Among 283 symptomatic healthcare personnel (HCP) tested for SARS-CoV-2, 51 (18%) were positive. Among those 51 HCP, self reported loss of smell and taste were present in 51% and 52.9%, respectively, with either present in 60.8%. These symptoms had high specificity (93% each, 96% for either) for a positive SARS-CoV-2 test.
Objectives: Harris Health System (HHS) is a safety net system providing health care to the underserved of Harris County, Texas. There was a 6-month waiting period for a rheumatologist consult for patients with suspected systemic lupus erythematosus (SLE). The objective of the intervention was to improve access to specialty care.Methods: An algorithmic approach to testing for SLE was implemented initially through the HHS referral center. The algorithm was further offered as a "one-click" order for physicians, with automated reflex testing, interpretation, and case triaging by clinical pathology.Results: Data review revealed that prior to the intervention, 80% of patients did not have complete laboratory workups available at the first rheumatology visit. Implementation of algorithmic testing and triaging of referrals by pathologists resulted in decreasing the waiting time for a rheumatologist by 50%. Conclusions:Clinical pathology intervention and case triaging can improve access to care in a county health care system.The Harris Health System (HHS) is the safety net health care system for Harris County, Texas, which is the third largest county in the United States. This health care system consists of two hospitals, 23 community health centers, five school-based clinics, and several clinics that provide specialist care. The HHS provides access to care for many patients who would otherwise be unable to see a physician outside of an emergency department setting. However, this system is challenged by a shortage of clinic visit spots available for patients, especially for specialist care. For example, it was taking as long as 6 months for a patient to get an appointment with a rheumatologist in the HHS. Rheumatologic conditions such as systemic lupus erythematosus (SLE) necessitate prompt diagnosis and early treatment to avoid permanent end-organ damage.1 Thus, the prolonged waiting period to see a rheumatologist is anticipated to delay timely diagnosis, postpone initiation of therapy, and cause dissatisfaction for both patients and theirUpon completion of this activity you will be able to:• identify how a clinical pathology consultation service can improve access to specialty care in a resource limited setting.• describe the benefits of automated reflex testing.• understand the importance of value-based health care.The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit TM per article. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance of Certification Part II Self-Assessment Module.The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.Exam is located at www.ascp.org/ajcpcme. CME/SAM
Background: Hydrocodone-combination analgesics were changed from Schedule III to Schedule II to discourage the prescribing of these analgesics. Our primary aim was to explore the effect of hydrocodone rescheduling on opioid prescribing within an urban safety-net health care system.Methods and Design: Data were extracted from electronic records of ambulatory patients (N ؍ 82,432 patients) prescribed hydrocodone-combination, codeine-combination, or tramadol opioid analgesics (N ؍ 200,675 prescriptions) between October 6, 2013 and October 6, 2015. Data analyses modeled predicted probabilities of hydrocodone-combination prescriptions (HCPs). Chronic opioid therapy (COT) for chronic pain (ie, >3 opioid prescriptions/12 months) and morphine milligram equivalency (MME) levels were also examined.Results: The probability of providers writing HCPs decreased significantly from pre-to postrescheduling (0.525 vs 0.158, respectively, P < .0001). However, this coincided with large probability increases in codeine-combination (0.064 vs 0.269) and tramadol prescriptions (0.412 vs 0.573). The probability of HCPs varied across physician specialty (P < .0001), patient diagnoses (P < .0001), COT versus non-COT patients (P < .0001), and patient characteristics (sex, race/ethnicity, and age; P < .05). COT patients received significantly more opioid prescriptions in the postrescheduling period (M ؍ 4.81 vs M ؍ 4.27; P < .0001). Patients on <20 MME/day increased slightly from pre-to postrescheduling (P < .0001).Discussion: Significant declines in HCPs occurred after rescheduling; however, one third of patients prescribed opioids remained on doses >20 MME/day. Codeine-and tramadol-prescription probabilities increased significantly and providers may have an increased perception of safety about these medications. Physicians and health care systems must reduce their overreliance on opioids in treating pain, especially chronic pain, as all opioids incur some level of risk.(J Am Board Fam Med 2019;32: 362-374.)
COVID-19 vaccine hesitancy among healthcare workers (HCW) undermines community vaccine confidence. Predictors and reasons for HCW hesitancy in the Atlanta region were evaluated using a survey between May and June 2021. Vaccine hesitancy was highest in younger and less educated HCW. Interventions to address vaccine hesitancy in HCW are necessary.
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