Emerging Challenges in Primary Care: 2018

Transcription

1 Atlanta Simulcast 2018 Cover.qxp_Cover 5/11/18 1:38 PM Page 1 17th Annual Emerging Challenges in Primary Care: 2018 LIVE CONFERENCE Saturday, June 2, 2018 Broadcast Live From Atlanta, GA Jointly Provided by

2 COPYRIGHT 2018 All rights reserved. No part of this book, except those portions specifically noted, may be reproduced or transmitted in any form or by any means now known or to be invented, electronic or mechanical, including photocopying, recording, or by any information storage or retrieval system without written permission from the authors, except for the brief inclusion of quotations in a review. Requests for permission or further information should be addressed to the author(s) of each presentation. National Association for Continuing Education 300 NW 70 th Avenue, Suite 102 Plantation, Florida (954) Printed in the United States of America.

3 Table of Contents A Message from the Course Director 2 Agenda 3 Course Faculty and Planning Committee 4 CME/CE Information 6 Accreditation and Designation Statements How to Claim Your CME Credit Disclosure Policy Summary of Individual Disclosures Disclosure of Commercial Support Americans with Disabilities Presentations* The Progression of Type 2 Diabetes: A Rational Approach for Long Term Disease Management Safely Achieving Goals in Type 2 Diabetes (T2DM): The Role of Concentrated and Long-Acting Insulins Safe Means of Administering the Right Therapy Extended-Release and Long-Acting Opioids (Get SMART Part I and II) The Role of Type 2 Inflammation in Severe Persistent Asthma: Integrating Biologic Therapy to Optimize Outcomes Evolving Strategies of Care in Pulmonary Arterial Hypertension: Integrating the Data into Practice * Full slide presentations are available for download at 1

4 A Message from the Course Director 300 NW 70 th Avenue Suite 102 Plantation, Florida (954) Phone (954) Fax internet: s a primary care physician, I know first-hand the complex challenges that primary care providers face everyday in their busy practices. I also know that with rapid changes in medicine, staying informed about new developments can be equally challenging. Our goal in this CME activity is to help you hone your skills in the diagnosis and management of patients with varied conditions you are likely encountering in your practice. One of the key messages to be discussed this year will be communication strategies to allow a better understanding of our patients and help them manage their diseases more effectively. Topics to be addressed will include diabetes, Opioids, asthma, and PAH. To reach this goal we have recruited a faculty of well-known thought leaders and experienced teachers who, as clinicians themselves, understand the challenges you face every day as a primary care provider. Our faculty will be at your disposal to provide evidence-based science, current treatment guidelines, discuss challenging cases, and provide answers for you that can ultimately lead to better health care for your patients. The presentations will include several interactive cases and discussion sessions to keep you actively learning. We invite you to engage with our faculty and share your ideas in peer-to-peer dialogue. We know you will leave with new ideas, skills, and tools to help your patients. Enjoy the conference! Gregg Sherman, MD Chief Medical Officer National Association for Continuing Education 2

5 Agenda 7:30-8:00 am Continental Breakfast and Registration 8:00 8:10 Welcome Remarks Marlene R. Wolf, MD, FAAFP 8:10 9:10 The Progression of Type 2 Diabetes: A Rational Approach for Long Term Disease Management Javier Morales, MD 9:10 10:10 Safely Achieving Goals in Type 2 Diabetes (T2DM):The Role of Concentrated and Long- Acting Insulins Javier Morales, MD 10:10 10:30 Break 10:30 11:45 Safe Means of Administering the Right Therapy Extended-Release and Long-Acting Opioids (Get SMART Part I) Michael R. Clark, MD, MPH, MBA and Yvonne D'Arcy, MS, ARNP-C, CNS, FAANP 11:45 1:00 Lunch Presentation Theater: Long-Term Results of Treatment Across a Broad Range of Patients with Type 2 Diabetes (CME not offered) 1:00 2:15 Safe Means of Administering the Right Therapy Extended-Release and Long-Acting Opioids (Get SMART Part II) Michael R. Clark, MD, MPH, MBA and Yvonne D'Arcy, MS, ARNP-C, CNS, FAANP 2:15 2:30 Break 2:30 3:40 The Role of Type 2 Inflammation in Severe Persistent Asthma: Integrating Biologic Therapy to Optimize Outcomes Diego J. Maselli, MD, FCCP 3:40 4:40 Evolving Strategies of Care in Pulmonary Arterial Hypertension: Integrating the Data into Practice Franck Rahaghi, MD, MHS, FCCP 4:40 4:45 Program Summary and Closing Remarks Marlene R. Wolf, MD, FAAFP 3

