AOMA Health and Information Alerts

 

Posted on July 22, 2013

Support Continues for Discussions on Unified Accreditation System for GME

Over the last 18 months, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) have been exploring the possibility of a new unified graduate medical education (GME) accreditation system with the Accreditation Council for Graduate Medical Education (ACGME). 
 
The AOA and AACOM announced during the AOA’s Annual Business Meeting, held July 16 – 21, 2013, that to date they have been unsuccessful in reaching an agreement with ACGME on a Memorandum of Understanding (MOU) for a unified graduate medical education accreditation system. However, the AOA and AACOM remain open to continued discussions with the ACGME. Read more...
 

 

Posted on June 13, 2013

Nationwide Shortage of Doxycycline: Resources for Providers and Recommendations for Patient Care

Summary
The Food and Drug Administration (FDA) originally reported a shortage of some forms of doxycycline (doxycycline hyclate) and unavailability of tetracycline on January 18, 2013, caused by increased demand and manufacturing issues. FDA continues to report shortage from some, but not all, manufacturers of some dosages and forms of doxycycline hyclate and doxycycline monohydrate. FDA does not currently report a shortage of intravenous doxycycline hyclate or the oral suspension doxycycline calcium commonly used in pediatric patients. For additional information about the availability of doxycycline, visit the FDA Drug Shortage website (http://www.fda.gov/Drugs/DrugSafety/DrugShortages/default.htm). Information about drug shortages can also be found at the American Society of Health-System Pharmacists (ASHP) website (http://www.ashp.org/default.aspx). This notice provides advice on alternatives to doxycycline when available, as well as situations where there is no recommended alternative to doxycycline.

Click here to download the guidance
 

Posted June 12, 2013

OMT Coding Instructional Manual Second Edition

The American Osteopathic Association (AOA) announces the release of the Second Edition of the Osteopathic Manipulative Treatment (OMT) Coding Instructional Manual. This must read edition provides the most up-to-date information and key changes to assist osteopathic physicians in coding OMT procedure to instruct you and your staff perform on best practices related to OMT coding and documentation.

In addition, the OMT Coding Instructional Manual Second Edition contains the history of OMT coding, identification of OMT codes in CPT©2013, appropriate use of the OMT codes, OMT documentation and procedures for handing denied claims. The OMT Coding Instructional Manual is now available to view and download, please click: OMT Manual
 

 

Posted on February 15, 2013

Latest Edition of the Arizona Vaccine News Released

The Arizona Department of Health Services has distributed it's most recent issue of the Arizona Vaccine News. Click here to read.

 

Posted on January 19, 2013

Doctors Align and Support the Availability of High Quality Health Care - Joint Medical Association Press Release

The Arizona Medical Association, Arizona Osteopathic Medical Association, Maricopa County Medical Society, and Pima County Medical Society are pleased the Governor has included in her goals for 2013 expansion of the AHCCCS program. Availability of high quality health care remains one of our most pressing concerns in Arizona and the AHCCCS program is a key component of providing essential medical services. We stand ready to support the Governor in this effort and pledge to work with her administration, and the legislature, to secure this result on behalf of physicians and their patients.

For more information on the Governor's proposal - http://azgovernor.gov/dms/upload/PR_011413_MedicaidBudgetRec.pdf.

 

Posted on December 20, 2012

Enhanced PCP Fees for Medicaid

The Patient Protection and Affordable Care Act (ACA) requires state Medicaid programs to pay certain primary care providers (PCPs) at no less than the Medicare rates in effect for Calendar Years 2013 and 2014 for Evaluation and Management (E/M) services described by CPT codes 99201– 99499 and vaccine administration services described by CPT codes 90460, 90461, 90471, 90472, 90473 and 90474.

Both the federal statute and CMS rule define which primary care providers are eligible for these increased fees. Details of the eligibility requirements may be found through the link below. Physicians who are eligible for those fees must submit an attestation form to AHCCCS identifying themselves as eligible for the increased fees. Nurse Practitioners and Physician Assistants who work under the supervision of an eligible PCP are also paid at enhanced rates for services provided to AHCCCS members during that two-year period if their supervising physicians provide required information through the attestation process.

CMS published its Final Rule regarding these requirements on November 6, 2012, leaving little time for AHCCCS to timely implement these payment changes. AHCCCS will post the required attestation forms on its website during January 2013. Any attestations received by March 31, 2013 will result in retroactive payments at enhanced rates for eligible services provided on or after January 1, 2013. Attestations received on or after April 1, 2013 will result in the enhanced rates on a prospective basis.

