Archive for the 'Featured Posts' Category

The New York State Hepatitis C Testing Law: A Focus on Baby Boomers

by Varsha Koripella, M2, Wayne State Medical School; Terri L. Wilder, MSW, Mt. Sinai Institute for Advanced Medicine, & Antonio E. Urbina, MD, Mt. Sinai Institute for Advanced Medicine

Hepatitis C virus (HCV) is a serious, often under-recognized public health problem in the U.S, especially in New York State (NYS) where an estimated 195,000 of the affected 3.2 million people live. If left untreated, HCV can cause serious liver damage and/or liver cancer, and is the leading cause of liver transplants in the U.S. Due to recent advances in medicine, new, more effective treatments are now available that can cure most people living with HCV.

To increase HCV testing and ensure timely diagnosis and linkage to care, the NYS Hepatitis C Testing Law was put into effect on January 1, 2014. The law has three main provisions:

  1. An HCV screening test must be offered to every individual born between 1945 and 1965 receiving inpatient services at a hospital or primary care services through a hospital outpatient clinic or diagnostic/treatment center or from a physician, physician assistant, or nurse practitioner regardless of setting. Exceptions occur if the individual is being treated for a life-threatening emergency, has previously been offered or received a HCV screening test, or lacks the capacity to consent. Emergency Departments are encouraged, but not required to offer testing;
  2. The offer of testing must be culturally and linguistically appropriate;
  3. If an individual accepts the offer and the test is reactive, the provider must offer the individual follow-up health care or refer them to a provider who will

The law specifies baby boomers because more than 75% of adults infected with HCV were born between 1945 and 1965, and most were infected in the 1970s and 1980s when drug use was highest. Even now, sharing needles is the most common way for people to become infected. In addition, some may have been infected by contaminated blood products before universal screening of the blood supply began in 1992. Early HCV screening is necessary for improving health outcomes and preventing HCV transmission to others. HCV is a curable disease for most, and the success of treatments depends on providers properly identifying and linking patients to care and treatment.

Are you up-to-date on the NYS Hepatitis C Testing Law?

The NYS Department of Health Clinical Education Initiative (CEI) provides free CME/CNE trainings on HCV for medical providers in NYS. To request a training or to view on-line HCV courses, please visit www.ceitraining.org. To speak with a clinician experienced in managing HCV, call the CEI Line toll-free at 1-866-637-2342.

 

References

  1. Smith, Bryce D., Rebecca L. Morgan, Geoff A. Beckett, Yngve Falck-Ytter, and Deborah Holtzman. “Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born during 1945-1965.”Morbidity and Mortality Weekly Report 4 (2012): 1-32. Print.
  2. New York State Department of Health. Web. 6 June 2015. <http://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/providers/testing_law.htm&gt;.
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Preventing HIV: What Every Clinician Needs to Know about Non-Occupational Post-Exposure Prophylaxis

By Varsha Koripella, M2, Wayne State Medical School, Terri L. Wilder, MSW, Mt. Sinai Institute for Advanced Medicine, Antonio E. Urbina, MD, Mt. Sinai Institute for Advanced Medicine

This is part 3 in a 4 part series of articles detailing New York’s efforts to combat HIV through PrEP and other regiments

If a patient presents to a medical provider with a recent HIV exposure, immediate nPEP (non-occupational post-exposure prophylaxis) administration may prevent HIV transmission. This 28-day regimen is recommended for exposed patients of at least 13 years of age, and the recommended regimen is tenofovir + emtricitabine plus either raltegravir or dolutegravir. Situations that prompt a request for nPEP include condom slippage, breakage or lapse in use, and unsafe needle-sharing.

The NYS Department of Health nPEP guidance states: for maximum effectiveness, nPEP must be administered within 36 hours of exposure, ideally within two hours. If the source person is known to be HIV-infected, the provider should obtain information about his/her viral load and antiretroviral medication history, but do not delay administration of the first dose. After administration, telephone or in-person consultation with an experienced HIV provider is recommended. To speak with a clinician experienced in managing nPEP, call the CEI Line toll-free 24/7 at 1-866-637-2342.

When deciding whether to prescribe nPEP, the clinician should assess the patient’s risk of HIV acquisition based on the type of exposure. The behaviors that confer the highest risk are needle-sharing and receptive anal intercourse with an HIV-infected person. Treatment of these exposures should be combined with a strong educational component that emphasizes prevention of future exposures.

All patients receiving nPEP should be re-evaluated within 3 days of the exposure and weekly during the recommended 28-day regimen to assess adherence and side effects. In addition to the baseline test, HIV testing should also be done at week 4 and week 12 post-exposure regardless of whether nPEP was initiated. If the HIV test result is positive at any time, perform a FDA-approved confirmatory assay to confirm the diagnosis. A negative HIV test result at 12 weeks post-exposure reasonably excludes HIV infection related to this exposure.