6 Course Faculty and Planning Committee Chief Medical Officer and Course Director Gregg Sherman, MD Emerging Challenges in Primary Care National Association for Continuing Education Plantation, FL Faculty Sandra G. Adams, MD, MS Professor, Division of Pulmonary Diseases and Critical Care Medicine, UT Health San Antonio Staff Physician, The South Texas Veterans Health Care System Founder, President WipeDiseases Foundation San Antonio, TX Dean Beals President & CEO DKBmed New York, NY Michael R. Clark, MD, MPH, MBA Chair, Psychiatry & Behavioral Health Inova Health System Falls Church, VA Yvonne D'Arcy, MS, ARNP-C, CNS, FAANP Pain Management Nurse Practitioner Ponte Vedra Beach, FL Rachel Deerr Program Manager DKBmed New York, NY Alexander Duarte, MD Professor Division of Pulmonary Critical Care & Sleep Medicine Department of Internal Medicine University of Texas Medical Branch Galveston, TX Rodolfo J. Galindo, MD Assistant Professor of Medicine Emory University School of Medicine Principal Investigator, Center for Diabetes and Metabolism Research Division of Endocrinology, Diabetes and Metabolism Emory University Hospital Midtown Medical Chair, Hospital Diabetes Taskforce Emory Healthcare System Atlanta, GA Jack Kravitz, MD Family Practice - Geriatrics Coral Springs, FL Diego J. Maselli, MD, FCCP Assistant Professor of Medicine Division of Pulmonary Diseases & Critical Care University of Texas Health Science Center at San Antonio Director, Respiratory Care, University Health System Director, Severe Asthma Program, University Health System San Antonio, TX Javier Morales, MD, FACP, FACE Clinical Associate Professor of Medicine Donald and Barbara Zucker School of Medicine At Hofstra/Northwell University Vice PresidentAdvanced Internal Medicine Group, P.C. East Hills, NY Leann Olansky, MD, FACP, FACE Department of Endocrinology, Diabetes and Metabolism Endocrinology & Metabolism Institute Cleveland Clinic Cleveland, OH Deborah Paschal, CRNP Clinical Nurse Practitioner Philadelphia, PA Stan J. Pogroszewski, JD COO/Director of Compliance DKBmed New York, NY Franck Rahaghi, MD, MHS, FCCP Director of Advanced Lung Disease Clinic Director, Pulmonary Hypertension Clinic Chairman, Dept. of Pulmonary and Critical Care Cleveland Clinic Florida Weston, FL Mark Stolar, MD Associate Professor of Clinical Medicine Northwestern University Medical School Chicago, IL Arunabh Talwar, MD, FCCP Director, Pulmonary Hypertension and Advanced Lung Disease Program North Shore University Hospital, Manhasset, New York Professor of Medicine Donald and Barbara Zucker School of Medicine Hofstra/ Northwell Hofstra University Hempstead, NY 4

7 Jeff Unger, MD, FAAFP, FACE Assistant Clinical Professor of Family Medicine, UC Riverside School of Medicine Director, Unger Concierge Primary Care Medical Group Rancho Cucamonga, CA Marlene R. Wolf, MD, FAAFP Clinical Assistant Professor of Family Medicine Nova Southeastern University's College of Allopathic Medicine Family Practice Lifetime Medical Consulting, LLC Coral Springs, FL Staff and Planning Committee Sandy Bihlmeyer, M.Ed. National Association for Continuing Education Plantation, FL Michelle Frisch, MPH, CHCP National Association for Continuing Education Plantation, FL Alan Goodstat, LCSW National Association for Continuing Education Plantation, FL Joshua F. Kilbridge President and Creative Director Kilbridge Associates San Francisco, CA Sheila Lucas, CWEP National Association for Continuing Education Plantation, FL Cedric Nazareth, MBBS Medical Writer Cedric Nazareth Medical Writing Mississauga, ON Harvey C. Parker, PhD, CHCP Director of Continuing Education National Association for Continuing Education Plantation, FL Gregg Sherman, MD Chief Medical Officer National Association for Continuing Education Plantation, FL 5