In addition to the attestation forms, CMS is also requiring changes to the way in which vaccine administration is reported to the state. Due to the change in Federal regulations regarding increased reimbursement to qualified providers, beginning with dates of service January 1, 2013, AHCCCS will require all providers to submit two CPT codes for vaccine services:

  • One code will identify the vaccine administration service and
  • The other will identify the actual vaccine administered.

For more information, please review the memos available on the AHCCCS website at: http://www.azahcccs.gov/commercial/ProviderBilling/rates/PCSrates.aspx
 

 

Posted on October 4, 2012

Meningitis and Stroke Associated with Potentially Contaminated Product

Summary

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are coordinating a multi-state investigation of fungal meningitis among patients who received an epidural steroid injection. Several of these patients also suffered strokes that are believed to have resulted from their infection. As of October 4, 2012, five deaths have been reported. Fungal meningitis is not transmitted from person to person. These cases are associated with a potentially contaminated medication. Investigation into the exact source is ongoing; however, interim data show that all infected patients received injection with preservative-free methylprednisolone acetate (80mg/ml) prepared by New England Compounding Center, located in Framingham, MA.

 

Background

On September 21, 2012, CDC was notified by the Tennessee Department of Health of a patient with the onset of meningitis approximately 19 days following epidural steroid injection at a Tennessee ambulatory surgery center (ASC). Initial cultures of cerebrospinal fluid (CSF) and blood were negative; subsequently, Aspergillus fumigatus was isolated from CSF by fungal culture. On September 28, investigators identified a case outside of Tennessee, possibly indicating contamination of a widely distributed medication. As of October 4, a total of 35 cases* in the following six states have been identified with a clinical picture consistent with fungal infection: Florida (2 cases), Indiana (1 case), Tennessee (25 cases, including 3 deaths), Maryland (2 cases, including 1 death), North Carolina (1 case), and Virginia (4 cases, including 1 death). Fungus has been identified in specimens obtained from five patients, one of whom also had Propionobacterium acnes, of unclear clinical significance, isolated from a post-mortem central nervous system specimen.

Infected patients have presented approximately 1 to 4 weeks following their injection with a variety of symptoms, including fever, new or worsening headache, nausea, and new neurological deficit (consistent with deep brain stroke). Some of these patients’ symptoms were very mild in nature. CSF obtained from these patients has typically shown elevated white cell count (with a predominance of neutrophils), low glucose, and elevated protein.

 

Recommendations

On September 25, 2012, the New England Compounding Center located in Framingham, MA voluntarily recalled the following lots of methylprednisolone acetate (PF) 80mg/ml:

  • Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #05212012@68, BUD 11/17/2012
  • Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #06292012@26, BUD 12/26/2012
  • Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #08102012@51, BUD 2/6/2013

On October 3, 2012, the compounding center ceased all production and initiated recall of all methylprednisolone acetate and other drug products prepared for intrathecal administration.

Physicians should contact patients who have had an injection (e.g., spinal, joint) using any of the three lots of methylprednisolone acetate listed above to determine if they are having any symptoms. Although all cases detected to date occurred after injections with products from these three lots, out of an abundance of caution, CDC and FDA recommend that healthcare professionals cease use of any product produced by the New England Compounding Center until further information is available.

For patients who received epidural injection and have symptoms of meningitis or basilar stroke, a diagnostic lumbar puncture (LP) should be performed, if not contraindicated. Because presenting symptoms of some patients with meningitis have been mild and not classic for meningitis (e.g., new or worsening headache without fever or neck stiffness), physicians should have a low threshold for LP. While CDC is aware of infections occurring only in patients who have received epidural steroid injections, patients who received other types of injection with methylprednisolone acetate from those three lots should also be contacted to assess for signs of infection (e.g., swelling, increasing pain, redness, warmth at the injection site) and should be encouraged to seek evaluation (e.g., arthrocentesis) if such symptoms exist.

For guidance on diagnostic testing that should be performed on patient specimens, physicians can go to www.cdc.gov/hai. State health departments should be informed of patients undergoing evaluation. Clinicians should report any suspected adverse events following use of these products to FDA's MedWatch program at 1-800-332-1088 or www.fda.gov/medwatch.

