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Pain clinic closure; Treatment of chronic hepatitis C; Antimicrobial-resistant gonorrhea

Today’s topics:

  • Pain clinic closure
  • Treatment of chronic hepatitis C
  • Antimicrobial-resistant gonorrhea

Pain clinic closure

Actions requested:  Be aware that services for patients seen at area pain clinics may be limited, leading to more patients who have been on chronic opioid treatment needing to be seen urgently by other providers.

Background & Recommendations

The Washington State Medical Commission has suspended the license of Frank Li, MD, for substandard care. Because Dr. Li is the Medical Director of Seattle Pain Centers, this action affects eight clinics across Washington (Everett, Seattle, Renton, Tacoma, Poulsbo, Olympia, Vancouver, and Spokane) and potentially 25,000 patients, many of whom may be on chronic opioid treatment.  Although other providers within these clinics will continue to see patients, many patients may need alternative care.  Along with the Medical Commission, I urge all practitioners to accept Seattle Pain Center patients for care.  Pharmacists should continue to honor prescriptions written before July 15, 2016.

The Medical Commission has a website (http://goo.gl/TEu1fg) of resources dedicated to pain management and opioid use.

  • University of Washington (UW) Medicine offers TelePain (http://goo.gl/59NOMl), weekly sessions offering community providers consultation in the management of chronic pain problems.  CME is available.
  • Consultation options are also available at UW Pain Medicine (http://goo.gl/EHDrML).
  • UW launched a weekly psychiatry and addiction case conference series in July. For more information, see the announcement on the newsletter at https://goo.gl/uzsemd or email UWpacc@uw.edu. CME is available.
  • The Agency Medical Directors’ Group guideline (http://goo.gl/u6IewG) and the Centers for Disease Control & Prevention (CDC) Guidelines for Prescribing Opioids at http://goo.gl/SiLbUK provide recommendations for chronic opioid cases.
  • The Washington Prescription Monitoring Program (PMP) is a tool all providers should use to monitor the total quantity of all controlled substances, including opioids, dispensed to a patient (http://goo.gl/RljAZE).
  • For patients, a one-page “Pain Medication Safety Guidelines in the Emergency Department” is available at (http://goo.gl/4WmS5A).


Treatment of chronic hepatitis C

Actions requested:  Review the revised hepatitis C (HCV) guidelines from the Washington State Healthcare Authority (HCA) and Apple Health, and take steps to optimize identification and treatment of chronic hepatitis C patients who are Apple Health beneficiaries.

Background & Recommendations

Testing for chronic HCV infection is recommended for all persons born during 1945-1965 (baby boomers), persons who ever injected drugs, and persons with other risk factors.  Previously, eligibility for chronic HCV treatment through Apple Care required documentation of more advanced stages of liver disease.  The revised guidelines make treatment available to many more infected persons and expand the number of prescribers who can administer HCV antiviral treatment.

Many patients are now eligible for treatment regardless of the stage of liver disease, in accordance with guidance from the American Association for the Study of Liver Diseases and the Infectious Disease Society of America.  Approved prescribers now include specialists in gastroenterology, hepatology, HIV, and infectious disease, and prescribers consulting with Project ECHO or one of the specialists listed above (requires consultation note or documentation of phone call).  Exceptions may be made for other specialties or non-specialist providers who work in coordination with an organized system of care, have received training in hepatitis C diagnosis, staging and treatment protocols, and have ready access to specialists that treat HCV.

You will find the complete guidelines at http://www.hca.wa.gov/medicaid/pharmacy/Documents/wa-apple-health-hepatitis-c-clinical-policy.pdf

Other resources:

 

Antimicrobial-resistant gonorrhea

Actions requested:  Be aware that treatment of gonorrhea requires dual therapy.

Background

Neisseria gonorrhoeae resistance to antimicrobials appears to be increasing.  Laboratory data suggest that oral cefixime is becoming less effective and resistance to azithromycin is emerging.  Therefore dual therapy is essential to assure cure and reduce the risk of resistance developing further.

Recommendations

  • Treat gonorrhea with a single dose of 250 mg of intramuscular ceftriaxone in combination with 1 gram of oral azithromycin.
  • Report all cases of gonorrhea to the Health District (425-339-5261).
  • Offer expedited partner therapy (EPT) to heterosexual partners.  EPT is not supported for men who have sex with men. For information on EPT, see http://www.snohd.org/Providers/STD-Screening-Guidelines).

 

You can find my recent health alerts posted on the Provider pages of our website, at http://www.snohd.org/Providers/Health-Alerts.

Gary Goldbaum, MD, MPH | Health Officer & Director | Administration

3020 Rucker Avenue, Ste 306 | Everett, WA 98201 | 425.339.5210 | ggoldbaum@snohd.org

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