8 CME/CE Information Accreditation and Designation Statement The National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The National Association for Continuing Education designates this live activity for a maximum of 5.0 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The National Association for Continuing Education is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners. AANP Provider Number This program has been approved for 5.0 contact hours of continuing education (which includes 2.75 pharmacology hours). Joint Accreditation Statement Postgraduate Institute for Medicine In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and DKBmed. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Physician Continuing Medical Education The Postgraduate Institute for Medicine designates this live activity for a maximum of 2.5 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.5 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Continuing Nursing Education The maximum number of hours awarded for this Continuing Nursing Education activity is 2.5 contact hours. Designated for 2.0 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses. Method of Participation for learners who will be requesting credit for the REMS sessions Request for Credit if you wish to receive AMA or ANCC credit If you wish to receive acknowledgment for completing this activity, please complete the evaluation on On the navigation menu, click on Find Post-test/Evaluation by Course and search by course ID Upon registering and completing the activity evaluation, your certificate will be made available immediately. How do I claim CME credit for this activity? To claim CME credit for your participation today, you need to complete and submit the evaluation form included in your handout and you will need to claim your credits online. Within 2 weeks, NACE will send you an with instructions on how to claim your CME credits online and print your CME certificate. Disclosure Policy It is the policy of the accredited providers to ensure fair balance, independence, objectivity and scientific rigor in all activities. All faculty participating in CME activities sponsored by the accredited providers are required to present evidence-based data, identify and reference off-label product use and disclose all relevant financial relationships. Faculty disclosure will be provided in the activity materials. Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. The existence or absence of COI for everyone in a position to control content will be disclosed to participants prior to the start of each activity. Summary of Individual Disclosures Sandra G. Adams, MD, MS Investigator/Grants/Research/Continuing Education - National Institute of Health; Veterans Affairs, University of Texas System, Chest Foundation, AstraZeneca Pharmaceuticals LP, Boehringer Ingelheim Pharmaceuticals, Inc, Daiichi Sankyo, 6

9 Dean Beals Sandy Bihlmeyer, M.Ed. Michael R. Clark, MD, MPH, MBA Yvonne D'Arcy, MS, ARNP-C, CNS, FAANP Rachel Deerr Alexander Duarte, MD Michelle Frisch, MPH, CHCP Rodolfo J. Galindo, MD Alan Goodstat, LCSW Joshua F. Kilbridge Jack Kravitz, MD Sheila Lucas, CWEP Diego J. Maselli, MD, FCCP Javier Morales, MD, FACP, FACE Cedric Nazareth, MBBS Leann Olansky, MD, FACP, FACE Deborah Paschal, CRNP Harvey Parker, Ph.D., CHCP Stan J. Pogroszewski, JD Franck Rahaghi, MD, MHS, FCCP Gregg Sherman, MD Mark Stolar, MD Arunabh Talwar, MD, FCCP Jeff Unger, MD, FAAFP, FACE Marlene R. Wolf, MD, FAAFP GlaxoSmithKline, Novartis Pharmaceuticals, Sunovion Pharmaceuticals, Inc; President - WipeDiseases Foundation Royalty - Springer Publishing-books; Consulting Fees - Egalet, Purdue, Practicing Clinicians Exchange, Ortho-Mcneil; Fees for Non-CME/CE Services - Purdue-non branded materials Consultant - Sunovion, Astra Zeneca, Bayer Speakers Bureau/Consultant - Lilly, Novo Nordisk, Janssen, Abbott Consultant, Speaker, Researcher - Actelion, Bayer, Gilead; Consultant/Speaker - United Therapeutics Speakers Bureau - AstraZeneca Speaker - Boehringer Ingelheim; Advisory Board - Genentech Consultant, Research, Advisory Board - Novo Nordisk, Janssen, Abbott Diabetes Consultant - Lifetime Medical; Independent Consultant - Consulting, LLC. Disclosure of Commercial Support This activity is supported by an educational grant from Actelion Pharmaceuticals US, Inc., an educational grant from AstraZeneca Pharmaceuticals LP, an educational grant from Novo Nordisk Inc, and an educational grant from Lilly. For further information concerning Lilly grant funding visit This activity is supported by an independent educational grant from the ER/LA Opioid Analgesic REMS Program Companies. Please see for a listing of the member companies. This activity is intended to be fully compliant with the ER/LA Opioid Analgesic REMS education requirements issued by the US Food and Drug Administration (FDA). PIM Disclosure Information The PIM planners and managers have nothing to disclose. Disclosure of Unlabeled Use This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Target Audience This activity is intended for primary care physicians delivering primary care to adults. Disclaimer Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without 7