*Case Definition
1: A person with meningitis1 of sub-acute onset (1-4 weeks) following epidural injection after July 1, 2012.
2: A person, who has not received a lumbar puncture, with basilar stroke 1-4 weeks following epidural injection after July 1, 20122.
3. A person with evidence of spinal osteomyelitis or epidural abscess at the site of an epidural injection diagnosed 1-4 weeks after epidural injection after July 1, 2012.
1clinically diagnosed meningitis meaning 1 or more of the following symptoms: headache, fever, stiff neck, or photophobia and a CSF profile consistent with meningitis (elevated protein/low glucose/pleocytosis)
2These people, if possible, should have an LP.
 

 

Posted on August 30, 2012

AHCCCS to host Community Meetings

AHCCCS is hosting community meetings across the state to provide the public with information about some of the potential options regarding the future of Arizona’s Medicaid program. Click here for the schedule.

 

Posted on August 27, 2012

Latest Edition of the Arizona Vaccine News Released

The Arizona Department of Health Services has distributed it's most recent issue of the Arizona Vaccine News. Click here to read.

 

Posted on August 22, 2012

New VFC Vaccine Inventory Management and Reporting Requirements

Effective October 15, 2012, all Vaccines for Children (VFC) providers must follow new VFC vaccine inventory management and reporting requirements.

The Centers for Disease Control and Prevention (CDC) is requiring the Arizona Immunization Program Office (AIPO) to improve the accountability of VFC vaccines. VFC providers will be required to submit current VFC vaccine inventory with lot number, expiration date and manufacturer with each vaccine order. The enhanced vaccine accountability provided by these new inventory requirements is essential to the viability of the VFC Program.

Please review the cover letter for a detailed description of these new requirements and how to meet the new requirements.

Please review the manual for a step-by-step guide on how to meet these new requirements and watch the video for a live step-by-step ASIIS demonstration. Both the manual and video can be found on the AIPO homepage: http://www.azdhs.gov/phs/immun/index.htm.

AIPO will host frequent conference call trainings. The training schedule can also be found on the AIPO homepage. Every VFC provider should attend at least one training.

This is a significant change that will involve extra effort by your staff. ADHS is trying to minimize the impact to your practice by providing helpful inventory management tools that are located in ASIIS, simple training materials, and one-on-one assistance, if necessary.
 

 

Posted on August 20, 2012

AHCCCS Primary Care Rates Under the Affordable Care Act

Under the Affordable Care Act, Medicaid programs, including AHCCCS, must set fees for certain primary care services at the Medicare Physician Fee Schedule amount for those services for calendar years 2013 and 2014. If the 2013 or 2014 Medicare rates for those services decreases below the 2009 Medicare rates, then the primary care services fees would be set at the 2009 Medicare rates. The actual rule is complex and involves physicians from multiple specialties and subspecialties. This is explained more fully on the AHCCCS web site at www.azahcccs.gov/shared/news.aspx#PCS. In addition, AHCCCS posted a memo that explains these changes. These fee schedule changes are set to begin on January 1, 2013 under the Proposed Rule promulgated by CMS. The Final Rule may not be published until November, which could result in some changes to these payment requirements. AHCCCS will post an update to this information once the Final Rule is published.

 

Posted on March 30, 2012

HEALTH ADVISORY: Rocky Mountain Spotted Fever Update

Arizona Department of Health Services has detected increased levels of Rocky Mountain spotted fever (RMSF) in the state including one confirmed and one suspect fatality. RMSF is a serious illness that can be fatal if not treated promptly and correctly, even in previously healthy people. Doxycycline is the treatment of choice for adults and children of all ages and should be initiated immediately whenever RMSF is suspected. Use of antibiotics other than doxycycline is associated with a higher risk of fatal outcome. Treatment is most effective at preventing death if doxycycline is started in the first 5 days of symptoms.

Treatment should never be delayed pending the receipt of laboratory test results, which are unlikely to be available in time for treatment to prevent death. Treatment should not be withheld in a patient where there is clinical suspicion on the basis of an initial negative finding for R. rickettsii. The diagnosis of RMSF must be made based on clinical signs and symptoms, and can later be confirmed using paired sera.

