Dec 7, 2023 Why Drug Shortages Persist
“Patients bear the harm of drug shortages, yet they cannot choose the manufacturers of their essential drugs nor evaluate their reliability”.
NYT Opinion piece by Emily Tucker, MD (Clemson University) states 3 avenues needed:
Legislative action is the only real way to ensure the availability of essential medications. After 20 years of drug shortages, it seems clear that markets alone are not the solution. And there are a few specific ways Congress should address drug shortages.
- The first is to ensure better quality drug manufacturing. Modernizing manufacturing facilities would make them more reliable and prevent shortages.
- The second is to improve the adaptability of drug manufacturing itself. Manufacturers should be able to switch quickly to alternative facilities or to increase production when demand unexpectedly increases.
- The last is to maintain buffer inventory of essential medications within our health care system. Having inventory available to allocate to those most in need during shortages would buy time for the system to adapt to supply disruptions or surges in demand….
Aug 31, 2023 Do Masks work?
Interesting article on effectiveness of masking, social distancing and a nuanced discussion of where , what, and when each strategy worked best! (Clue: social distancing!) Read more…
August 24, 2023 Nancy Valentine Award!
I guess the word is out!
I received the Nancy Valentine Leadership in Psychiatric Nursing award!
This award is given to a nurse leader in New England who has made a significant contribution to the field of psychiatric nursing and will be bestowed on Oct 6th, 2023.
I must say I was very surprised and honored by the acknowledgment. I am so excited to let my professional community, patients and family/friends know how happy I am to be honored in this way. Leadership is something that I had not necessarily aspired throughout my career, as I am always most excited to be a “team player” but so happy to know that many of my colleagues and friends have experienced my work in such a wonderful way.
Thank you to those who supported and nominated me (Diane Grimaldi – also a recipient of the Nancy Valentine Award!) and reminding me of how wonderful it is to be thought of in such esteem by my wonderful colleagues!
Women with ADHD who become pregnant must decide whether to remain on medication or cease taking their Adderall or Vyvanse or other prescription for at least nine months. For women hoping to breastfeed, this decision may impact life — for the mother, the child, and the rest of the family — for two years or more.
Complicating this decision is the fact that there are no clear-cut studies regarding the safety of stimulant medication use while pregnant. None of the medications used to treat ADHD — including Vyvanse, Adderall, and Ritalin — are proven to be safe to use during pregnancy, but they are also not proven to be harmful, according to the Federal Drug Administration (FDA). In short, there is no ethical way to conduct a study, giving medication or a placebo to a population of pregnant or nursing women, and then collecting data on the outcome for the babies…. (read more)
May 22, 2023 Pracice Update
I have recently made important changes to my solo practice, leading to improvements in time management, stronger boundaries around screen time and increased efficiency. There are still improvements to be made in billing/collecting copayments following the brief pause during the COVID emergency from MArch 2020 to July 2021. Although I am still working through paperwork and billing challenges, I am confident that I will resolve them in the next few months. Additionally, I am planning to simplify my non-practice responsibilities by stepping down from the Chair position at MAAPPN (Massachusetts Association for Advanced Practice Psychiatric Nurses) after December 2023.
Over the years, I have been dedicated to advocating for high-quality psychiatric care in Massachusetts and supporting the role of Advanced Practice Psychiatric nurses. I am proud to say that we have largely achieved our mission with the enactment of full independent practice legislation. However, it is important to secure these gains and continue supporting new Psych APRNs. As I transition, MAAPPN is exploring options, including partnering with similar organizations starting in 2024 or coninuing with new volunteers. This process will take most of 2023.
After that, I aim to keep a priority focus on solo practice and continue Psych APRN advocacy activities through old and new alliances formed during this year.
March 19, 2023 Practice Update
Many of you (of my current patients) will be receiving notices to about my decision to cut back in my practice starting in June, 2023. I will attemptot refer to other providers (see below) and I do so with a confident heart. As you may or may not know, the environment for care has become onerous for solo practitioners. Paperwork, medication supply shortages, insurance demands, volume of patient communications and federal law changes in prescribing controlled substance medications (such as stimulants) have placed the usual care and quality that I aspire to give in jeopardy. I have tried to adjust my practice procedures to meet these demands, but sadly, these changes do not appear to be effective in this new environment.
To this end there are new providers entering the field that you should be able to find in any internet search. I can recommend two practices that may be able to help:
Lighthouse Mental Wellness: https://www.lighthousementalwellness.com/
If there are interim gaps in retaining new providers, I am asking that patients reach out to their primary care providers for prescription assistance and make an appointment soon so that we may form an adequate medication transition plan.
I regret that I am losing many long-time patients and some newer ones too for whom I care a great deal about. But I feel that there are providers that can meet the care and treatment needs now and in the future and with whom I know my patients will be in good hands with!
January, 2023 Practice Update
Co-pays/Scheduling Link: For telemedicine or in-person the co-pay policies must be followed. You may use the button below to schedule your appointment and/or pay your co-pay in advance: https://appointmentsKANDOLINA.as.me/
In-Person Office Visits Available: Thursdays at 82 Marlborough St. Although I have moved properly out of Boston, I will still commute to the office at least 2 – 4 times a month and hope to see many of you in person this coming year (weather permitting). New regulations from the Centers for Medicare Services (CMS) re: frequency required for in person office visits may be forthcoming in 2023.
Winter Weather Cancellation Policy: For in-person appointments, if the Boston City Schools are closed so will my office be closed
COVID Precautions: Please stay up dated with your boosters and self-care. Office visits will have air filtration, chair distancing and masking available as needed.
November 3, 2022 Adderall Shortages