Archive for the ‘Public Health News’ Category

Several changes to the Georgia Prescription Drug Monitoring Program (PDMP)

 

 

 

 

 

 

 

 

 

Brenda Fitzgerald, M.D.

Commissioner, Georgia Department of Public Health

Dear Health Care Provider,

During the 2017 legislative session, the Georgia General Assembly passed House Bill 249 which provided for several changes to the Georgia Prescription Drug Monitoring Program (PDMP). The first of these changes takes effect July 1, 2017, when management of the PDMP transfers to the Georgia Department of Public Health (DPH). DPH will continue to work closely with the Georgia Drug and Narcotics Agency, which will retain enforcement responsibilities.

While these changes will not impact the way most dispensers and prescribers input information into the system, there are new requirements mandated by law.

  1. Effective July 1, 2017, dispensers will be required to enter prescription information for Schedule II, III, IV, V controlled substances within 24 hours. This will provide prescribers more efficient access to information with less wait time as they make the best clinical decisions possible for their patients.
  2. All prescribers will be required to register in the PDMP by Jan. 1, 2018. Currently only about 10 percent of prescribers in Georgia are registered in the PDMP. Prescribers already registered DO NOT need to re-register.
  3. Beginning July 1, 2018, prescribers will be required to check PDMP before prescribing Schedule II drugs or benzodiazepines. (Prescribers are currently encouraged to check the PDMP before prescribing Schedule II drugs or benzodiazepines, but are not yet required to do so.)

The purpose of the PDMP is to reduce the abuse of controlled substances and to promote proper use of medications used to treat pain and terminal illness. The PDMP also helps reduce duplicative prescribing and overprescribing of controlled substances. To that end, the PDMP will now generate clinical alerts when you log in to check a patient if:

  • A patient has five prescriptions or uses five pharmacies for controlled substances over 90 days (Tennessee model)

or

  • A prescribed daily dosage of greater than 100 MME (morphine milligram equivalents)

Because there is a large number of prescribers to be registered in the PDMP by Jan. 1, 2018, we have devised a system for prescribers to register based on their birth month. Refer to the table below to find out when to register.

If you were born in: Register in PDMP in:
January, February, March July
April, May, June August
July, August, September September
October, November, December October

To register, go to georgia.pmpaware.net/login. You will need:

  • Your name and business address
  • Primary phone number
  • Last 4 digits of SSN
  • DEA number
  • NPI number
  • Professional license number and type
  • Health care specialty

Under the new law, prescribers and dispensers are allowed to register two delegates (staff without a DEA number) per shift or rotation to check the PDMP and enter prescription information. However, to ensure prescribers and dispensers are all registered by their mandated date, DPH will register new users in two phases. In the first phase, DPH will ensure all prescribers are registered by Jan. 1, 2018, and in the second phase, DPH will allow new delegates to register. We will provide more information about delegates and how they may be registered after Jan. 1, 2018.

Trainings and webinars will be available on the DPH website dph.georgia.gov/pdmp to assist you during this transition. You will also find a copy of the amended law regarding PDMP and a list of frequently asked questions. If you have any questions about the PDMP or registering, please send an email to pdmpsupport@dph.ga.gov or call 404-463-1517.

We know that Georgia, like the rest of the country, is in the midst of an opioid epidemic. Whether it manifests itself in a cluster of opioid overdoses as we saw earlier this month, or the number of babies being born addicted to drugs and experiencing heartbreaking withdrawal symptoms in the first hours after birth, opioid addiction, overdoses and abuse of prescription pain medications are a public health crisis. Working together we have the power to help reduce the number of Georgians severely affected by or dying from opioid overdoses.

 

 

Very truly yours,

Brenda Fitzgerald, M.D.

Commissioner

Letter to the Editor: Say ‘No’ to GOP health legislation

Dear Editor:

I am writing to express my concern over the actions of Congress on health reform. Currently, the U.S. Senate is working behind closed doors to draft legislation that could change the future of health care in America. The U.S. House of Representatives’ approach to health reform led to the truly flawed American Health Care Act (AHCA) — legislation that would weaken benefits and cause millions of Americans to lose their health insurance. As a family physician from Eatonton, I provide comprehensive care to my patients. The AHCA would harm many of them. Analysis of the bill shows 987,600 people in Georgia would lose health care coverage and see dramatically increased premiums — an average of $1,034 in Georgia. The AHCA threatens the health security of people who have pre-existing conditions or cannot pay for skyrocketing premiums or co-payments and deductibles. It doesn’t address the real-life challenges people have with health care. The policies in the AHCA disguise discrimination as flexibility and make health care less accessible and more expensive for those who need it most. Health reform is needed, but we must maintain the gains in patient protections provided by the current law, and I encourage Congress to work toward a bipartisan solution.