Most people will develop symptoms one week following the tick bite (range 3-14 days) and not all infected patients recall a tick bite.
RMSF usually presents with:

  • Acute onset of fever
  • Severe headache or other neurologic signs
  • ?Malaise and severe myalgia
  • ?Nausea/vomiting/diarrhea
  • ?A macular or maculopapular rash appearing within 4-7 days following onset of symptoms, often present on the palms and soles; may be followed by a petechial rash on ~ day 6

    Tick trapping in RMSF endemic areas indicates that the tick population is large and active at this time. RMSF should be considered in the differential diagnosis of febrile patients who reside in, or visit, tribal lands or are transferred from an Indian Health Service facility. It is important to note that few people with the disease will develop all symptoms and the number and combination of symptoms varies significantly from person to person. For example, in Arizona cases, 77% had any rash, 63.5% had fever documented, and 36.8% recounted a tick exposure

RMSF is a reportable condition in Arizona. In total, there have been six probable and confirmed RMSF cases reported in Arizona in 2012. Suspected cases should be reported to local health officials. Serologic testing is available at the Arizona State Public Health Laboratory (ASPHL), and paired sera collected 2-4 weeks apart are necessary to confirm or rule-out RMSF infection. The tests can be ordered using the ASPHL Microbiology Submission Form and selecting the “Rickettsial Spotted Fever” test from the Rickettsial IFA panel. Specimen collection guidelines can be found in the February 2012 Guide to Laboratory Services: Microbiology.
Specimens can be sent to:

Arizona State Health Laboratory
250 North 17th Avenue
Phoenix, AZ 85007

For more information on RMSF, contact your local health jurisdiction or ADHS Vector-Borne and Zoonotic Diseases staff at (602) 364-3676. You can also visit the ADHS RMSF and CDC RMSF websites.
 

 

Posted on March 21, 2012

Health Notice: Flu Hits "Widespread" Level in Arizona

Although influenza activity started late this season and has been relatively mild so far, influenza activity has been steadily increasing in Arizona over the past few weeks, and the Arizona Department of Health Services (ADHS) categorized activity as Widespread this week. Laboratory-confirmed influenza has been identified in fourteen counties, and more than 300 cases were reported by laboratories in the past week. Most cases are caused by influenza A, and both influenza A (H1N1) pdm09 (the 2009 influenza pandemic strain) and influenza A (H3) are circulating in the state. Low numbers of influenza B have also been reported.

We would like to remind everyone that it is not too late to get a flu shot. Influenza vaccination is the best prevention against flu, and influenza activity in Arizona usually lasts through the spring months. National data indicate that this year's vaccine is a good match to the circulating viruses. Flu vaccination locations and other information can be found at http://www.azdhs.gov/flu.

More information can be found in the influenza surveillance reports, posted weekly at http://www.azdhs.gov/phs/oids/epi/flu/.

This message is being sent to clinicians and health departments.

***Distributed by the Arizona Health Alert Network***

 

Posted on March 21, 2012

Enhanced Surveillance for Measles cases in Maricopa County

A presumptive measles exposure has occurred during a conference in WA/OR area (Skamania Lodge, Stevenson, WA) in March among Intel employees where several Maricopa County residents were in attendance. The exposure was from an unvaccinated man visiting from Romania. He was diagnosed clinically by a physician (no lab confirmation) in Romania with rash, fever, conjunctivitis, coryza, and cough. The infectious period would have been 3/6-3/9 so secondary cases could be expected as early as 3/14-3/27.

Please include measles in the differential for all rash illness. Early symptoms of measles include runny nose, cough, red eyes and fever followed in about 3-5 days by a maculopapular rash that starts on the face and travels down the body. Conjunctivitis is the main symptom that distinguishes it from flu early in the onset of the disease. The incubation period (time from exposure to first symptoms) is generally between 7 and 21 days.

Most people do not have complications. However, complications include otitis media, pneumonia, and encephalitis, and are more likely to occur in children younger than 5 years of age and in immuno-compromised persons of all ages.

Measles is able to spread even in a highly immunized population. Therefore, health care providers should be aware that a febrile illness in a person with red eyes and cough could be a case of measles presenting before the rash develops. Rubella also has a rash develops first on the face and upper body, but it is a much milder illness.

A febrile illness with a rash developing first on the face and upper body should be presumed to be measles. Providers should notify their Maricopa County Department of Public Health immediately at 602-747-7111if measles (or rubella) is suspected, and test for both measles and rubella (IgM and IgG). If the patient is in a health care setting, they need to be placed in airborne isolation.

People concerned they might have symptoms of measles should call their local Health Department and/or an outpatient provider before going in to be seen so as to arrange for isolation during the evaluation (to prevent the possible exposure of others).
 