10 evaluation of their patient s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer s product information, and comparison with recommendations of other authorities. Americans With Disabilities Any activity registrant who feels s/he may need accommodations based on the impact of a disability should contact NACE to discuss your specific needs. 8

11 The Progression of Type 2 Diabetes: A Rational Approach for Long Term Disease Management Learning Objectives Recognize the pathogenesis of type 2 diabetes (T2DM) as a progressive, multi-defect disorder. Discuss the strengths and limitations of current guidelines for diabetes management. Successfully use strategies for adherence to multiple medications to improve outcomes in diabetes. Examine data on current combination strategies to choose therapies that most effectively address a patient's underlying pathophysiologic needs. Faculty Members The faculty members listed below contributed to the development of the content being presented. One of these individuals will present the content today. Javier Morales, MD, FACP, FACE Clinical Associate Professor of Medicine Donald and Barbara Zucker School of Medicine Hofstra/Northwell University Vice President Advanced Internal Medicine Group, P.C. East Hills, NY Leann Olansky, MD, FACP, FACE Department of Endocrinology, Diabetes and Metabolism Endocrinology & Metabolism Institute Cleveland Clinic Cleveland, OH Jeff Unger, MD, FAAFP, FACE Assistant Clinical Professor of Family Medicine UC Riverside School of Medicine Director Unger Concierge Primary Care Medical Group Rancho Cucamonga, CA Mark Stolar, MD Associate Professor of Clinical Medicine Feinberg School of Medicine Northwestern University Chicago, IL Rodolfo J. Galindo, MD Assistant Professor of Medicine Emory University School of Medicine Principal Investigator, Center for Diabetes and Metabolism Research Division of Endocrinology, Diabetes and Metabolism Emory University Hospital Midtown Medical Chair, Hospital Diabetes Taskforce Emory Healthcare System Atlanta, GA Slides are available for download at: 9

12 KEY NOTES WHAT SHOULD I IMPLEMENT IN MY PRACTICE? 10

13 Safely Achieving Goals in Type 2 Diabetes (T2DM): The Role of Concentrated and Long-Acting Insulins Learning Objectives Discuss clinician and patient barriers to initiation and intensification of insulin therapy. Recognize the prevalence and clinical impact of hypoglycemia in special populations at risk. Discuss the pharmacology and clinical differences between existing and new long-acting and concentrated insulins. Discuss how to incorporate new basal and concentrated insulins into clinical practice while minimizing the risk of adverse events. Faculty Members The faculty members listed below contributed to the development of the content being presented. One of these individuals will present the content today. Javier Morales, MD, FACP, FACE Clinical Associate Professor of Medicine Donald and Barbara Zucker School of Medicine Hofstra/Northwell University Vice President Advanced Internal Medicine Group, P.C. East Hills, NY Leann Olansky, MD, FACP, FACE Department of Endocrinology, Diabetes and Metabolism Endocrinology & Metabolism Institute Cleveland Clinic Cleveland, OH Jeff Unger, MD, FAAFP, FACE Assistant Clinical Professor of Family Medicine UC Riverside School of Medicine Director Unger Concierge Primary Care Medical Group Rancho Cucamonga, CA Mark Stolar, MD Associate Professor of Clinical Medicine Feinberg School of Medicine Northwestern University Chicago, IL Rodolfo J. Galindo, MD Assistant Professor of Medicine Emory University School of Medicine Principal Investigator, Center for Diabetes and Metabolism Research Division of Endocrinology, Diabetes and Metabolism Emory University Hospital Midtown Medical Chair, Hospital Diabetes Taskforce Emory Healthcare System Atlanta, GA Slides are available for download at: 11