I urge readers to contact U.S. Sens. Isakson and Perdue to urge them to oppose any legislation that would deprive the citizens of Georgia of meaningful health care coverage. It is important to me that none of my patients (and other Georgians) lose access to care because they have lost affordable health insurance.

Sincerely,

Eddie Richardson, Jr., MD, FAAFP President – Georgia Academy of Family Physicians

Read More: http://www.georgiahealthnews.com/2017/06/letter-editor-no-gop-healthbill/#disqus_thread

Opiod Overdose in Georgia

The Georgia Department of Public Health (DPH) is working with the Georgia Poison Center and the Georgia Bureau of Investigation (GBI) on a cluster of opioid overdoses and possible related deaths that have occurred in Central Georgia since June 3, 2017. This is the largest cluster of known opioid overdoses in Georgia and a serious public health crisis.

Patients reportedly purchased yellow pills on the street that are purported to be Percocet. One identifying mark indicating the pills are counterfeit is the Percocet stamp on the fake pills is at a slight angle. The pills are extremely potent and patients have required massive doses of naloxone to counteract the effects.

On Wednesday, June 7, 2017, the GBI received evidence related to these pills and reported overdoses. Preliminary results indicate a mixture of two synthetic opioids, with one of the drugs being consistent with a new fentanyl analogue. This fentanyl analogue has not previously been identified by the GBI Crime Lab and confirming the full identity of the drug will require additional time.

We estimate the number of overdoses to be approximately 30, including four deaths that may be related to the counterfeit pills. These numbers are fluid due to incomplete confirmatory testing. In addition, as treating facilities are able to interview patients, a case originally thought to be related may ultimately be determined to be unrelated.

As your Commissioner of Public Health, I am writing to stress the importance of early recognition of symptoms and the need for decisive action when a patient presents. DPH and the Georgia Poison Center have developed guidelines for patients who may have ingested the yellow pills and present to hospital emergency departments. I am sharing this same information with all Georgia physicians because of the critical need for awareness among all of us, and to appropriately track these cases and gain better understanding of the scope of the problem.

If a patient arrives in your ED meeting the following criteria:

  1. Patient presents on or after June 1, 2017.
  2. Patient presents with an opioid toxidrome requiring resuscitation, ventilation, and/or naloxone for reversal of symptoms.
  3. Exposure history that may involve “purchasing pills off the street” or like-story.
  4. Exposure history that may involve the ingestion of a SMALL quantity of the suspect pills resulting in BIGsymptoms. (e.g., the ingestion of 1-2 suspect tablets producing sudden onset of CNS, RESPIRATORY, CARDIOVASCULAR depression).

Please ensure the following: 

  1. Immediately upon admission to ED, obtain WHOLE BLOOD sample, preferred gray-top tube (sodium fluoride preservative).
  2. Urine sample collected if possible, per standard collection protocol.
  3. The sample(s) should be sent to the hospital’s lab for refrigeration in case further analysis is needed.
  4. If you are unsure if the case is related to counterfeit Percocet pills, collect and hold admission samples as described above and call the Georgia Poison Center for guidance.

 If a pill is found on a patient in the hospital: 

  1. Wear adequate PPE when handling the substance.
  2. Specific recommendations from the GBI include double gloving, gown, n95 mask and goggles.
  3. Double bag the substance with a bio-hazard label on the outside and handle per hospital protocol.

To appropriately track these cases, it is highly recommended that the Georgia Poison Center be notified of all cases suspected to be related to this outbreak of overdoses.

For any additional questions, including sample procurement and storage, please call the Georgia Poison Center at 1-800-222-1222 or 404-616-9000.

DPH will continue to monitor this situation. Please do not hesitate to contact me if you have any questions.

Thank you for all that you do.

Sincerely,

Brenda Fitzgerald, M.D.
Commissioner

Did You Miss our Public Health Webinars in May? Check Out the Recorded Webinars on the GAFP Website

Through a partnership with the Georgia Department of Public Health, GAFP offered two webinars on Infant Oral Health and Health Care Transition. Both webinars were recorded and are now available to view on the GAFP website at https://gafp.org/education/webinars/. You can see objectives and speaker information for each webinar below!

Out of the Mouths of Babes – How Family Physicians Can Ease the Child Dental Crisis in Georgia

This program is presented by Carol Johnson Smith, RDH, MSHA, Director, Oral Health Program for Georgia. Carol manages surveillance for the program and she developed a Georgia Oral Health Coalition with 7 Coalition Regional Boards and recently obtained 501c3 status for the Coalitions.