 

Posted on March 15, 2012

 

Latest Edition of the Arizona Vaccine News Released

The Arizona Department of Health Services has distributed it's most recent issue of the Arizona Vaccine News. Click here to read.

 

 

Posted on February 8, 2012

Craig Phelps, D.O. Selected as President of A.T. Still University

After an extensive search that included many of the national leaders in osteopathic medical education, the ATSU Board of Trustees announced on February 4, 2012 the appointment of Dr. Craig Phelps as the next President of A.T. Still University. Dr. Clyde Evans, Ph.D., Board Chair, announced that Craig Phelps, D.O., FAOASM, will become President effective July 1; he will replace President Jack Magruder, who several months ago had announced his intention to retire. Dr. Phelps is a long-time AOMA Member and presently serves as our President Elect.

Dr. Phelps, a 1984 graduate of ATSU’s Kirksville College of Osteopathic Medicine, became Provost of the University’s Arizona campus in 1998, where he led the team that developed the campus and its three academic units: the Arizona School of Health Sciences, the Arizona School of Dentistry & Oral Health, and the School of Osteopathic Medicine in Arizona. In 2010 Dr. Phelps became the University’s first Executive Vice President for Strategic Initiatives; he has been working with Dr. Magruder and key ATSU leaders to develop the Missouri School of Dentistry & Oral Health, as well as other programs.

Are you Pertussis aware?

 
Pertussis, also known as whooping cough, is a highly contagious respiratory disease.
 
Pertussis is known for uncontrollable, violent coughing which often makes it hard to breathe. After fits of many coughs, someone with pertussis often needs to take deep breathes which result in a "whooping" sound. Pertussis most commonly affects infants and young children and can be fatal, especially in babies less than 1 year of age.
The best way to protect against pertussis is immunization. (Information courtesy of Centers for Disease Control and Prevention)
 
For more information visit these sites:

 

 

Posted on December 15, 2011

First Confirmed Influenza Cases of the 2011-2012 Season

The Arizona Department of Health Services and the Maricopa County Department of Public Health have confirmed the first two influenza cases in Arizona for the 2011-2012 influenza season. Both were confirmed as influenza A and are recovering. The first case is a 70-year old female in Maricopa County who had not received influenza vaccine and had no recent travel out of the state. The second case is a 38-year old male with no recent travel out of state. Vaccination history on this case is unknown at this time.
 
We would like to remind providers of the importance of vaccinating their patients against influenza throughout the flu season. There is ample vaccine supply for the season and vaccination of all eligible individuals is recommended. For a list of influenza vaccine clinics please go to www.StopTheSpreadAZ.org or call 877-764-2670. 
 
All rapid positive influenza tests will now count as confirmed influenza cases for this season. All positive influenza results, including rapids, should be reported to ADHS at (602) 364-3676, fax (602) 364-3199.

Please contact your county health department or the Arizona Department of Health Services for more information or log on to www.azdhs.gov/flu or www.cdc.gov/flu.

For questions regarding the 2011-2012 flu vaccine, providers can call the Arizona Immunization Program Office at (602) 364-3642 or (602) 364-3630. This year's national influenza vaccine recommendations are available at http://www.cdc.gov/flu/protect/vaccine/index.htm or http://www.cdc.gov/vaccines/pubs/ACIP-list.htm.

 

Posted on November 28, 2011

Latest Edition of the Arizona Vaccine News Released

The Arizona Department of Health Services has distributed it's most recent issue of the Arizona Vaccine News. Click here to read.

 

Posted November 17, 2011

Award-Winning Scottsdale Physician Assumes Leadership Role in National Medical Society

Denver, CO – David Bryman, DO of Scottsdale, Arizona was recently inducted as President of the American Society of Bariatric Physicians (ASBP) on October 29, 2011 at the society’s annual meeting in Las Vegas. He also received the Steelman-Seim Educator Award which recognizes those who have exhibited excellence in advancing the cause of health care through education and teaching. Formed in 1950, the ASBP is the primary source for clinical education and training for the non-surgical medical management of obesity.

Dr. Bryman is a Board certified Family Physician by the American Osteopathic Board of Family Practice and a Diplomate of the American Board of Bariatric Medicine (ABBM). He maintains a private practice in Scottsdale, Arizona and is an Adjunct Clinical Professor at the Mid-Western University Arizona College of Osteopathic Medicine. He is a Senior International Aviation Medical Examiner for the Federal Aviation Administration, Transport Canada, Civil Aviation Authority of New Zealand, the Australian Civil Aviation Safety Authority, and the Joint Aviation Authorities of Europe. Dr. Bryman speaks regularly for the American Society of Bariatric Physicians. In addition to his involvement with ASBP, he has also served in various leadership roles with the ABBM. He is also the past chair of the Patient Chart Review Committee for the ABBM.