14 KEY NOTES WHAT SHOULD I IMPLEMENT IN MY PRACTICE? 12

15 Safe Means of Administering the Right Therapy Extended- Release and Long-Acting Opioids (Get SMART Part I and II) Learning Objectives Assess patients for treatment with ER/LA opioid analgesics. Evaluate and initiate therapy, modify dose, and discontinue use of ER/LA opioid analgesics. Manage ongoing therapy with ER/LA opioid analgesics. Perform effective counseling with patients and caregivers about the safe use of ER/LA opioid analgesics, including proper storage and disposal. Identify general and product-specific drug information concerning ER/LA opioid analgesics. Faculty Members The faculty members listed below contributed to the development of the content being presented. One of these individuals will present the content today. Michael R. Clark, MD, MPH, MBA Chair, Psychiatry & Behavioral Health Inova Health System Falls Church, VA Yvonne D'Arcy, MS, ARNP-C, CNS, FAANP Pain Management Nurse Practitioner Ponte Vedra Beach, FL Slides are available for download at: 13

16 KEY NOTES WHAT SHOULD I IMPLEMENT IN MY PRACTICE? 14

17 The Role of Type 2 Inflammation in Severe Persistent Asthma: Integrating Biologic Therapy to Optimize Outcomes Learning Objectives Describe the newer concepts in the pathophysiology of asthma and type 2 inflammation, and the implications of biologic therapies in the era of precision medicine. Determine the utility of simple biomarkers to identify patients who are candidates for targeted biologic therapies and appropriate referral. Discuss the impact of comorbid conditions on asthma control and the evidence-based approach to their treatment. Discuss the paradigms of multidisciplinary care in asthma, with an emphasis on patient and provider education, to improve adherence to inhalers and emerging biologic therapies in asthma. Faculty Members The faculty members listed below contributed to the development of the content being presented. One of these individuals will present the content today. Sandra G. Adams, MD, MS Professor, Division of Pulmonary Diseases and Critical Care Medicine, UT Health San Antonio Staff Physician, The South Texas Veterans Health Care System Founder, President WipeDiseases Foundation San Antonio, TX Diego J. Maselli, MD, FCCP Assistant Professor of Medicine Division of Pulmonary Diseases & Critical Care University of Texas Health Science Center at San Antonio Director, Respiratory Care, University Health System Director, Severe Asthma Program, University Health System San Antonio, TX Slides are available for download at: 15

18 KEY NOTES WHAT SHOULD I IMPLEMENT IN MY PRACTICE? 16

19 Evolving Strategies of Care in Pulmonary Arterial Hypertension: Integrating the Data into Practice Learning Objectives Review the risk factors and classification of pulmonary hypertension (PH). Discuss the appropriate diagnostic strategy for pulmonary arterial hypertension (PAH), including the roles of echocardiography, ventilation/perfusion (V/Q) scanning, and right heart catheterization (RHC). Review current and emerging treatments for patients with PAH. Describe how to monitor patients with PAH for disease progression. Faculty Members The faculty members listed below contributed to the development of the content being presented. One of these individuals will present the content today. Alexander Duarte, MD Professor Division of Pulmonary Critical Care & Sleep Medicine Department of Internal Medicine University of Texas Medical Branch Galveston, TX Franck Rahaghi, MD, MHS, FCCP Director of Advanced Lung Disease Clinic Director, Pulmonary Hypertension Clinic Chairman, Dept. of Pulmonary and Critical Care Cleveland Clinic Florida Weston, FL Arunabh Talwar, MD, FCCP Director, Pulmonary Hypertension and Advanced Lung Disease Program North Shore University Hospital, Manhasset, New York Professor of Medicine Donald and Barbara Zucker School of Medicine Hofstra/ Northwell Hofstra University Hempstead, NY Slides are available for download at: 17

20 KEY NOTES WHAT SHOULD I IMPLEMENT IN MY PRACTICE? 18