Webinar Objectives

  • Explain why primary teeth are important
  • Encourage that patients brush teeth regularly with a smear of fluoridated toothpaste
  • Encourage regular dental visits
  • Outline proper dietary habits
  • Educate parents about good oral health habits for them and their children

Adult Disability Medical Home (ADMH) – Transitioning from pediatric to adult healthcare

This program is presented by JEFFREY REZNIK, MD and ANDREA VIDELEFSKY, MD. 

Dr. Reznik is a partner with Urban Family Practice Associates, Medical Co Director of the Adult Disability Medical Home. He is a member of Down Syndrome Medical Interest Group and a Family Physician Champion for Health Care Transition. Jeff has special interests in treating patients with special needs and their families and has expertise in the areas of cerebral palsy, Down syndrome and autism.

Dr. Videlefsky is a Family Practice Physician of Urban Family Associates, an active member of Down Syndrome Medical Interest Group and serves as a Family Physician Champion for Health Care Transition. She is dedicated to serving patients through the patient-centered medical home model. She has a special interest and expertise in treating teens and adults with Down syndrome and other developmental disabilities.

Webinar Objectives:

  • Strategies for transitioning patients to the adult care system
  • Information about a best practice model of the Patient Centered Medical Home which places the needs of patients at the center of healthcare services.
  • Holistic approach to care for patients transitioning to adult services with respect to health, wellness, living and recreational options.
  • Strategies for a medical partnership

Upcoming Webinars for you and your staff: Register Today!

The Georgia Academy of Family Physicians is bringing you webinars with key information vital to Georgia’s family physicians and your patient population.  These educational CME webinars offer a streamlined, comprehensive approach to services that are needed and accessible to clinicians.

Please register and plan on participating to hear the latest updates. Can’t join us live? Register for one of our live sessions and we will send you the recording when it’s available!

1. Adult Disability Medical Home (ADMH) – Transitioning from pediatric to adult healthcare – May 24, 1:15 pm- 2:15 pm (1 AMA PRA Category 1 CME credit) Please click the link to register for the May 24th webinar.

https://attendee.gotowebinar.com/register/968565672425276418

2. Spring Cleaning– How Family Physicians Can Ease the Child Dental Crisis in Georgia¬– May 31, 12:00 pm – 1:00 pm (1 AMA PRA Category 1 CME credit) Please click the link to register for the May 31st webinar.

https://attendee.gotowebinar.com/register/1873115196169259267

Spring Cleaning: How Family Physicians Can Ease the Child Dental Crisis in Georgia

A family physician or pediatrician typically sees a child and their family about 13 times for routine checkups and vaccinations.  Each of these visits presents an opportunity for you and your clinical staff to review risk factors for oral disease.  In the U.S., tooth decay is the most prevalent chronic disease of childhood, five times more common than asthma.  Research has shown that from 1994-2004, 28 percent of 2-5-year-olds experience tooth decay.  Which is an increase of 15 percent from the prior decades.  We also know, that if parents have poor oral health status, so will their children.

What Can Family Physicians Do to Turn a Frown Upside Down for Our Children?

For all children and their families, it’s important to educate them and hit these main points:

  • Educate parents about good oral health habits for them and their children
  • Explain why primary teeth are important
  • Encourage that they brush teeth regularly with a smear of fluoridated toothpaste
  • Encourage regular dental visits
  • Outline proper dietary habits

Start providing fluoride varnish application in your practice!

Effective 2015, physicians can offer this service to Medicaid children with a new CPT code 99188.  Georgia’s Department of Public Health has a small staff dedicated to expanding fluoride varnish in primary care physicians’ offices around the state. Please see the contact below and consider adding this benefit to your practice.

Want to learn more? Register for the upcoming webinar, Wed, May 31, 2017 12:00 PM – 1:00 PM https://attendee.gotowebinar.com/register/1873115196169259267

If you cannot join us but would like a recording of the webinar email twallace@gafp.org to receive the live link.

For more information, please outreach to the following:

Carol C. Smith, RDH, MSHA, Director of Oral Health
Maternal and Child Health
Georgia Department of Public Health
2 Peachtree Street, 11-222
Atlanta, Georgia 30303-3142
Phone 404-657-3138
Fax: 404-657-7307

Carol.smith@dph.ga.gov

Gonorrhea: Who’s at risk and what do we do about it?