Bariatric physicians practice weight loss or management by reducing body fat using an individualized approach crafted for the patient. Bariatricians use medical (non-surgical) methods including dietary modification, exercise prescription, psychological support and when appropriate, medication.

Dr. Bryman commented on his recent appointment, "It is an honor and privilege to be associated with this fine group of physicians. In light of the current obesity health crisis, the group’s dedication and commitment to improving the lives of overweight and obese patients is exactly what we need in order to further the health of our nation.”

For more information or to contact the Denver-based association, please visit www.asbp.org or call (303)770-2526. Dr. Bryman is available for interviews by calling his office at (480) 893-6728.
 

 

Posted on October 18, 2011

Members Weigh in on Prior Authorizations: A Barrier to Patient Care

There are shared concerns among all Arizona physicians when it comes to prior authorizations. Results from a survey of members of the Arizona’s Osteopathic Medical Association (AOMA) affirm that this growing trend dictated by health plans, or third party administrators is quickly becoming an obstruction to caring for patients.

With prior authorizations, physicians find themselves having to justify their treatment plans; partly defending a particular service or medication (drug) for a patient. This interference derails the professional medical opinion of a physician on whether a service or medication is ‘correct’ or ‘truly necessary’: language used by insurers in patient literature.

What’s most discerning is that prior authorization places individuals with no direct patient contact in the position of decision maker for patients.

Members surveyed agreed that it is a distraction from patient care and that a new, more simplified process is needed. Highlights from the AOMA survey follow:

  • Ninety-eight percent surveyed agreed that the prior authorization process interrupts patient care and everyone surveyed agreed it was ‘important’ or ‘very important’ to eliminate it.
  • Sixty-eight percent of respondents believed that having an automated (electronic) prior authorization process would help manage patient care more efficiently, while 95 percent felt it was ‘very important’ or ‘important’ to streamline the prior authorization process.
  • An overwhelming 92 percent said that they would prescribe an alternate drug if it meant avoiding the prior authorization and 89 percent reported that they already take such measures.
  • More than half, 66 percent of the respondents expressed that they have difficulty obtaining prior authorization on 25 – 74 percent of prescription drugs and that 10 percent of prescription drugs are rejected 90 percent of the time.

Finally, the administrative strain on doctor’s office is clear, with 73 percent of respondents reporting that their staff spends 10 hours or more a week, obtaining prior authorizations for drugs or services.

All of this sheds light on the barriers and the red tape caused by prior authorizations. Cost-savings measures that ambush patient care time, alter treatment plans and cause a burden on a doctor’s practice, demands a closer examination.

The issue is gaining traction among physicians everywhere. The AOMA results mirror those from surveys conducted with physicians across the nation and by ARMA (Arizona Medical Association) this summer. In fact a national survey administered in November 2010 by the American Medical Association of 2,400 member physicians concluded that the prior authorization process poses a problem in patient care.
 

 

Increase in Gonorrhea Cases in Arizona

The Arizona Department of Health Services has identified a 35% increase in gonorrhea (GC) reports in 2011. The majority of the cases have been reported from Maricopa County. However, additional increases have been detected in northern counties, as well. The GC case rate is highest among younger people, especially those between the ages of 15-29.

All uncomplicated gonorrhea must now be treated with dual therapy: 250 mg IM ceftriaxone along with azithromycin or doxycycline. If IM ceftriaxone is not an option, cefixime along with azithromycin or doxycycline may be used; however, cefixime may only be used if the patient reports no oral sexual exposure. CDCs 2010 Treatment Guidelines can be found at (http://www.cdc.gov/std/treatment/2010/default.htm). If treatment failure is suspected, treat patient with ceftriaxone 250 mg IM x 1 AND azithromycin 1 gram orally in a single dose, if the patient has not already been treated with ceftriaxone 250 mg; Perform a test of cure with culture and antibiotic susceptibility testing;

The Arizona Department of Health Services is encouraging health care providers to:

  • Increase traditional partner services, provider elicitation and phone/electronic referral, and dissemination of materials and tools to providers and patients to enhance partner referral.
  • Utilize expedited partner therapy (EPT). Partners should be provided both cefixime and azithromycin or doxycycline in accordance with the CDC STD Treatment Guidelines. http://azdhs.gov/phs/oids/std/provider_info.htm.
  • Encourage increased targeted GC screening by public and private providers serving populations at increased risk.
  • Report suspect cases to the local health department.

