire) and chronic pain (duration ≥3 months) of moderate intensity. Data were analyzed from March 1 to July 1, 2015.Interventions  The intervention and control groups received an 8-week group program followed by 6 monthly sessions. The intervention was modeled on the Mindfulness-Based Stress Reduction program; the control program, on the “10 Keys” to Healthy Aging.Main Outcomes and Measures  Follow-up occurred at program completion and 6 months later. The score on the Roland and Morris Disability Questionnaire was the primary outcome and measured functional limitations owing to LBP. Pain (current, mean, and most severe in the past week) was measured with the Numeric Pain Rating Scale. Secondary outcomes included quality of life, pain self-efficacy, and mindfulness. Intent-to-treat analyses were conducted.Results  Of 1160 persons who underwent screening, 282 participants enrolled in the trial (95 men [33.7%] and 187 women [66.3%]; mean [SD] age,74.5 [6.6] years). The baseline mean (SD) Roland and Morris Disability Questionnaire scores for the intervention and control groups were 15.6 (3.0) and 15.4 (3.0), respectively. Compared with the control group, intervention participants improved an additional −1.1 (mean, 12.1 vs 13.1) points at 8 weeks and −0.04 (mean, 12.2 vs 12.6) points at 6 months (effect sizes, −0.23 and −0.08, respectively) on the Roland and Morris Disability Questionnaire. By 6 months, the intervention participants improved on the Numeric Pain Rating Scale current and most severe pain measures an additional −1.8 points (95% CI, −3.1 to −0.05 points; effect size, −0.33) and −1.0 points (95% CI, −2.1 to 0.2 points; effect size, −0.19), respectively. The changes in Numeric Pain Rating Scale mean pain measure after the intervention were not significant (−0.1 [95% CI, −1.1 to 1.0] at 8 weeks and −1.1 [95% CI, −2.2 to −0.01] at 6 months; effect size, −0.01 and −0.22, respectively).Conclusions and Relevance  A mind-body program for chronic LBP improved short-term function and long-term current and most severe pain. The functional improvement was not sustained, suggesting that future development of the intervention could focus on durability.Trial Registration Identifier: NCT01405716

And now the news you’ve all been waiting for–the next Psychosomatic Medicine Interest Group Meeting (PMIG) announcement. It will be held in the new conference room. It’s on the 8th floor, and I’ve considered running a poll on who climbs the stairs and who takes the elevator. There will be a very interesting case presentation, which will likely cover every slice of the Core Competency Pizza. The medical students are learning how important the Interpersonal and Communication Skills slice. In my humble (OK, I’m not humble!) opinion, every other core competency probably hinges on communication.

Core Competency Pizza
Core Competency Pizza

This is easily more important to my practice than the American Board of Psychiatry and Neurology (ABPN) Maintenance of Certification (MOC) boondoggle, despite the recent changes to the Performance in Practice (PIP) Clinical Module. Dr. Rosin said it all in an article recently published in Clinical Psychiatry News:

Because it might be a little tricky to find the new conference room, I tried to provide some helpful directions.