Priya Gulati, MD Emory Family & Preventive Medicine Resident Physician

Family physicians regularly complete STD testing as part of routine preventive visits. It is not a surprise that overprescribing creates antibiotic resistance, and this has now been identified as an issue with gonorrhea. Much like the common cold and resulting resistance to zpack, gonorrhea is progressively becoming a resistant organism to standard therapy.

The Center for Disease Control & Prevention (CDC) began monitoring the emergence of antibiotic resistant gonorrhea in the U.S. with the Gonococcal Isolate Surveillance Project (GISP) in 1986. In 2013, the CDC listed N. gonorrhoeae as one of three organisms posing the highest threat to human health. Although antibiotic resistant gonorrhea has so far been concentrated on the west coast of the U.S., it is clear from the CDC’s threat assessment that public health professionals across the country, including Georgia, need to be concerned. Decreased susceptibility of gonorrhea to antibiotics is expected to continue, so state and local surveillance for antimicrobial resistance is crucial for guiding local therapy recommendations.

As primary care providers, it is imperative to do our part to prevent the spread of antibiotic resistance in cases of gonorrhea. So how is this accomplished?

It is critical to report all cases to a local health department within 7 days, including patient demographics, lab testing, and treatment. If cephalosporin treatment failure is suspected (based on persistent symptoms 3-5 days after appropriate therapy without new sexual contact), clinicians should perform culture and antimicrobial susceptibility testing of relevant specimens, consult an infectious disease specialist, and report the case to the Georgia Department of Public Health. Isolates should be saved in case they need to be sent on for further testing.

On the basis of experience with other microbes that have developed antimicrobial resistance rapidly, a theoretical basis exists for combination therapy using two antimicrobials with different mechanisms of action to improve treatment efficacy and potentially slow the emergence and spread of resistance. Therefore, CDC recommends prescribing dual antibiotic therapy for all gonorrhea cases with 250 mg ceftriaxone IM+ 1 g azithromycin PO on the same day, preferably simultaneously and under direct observation; monotherapy is no longer recommended. Azithromycin is preferred as the second antimicrobial over doxycycline.

Clinicians should also ensure patients’ sexual partners are treated appropriately to prevent further transmission.

Additionally, primary care providers should be diligent about screening at risk populations, assessing screening appropriateness on a case by case basis:  Patients <25 years old, with a prior previous history of STD, with report of new or multiple partners/report of inconsistent condom use, men who have sex with men, sex workers or drug users.

By implementing these strategies and identifying at risk populations more effectively, primary care providers in Georgia can help mitigate the risk of antibiotic resistant gonorrhea.

Additional guidelines for treatment shortages, individuals with allergies, pregnant women and children are available at https://www.cdc.gov/std/tg2015/gonorrhea.htm.

Register Now!! April Webinar: HB 436 (GA HIV/Syphilis Pregnancy Screening Act of 2015) – April 26th

This month’s webinar, HB 436 (GA HIV/Syphilis Pregnancy Screening Act of 2015), will be held on April 26th at 1:15 pm with Rana Chakraborty MD, MSc, FRCPCH, DPhil (PhD), Director, Ponce Family and Youth Clinic at Emory University School of Medicine. He will be accompanied by Dr. Somer Smith from the Department of Public Health and Dr. Martina Badell who is an Obstetrician at Grady Memorial Hospital.  From this webinar, you’ll learn the facts of HIV Testing During Pregnancy. The most common route of HIV infection in children is HIV transmission from mother to baby during pregnancy, labor and delivery, or breastfeeding. Come learn how healthcare providers can help implement the Georgia HIV/Syphilis Pregnancy Screening Act of 2015 – H.B. 436

  • 1st and 3rd trimester HIV/Syphilis testing is required for all pregnant Georgia moms.
  • No written evidence of test at delivery? Attending physician MUST order an HIV/Syphilis test.
  • Mom refuses test? Documentation of refusal is required to relieve provider of any responsibility.

Please click the link to register for the April 26th webinar. https://attendee.gotowebinar.com/register/4886357598629140482

Spring Cleaning: How Family Physicians Can Ease the Child Dental Crisis in Georgia

A family physician or pediatrician typically sees a child and their family about 13 times for routine checkups and vaccinations.  Each of these visits presents an opportunity for you and your clinical staff to review risk factors for oral disease.  In the U.S., tooth decay is the most prevalent chronic disease of childhood, five times more common than asthma.  Research has shown that from 1994-2004, 28 percent of 2-5-year-olds experience tooth decay.  Which is an increase of 15 percent from the prior decades.  We also know that if family has poor oral health status, so will their children.

What Can Family Physicians Do to Turn a Frown Upside Down for Our Children?