**DISTRIBUTED BY THE ARIZONA HEALTH ALERT NETWORK
 

 

Posted on October 11, 2011

 

The Arizona Department of Health Services (ADHS) has been informed of 10 suspected heroin deaths and 3 heroin overdoses in Maricopa County since September 25, 2011. Specific reasons for deaths are unknown at this time. Reports indicate the type of heroin could be black tar and extra potent, dark in color, crumbly, and cooks very dark. No patterns have yet to be identified in terms of location, gender, race, age, and/or ethnicity. Please share this information with anyone who could be affected. For information on treatment resources, please visit the ADHS website at: http://www.azdhs.gov/bhs/

** Distributed by the Arizona Health Alert Network**

Posted on October 4, 2011

Arizona Supreme Court Order adopts Daubert standard for expert witness testimony

In an Order filed on September 7, 2011 revising the Arizona Rules of Evidence, the Arizona Supreme Court modified Arizona Rules for Evidence 702 (Testimony by Expert Witnesses) to model Federal Rules for Evidence 702, and thus adopted by implication the "Daubert standard" for the admissibility of expert opinion testimony.The Order states that "The amendment recognizes that trial courts should serve as gatekeepers in assuring that proposed expert testimony is reliable and thus helpful to the jury's determination of facts at issue. The amendment is not intended to supplant traditional jury determinations of credibility and the weight to be afforded otherwise admissible testimony, nor is the amendment intended to permit a challenge to the testimony of every expert, preclude the testimony of experience-based experts, or prohibit testimony based on competing methodologies within a field of expertise. The trial court's gatekeeping function is not intended to replace the adversary system. Cross-examination, presentation of contrary evidence, and careful instruction on the burden of proof are the traditional and appropriate means of attacking shaky but admissible evidence." The complete order is available at www.azcourts.gov/Portals/21/MinutesCurrent/R100035.pdf.

 

Posted on September 23, 2011

Latest Edition of the Arizona Vaccine News Released

The Arizona Department of Health Services has distributed it's most recent issue of the Arizona Vaccine News. Click here to read.

 

 

Posted on September 6, 2011

How do prior authorizations impact your practice?

AOMA invites you to participate in this 5-minute survey on your experience with health insurer Prior Authorization (PA) for prescription drugs. This survey is open to physicians and their practice staff and will help us determine how we can best equip your practice to effectively address prior authorization and prior notification program issues.

Prior authorization is a common cost-containment and utilization review method used by health plans, insurers, and some public coverage programs. The practice of prior authorization, also called prior approval or preauthorization, requires a prescriber to obtain permission from the health plan or insurer to prescribe a medication before prescribing it. According to a recent national survey conducted by the American Medical Association (AMA), more than two-thirds of physicians report difficulty determining which drugs require preauthorization by insurers, and typically wait several days to receive preauthorization (one in ten wait more than a week).

Please take the time to fill out this important survey at the following link, https://www.surveymonkey.com/s/52WWHSR, so we can better understand how this practice is impacting Arizona physicians.
 

 

Posted on July 5, 2011

The latest on Electronic Health Records

AOMA hosted an Office Managers Institute entitled "EMR - 20 Tips to Success." Speakers from MDTechPro and the Arizona Regional Extension Center updated the audience on the latest in Electronic Medical Records.

To view their presentations, click on the links below:

 

Posted on June 15, 2011

Latest Edition of the Arizona Vaccine News Released

The Arizona Department of Health Services has distributed it's most recent issue of the Arizona Vaccine News. Click here to read.

 

 

Posted on May 12, 2011

Latest Edition of the Arizona Vaccine News Released

The Arizona Department of Health Services has distributed it's most recent issue of the Arizona Vaccine News. Click here to read.

 

Posted on March 18, 2011

Nuclear Radiation Concerns

The events in Japan do not currently pose a public health risk in Arizona, nor is a risk to public health in Arizona expected in the future. Federal, state, and local agencies are continuing to monitor the situation and updates will be provided as necessary through the Arizona Emergency Information Network (www.azein.gov).

