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Exploring Outpatient Antibiotic Programs

Exploring Outpatient Antibiotic Programs

Several years ago, New York Hospital Queens (NYHQ) opened an Outpatient Parenteral Anti­biotic Therapy (OPAT) Unit as an alternative treatment option for patients who are healthy enough to be discharged from the hospital but still need once-daily intravenous (IV) antibiotics. “Our OPAT unit gives patients a chance to avoid spending days or weeks at the hospital for IV treatments,” explains Sorana Segal-Maurer, MD, who directs the OPAT unit at NYHQ. With the OPAT unit model, case managers help transition inpatients to an outpatient setting. These case managers are knowledgeable about patients’ care plans, insurance coverage, and discharge situation and can make referrals to the OPAT unit. Once discharged, patients return daily to receive IV antibiotics or other treatments on site by trained staff. The unit is supervised by physicians from the infectious diseases division who meet with patients and coordinate care with referring healthcare providers. The OPAT unit is also for people who need regular IV antibiotic infusions but do not otherwise require hospitalization—enabling them to avoid an inpatient admission. Important Benefits “With the OPAT unit model, patients can stay in the comfort of their own home and still receive effective treatment,” Dr. Segal-Maurer says. “In many instances, they can avoid future hospitalizations.” Quality of life and patient satisfaction improve because patients are discharged more efficiently and have shorter hospital stays. The OPAT unit is also convenient for those who can be treated on an outpatient basis and do not wish to self-administer IV antibiotics at home. Furthermore, the unit provides other IV options, including treatment for dehydration, anemia, and osteoporosis. Dr. Segal-Maurer and colleagues published a study in...

The ABIM Disallows Opposing Voices Regarding MOC

There is much controversy surrounding MOC (Maintenance of Certification) requirements. The American Board of Internal Medicine (ABIM) along with the American Board of Medical Specialties (ABMS) continue their stance imposing these duties upon doctors. Yet, 97% of physicians surveyed on Sermo (the largest online doctors-only community with over 300,000 members) oppose MOC as it currently stands. While life-long learning is very important in our profession, most of us feel MOC is not the way to achieve it. For one thing, we are already required to earn a certain number of CME hours in order to maintain our state medical licenses. So, there is a redundancy of work here. MOC is time-consuming, and many of us feel that the guidelines set in place have no relevancy to medicine in the real world. For learning to be effective, it needs to match the knowledge that is necessary in treating our patients in the exam room. Esoteric medical facts rarely come into play in clinical practice. Yet, that is much of what we are being tested on in our recertification exams. In fact, this past year I took my recertification exam and was expected to answer questions using outdated PAP test guidelines. “…we are not going away. We are seeking fairness and to abolish corruption in this process forced upon us.”   It is not just the time and lack of real world medical knowledge that we oppose but the cost. Doctors are forced to pay 10’s of thousands of dollars out-of-pocket for something we do not believe provides us any value. And we have no choice but to comply because our...
Guidelines for Treating Blood Cholesterol

Guidelines for Treating Blood Cholesterol

In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a new clinical practice guideline for the treatment of blood cholesterol in patients at high risk for atherosclerotic cardiovascular disease (ASCVD). The guideline was prepared by a panel of experts based on an analysis of the results of randomized controlled trials. The guidelines use the highest-quality scientific evidence to focus the treatment of blood cholesterol to those who are likely to benefit most. A Focus on Statins According to Neil J. Stone, MD, who served as chair of the expert panel that wrote the guideline, the ACC/AHA guidelines represent a departure from previous recommendations. “The guidelines don’t recommend specific target levels of LDL cholesterol,” he says. “Instead, they focus on defining patient groups for whom LDL lowering with statins has been proven to be most beneficial.” The panel recommended use of statins after a detailed review of other cholesterol-lowering drugs. “Most statins are generics and have been shown to provide the greatest benefit while having low rates of safety issues when taken as prescribed,” Dr. Stone says. The guidelines note, however, that there is a role for other cholesterol-lowering drugs in selected patients who suffer side effects from statins. The guidelines identified four major groups of patients for whom statins have the greatest likelihood of preventing stroke and heart attacks. Moderate- or high-intensity statin therapy is recommended for patients. 1. With clinical ASCVD. 2. With primary elevations of LDL cholesterol of 190 mg/dL or higher. 3. Aged 40 to 75 with diabetes and LDL cholesterol levels between 70 and 189 mg/dL without clinical ASCVD....
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