For all children and their families, it’s important to educate them and hit these main points:

  • Educate parents about good oral health habits for them and their children
  • Explain why primary teeth are important
  • Encourage that they brush teeth regularly with a smear of fluoridated toothpaste
  • Encourage regular dental visits
  • Outline proper dietary habits

Start providing fluoride varnish application in your practice!

Effective 2015, physicians can offer this service to Medicaid children with a new CPT code 99188.  Georgia’s Department of Public Health has a small staff dedicated to expanding fluoride varnish in primary care physicians’ offices around the State.  Please see the contact below and consider adding this benefit to your practice.

Want to learn more? Register for the upcoming webinar— https://attendee.gotowebinar.com/register/1873115196169259267

For more information, please outreach to the following:

Carol C. Smith, RDH, MSHA, Director of Oral Health

Maternal and Child Health

Georgia Department of Public Health

2 Peachtree Street, 11-222

Atlanta, Georgia 30303-3142

Phone 404-657-3138

Fax: 404-657-7307

Carol.smith@dph.ga.gov

GAFP is seeking a Family Physician Who is Exemplary in Supporting Georgia’s Maternal and Health Population

The Georgia Academy, in collaboration with the Department of Public Health, is seeking nominees for members who have supported Georgia’s mothers and children above and beyond the scope of family medicine.  Last year’s awardee was Dr. Andrea Videlsky of Marietta who has co-founded the Adult Disability Medical Home Clinic.  The clinic provides resources to adults with down syndrome and their families.

We are looking for YOU or a colleague to let us know about what you are doing in your community.  Please email Tenesha Wallace (twallace@gafp.org) with the name of your nominee and a few sentences about what makes them unique in their support of healthy moms and children.  The award will be presented at our Summer CME meeting in June.  Please send us a response no later than April 20th.

AAFP Supports Interim Recommendation That Live Attenuated Influenza Vaccine (LAIV) Should Not Be Used

The AAFP supports the interim recommendation that the live attenuated influenza vaccine (LAIV) should not be used during the 2016-2017 influenza season for any age group.

Background

The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted last week that live attenuated influenza vaccine (LAIV) should not be used during the 2016-2017 flu season for any age group. The ACIP continues to recommend annual flu vaccination, with either the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV), for everyone six months and older.

The ACIP had concerns about the lack of effectiveness of the vaccine. Of particular concern was the lack of LAIV effectiveness in providing protection against H1N1. Given that the target population coincides with the population most susceptible to severe morbidity and mortality if infected with H1N1, this is especially concerning.

Preliminary Data

The ACIP reported in May of 2016 that preliminary data on the effectiveness of LAIV among children two through 17 years during the 2015-2016 season had become available from the U.S. Influenza Vaccine Effectiveness Network. That data showed the estimate for LAIV vaccine effectiveness (VE) among study participants in that age group against any flu virus was 3 percent (with a 95 percent1 confidence interval (CI)(www.cdc.gov)(http://www.cdc.gov/flu/about/qa/vaccineeffect.htm) of -49 percent to 37 percent). The 3 percent estimate means no protective benefit could be measured. In comparison, IIV (flu shots) had a VE estimate of 63 percent (with a 95 percent CI of 52 percent to 72 percent) against any flu virus among children two through 17 years. Additional non-CDC studies support the conclusion that LAIV worked less effectively than IIV this season. The data from 2015-2016 follows two previous seasons2 (2013-2014 and 2014-2015(www.cdc.gov)(http://www.cdc.gov/media/releases/2015/s0226-acip.html) ) showing poor and/or lower than expected vaccine effectiveness for LAIV.

Vaccine Supply

CHPS will follow this issue closely and will work to advise members about influenza vaccine supply issues as the ACIP recommendation is finalized and implemented.

Department of Public Health Simplifies Reporting Guidelines for Neonatal Abstinence Syndrome

As of Jan. 1st, 2016, Neonatal Abstinence Syndrome (NAS) was added to the list of conditions that are notifiable by law to the Georgia Department of Public Health. NAS is a condition that results from the abrupt discontinuation of chronic fetal exposure to substances that were used or abused by the mother during pregnancy. In concurrence with the feedback received, DPH has simplified the criteria for reporting NAS to include at least one of the following: a newborn with withdrawal symptoms and/or a newborn with a positive drug screen. Reports should be submitted within seven days of identification. Cases can be reported electronically through the secure web-based State Electronic Notifiable Disease Surveillance System (SENDSS) at sendss.state.ga.us. As with all notifiable disease data, data regarding NAS will remain confidential in accordance with Georgia law, Code Sections 31-12-2 and 31-5-5.

For more detailed information regarding reporting NAS, click here.