Arizonans should NOT take potassium iodide as a precautionary measure:

  • It is not necessary given the current circumstances in Japan,
  • It can be dangerous to people with allergies to iodine, shellfish or who have thyroid problems, and
  • Taken inappropriately, it can have serious side effects including abnormal heart rhythms, nausea, vomiting, electrolyte abnormalities and bleeding.

The U.S. Food and Drug Administration and the World Health Organization recommend the use of KI only when people are exposed to high levels of radiation, such as those who were in the Japanese nuclear power plants when the explosions occurred. It is not anticipated that KI will be necessary for Arizonans as a result of the events in Japan. If it ever would become necessary for Arizonans to take potassium iodide, a recommendation would be made on how to acquire the drug and when to take it.

KI is a medicine used to protect the thyroid from absorbing radioactive iodine after high levels of radiation exposure. KI can have side effects in sensitive people or people with certain medical conditions. For questions about KI, please visit http://emergency.cdc.gov/radiation/ki.asp.

For more information on the emergency in Japan, including answers to some frequently asked questions, visit the Arizona Emergency Information Network (AzEIN) website at www.azein.gov or email questions to azein@azdema.gov.

 

Posted on February 11, 2011

Health Alert: Confirmed Case of Measles in Arizona, February 2011

Maricopa County Department of Public Health and ADHS have identified a confirmed case of measles in an Arizona resident. The case had a high fever starting on 1/29 and a maculopapular rash starting on his face and progressing downward. Case was diagnosed with suspect measles in an ED in Maricopa County on 2/4. A urine specimen was sent to the Arizona State Laboratory on 2/7 and tested PCR positive for measles on 2/8. Specimens are being sent to CDC to confirm the results. The case traveled outside of Arizona prior to illness onset, and it’s likely they may have been exposed during that time. Maricopa County and ADHS are working to identify possible contacts of this case. This case has no known link to the previously reported case of measles in Tucson.

Measles is a viral disease of the upper respiratory system and is highly transmissible among unvaccinated or immunocompromised populations. Both airborne and droplet transmission of measles can occur. Measles typically starts with a prodrome of a fever with a cough, conjunctivitis, or coryza; followed shortly by a maculopapular rash on the face that then progresses downward and outward to the trunk and limbs. Infections occurring in immunocompromised populations may present atypically. Measles is not often seen in the US; however cases in individuals who have travelled overseas to areas with endemic measles do sporadically occur.

Any provider suspecting measles in a patient should notify their local health department immediately. In addition to standard precautions, suspect measles cases should be placed in airborne precautions as soon as possible. If a patient calls saying that they are ill and may have been exposed to measles, please take precautions to be sure that patients in your waiting room will not be exposed and that all your staff are adequately vaccinated. The best way to prevent measles is to be vaccinated with two doses of MMR.

 

Posted on January 21, 2011

Health Alert: Confirmed Case of Measles in Arizona, January 2011

The Pima County Health Department and ADHS have identified a confirmed case of measles in Pima County. The case is a foreign national who was returning to the US to continue their schooling in Pima County. The case had a fever and rash that started on January 11th, while he was abroad, and he travelled internationally while infectious. The case was first seen with a rash and fever at an ED in Pima County on January 15th where measles was suspected. On January 18th, the case was laboratory confirmed at the Arizona State Laboratory as IgM positive for measles, and PCR results from a nasopharyngeal swab were positive on January 19th. Pima County and ADHS are working with CDC to identify possible contacts of this case while he travelled and Pima County is following up all hospital contacts.

Measles is a viral disease of the upper respiratory system and is highly transmissible among unvaccinated or immunocompromised populations. Both airborne transmission of measles can occur. Measles typically starts with a prodrome of a fever with a cough, conjunctivitis, or coryza; followed shortly by a maculopapular rash on the face that then progresses downward and outward to the trunk and limbs. Infections occurring in immunocompromised populations may present atypically. Measles is not often seen in the US, however cases in individuals who have travelled overseas to areas with endemic measles do sporadically occur.

Any provider suspecting measles in a patient should notify their local health department immediately. In addition to standard precautions, suspect measles cases should be placed in airborne precautions as soon as possible. If a patient calls saying that they are ill and may have been exposed to measles, please take precautions to be sure that patients in your waiting room will not be exposed and that all your staff are adequately vaccinated. The best way to prevent measles is to be vaccinated with two doses of MMR.

Arizona Osteopathic Medical Association
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Phoenix, AZ 85016
Phone: (602) 266-6699 | Fax: (602) 266-1393
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