A member of the health care team should provide risk-reduction counseling whenever someone is assessed for nPEP, and medical providers should assess for other factors that can contribute to risk behavior. Persons who present with repeated high-risk behavior should be the focus of intensified education and considered for initiation of pre-exposure prophylaxis (PrEP).

Are you up-to-date on nPEP?

The NYS Department of Health Clinical Education Initiative (CEI) provides free CME/CNE trainings on nPEP for medical providers in NYS. To request training or to view online nPEP courses, please visit www.ceitraining.org.

The complete NYS DOH PEP guidelines can be found at http://www.hivguidelines.org.

References

  1. HIV Clinical Resource. NYS Department of Health AIDS Institute, Oct. 2014. Web. 8 June 2015. <http://www.hivguidelines.org/clinical-guidelines/post-exposure-prophylaxis/hiv-prophylaxis-following-non-occupational-exposure/&gt;
  2. “I might have been exposed to HIV. What should I do?” Web. 8 June 2015. <http://www.hivguidelines.org/wp-content/uploads/2013/12/i-might-have-been-exposed-to-hiv.-what-should-i-do.pdf&gt;.

From the Physician’s Perspective: Diabetes in Older Adults

By: Louis Snitkoff, MD, FACP
Chair, NYACP Diabetes Advisory Group

Physician's PerspectiveType 2 diabetes in older adults presents internists with a number of clinical challenges. The prevalence of diabetes and prediabetes among adults 65 years of age or older is estimated to be as high as 33% and 50%, respectively. Despite this, older adults are under-represented in clinical treatment trials, and treatment targets are uncertain in this population.

Because post-prandial hyperglycemia is common in older adults, screening with fasting plasma glucose and/or HbA1C may underestimate the prevalence of type 2 diabetes among senior citizens. Nonetheless, it is estimated that the number of newly-diagnosed older adults will increase more than 4-fold by 2050. Continue reading ‘From the Physician’s Perspective: Diabetes in Older Adults’

Help Your Patients Quit – Great American Smokeout is November 15th

As the American Cancer Society marks the 37th Great American Smokeout on November 15, encourage your patients who smoke to use the date and make a plan to quit. Tobacco use remains the single largest preventable cause of disease and premature death in the US, yet about 43.8 million Americans still smoke cigarettes – Nearly 1 in every 5 adults.

The New York State Smokers’ Quitline is a free and confidential service that provides effective stop smoking services and resources to physicians and their patients who want to develop a plan to stop smoking.

Trained Quit Coaches at the Quitline are ready to help Assess, Assist and Arrange.  They will screen patients for FREE Nicotine Replacement Therapy (NRT) eligibility and provide cessation counseling. Eligible patients will receive NRT in the mail and an additional counseling call. Health providers will also receive a patient progress report.

According to the Public Health Service Clinical Practice Guideline, health care providers are recommended to:

  1. Ask patients about their tobacco use
  2. Advise patients to Quit
  3. Assess for willingness to quit
  4. Assist in a quit attempt
  5. Arrange for follow-up


Coding and Billing

The Quitline offers details on billing and coding requirements provided in the Outline: Practice Transformation for Smoking Cessation Counseling V3 and the Medicaid and Medicare materials: Continue reading ‘Help Your Patients Quit – Great American Smokeout is November 15th’

NYS DOH Issues Health Advisory: Guidance on Immunizations, Vaccine Storage, Medical Records, Prescriptions, Diarrheal Illness and ServNY as a result of Hurricane Sandy

The New York State Health Department issued a health advisory today that provides guidance to physicians and other medical practitioners in response to Hurricane Sandy including:

  •  recommended immunizations for emergency responders, volunteers, and the public;documentation; billing and reimbursement
  • vaccine storage if power is lost
  • what to do if medical records are destroyed or steps to save wet medical records
  • prescription information if patient’s pharmacy is not open or patient is a Medicaid member
  • potential increase in diarrheal illness
  • ServNY volunteers needed

Physicians and other medical practitioners with any additional questions should contact the Hurricane Sandy Provider Assistance Hotline at 1-866-544-1303

Access the advisory and other helpful resources by visiting www.nyacp.org/recovery

From the Physician’s Perspective: Continuous Glucose Monitoring in the Management of Adults with Diabetes Mellitus

By: Ruth S. Weinstock MD, PhD, FACP, FACE
Blogger

Individuals with type 1 diabetes have severe insulin deficiency and require basal/bolus insulin therapy with an insulin pump or multiple daily insulin injections.  Barriers to achieving optimal glycemic control include Continue reading ‘From the Physician’s Perspective: Continuous Glucose Monitoring in the Management of Adults with Diabetes Mellitus’


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