Part 2: Bypassing Prior Authorizations
By NIRAN AL-AGBA, MD
A few weeks ago, I saw a young patient who was suffering from an ear infection. It was his fourth visit in eight weeks, as the infection had proven resistant to an escalating series of antibiotics prescribed so far. It was time to bring out a heavier hitter. I prescribed Ciprofloxacin, an antibiotic rarely used in pediatrics, yet effective for some drug-resistant pediatric infections.
The patient was on the state Medicaid insurance and required a so-called prior authorization, or PA, for Ciprofloxacin. Consisting of additional paperwork that physicians are required to fill out before pharmacists can f...
Source: The Health Care Blog - October 4, 2018 Category: Consumer Health News Authors: matthew holt Tags: Medicaid Patients Pharmaceuticals Physicians Aetna andameds CVS health insurance companies Pharmaceutical companies Pharmacy Benefit Manager Washington state Source Type: blogs
My approach to acute pharyngitis 2018
First, we must define acute pharyngitis – no more than 3-5 days of symptoms.
Second, we should understand that pre-adolescent pharyngitis has major differences form adolescent/you adult pharyngitis.( Mitchell, M. S., Sorrentino, A., & Centor, R. M. (2011). Adolescent pharyngitis: a review of bacterial causes. Clinical Pediatrics, 50(12), 1091–1095. http://doi.org/10.1177/0009922811409571 ) Here are the differences:
Pre-adolescent pharyngitis really is group A strep vs viral
Adolescent pharyngitis has a much broader differential – GAS, Group C/G strep, Fusobacterium necrophorum, infectious mononucleosis...
Source: DB's Medical Rants - September 3, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tropical Travel Trouble 009 Humongous HIV Extravaganza
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 009
The diagnosis of HIV is no longer fatal and the term AIDS is becoming less frequent. In many countries, people with HIV are living longer than those with diabetes. This post will hopefully teach the basics of a complex disease and demystify some of the potential diseases you need to consider in those who are severely immunosuppressed. While trying to be comprehensive this post can not be exhaustive (as you can imagine any patient with a low ...
Source: Life in the Fast Lane - July 7, 2018 Category: Emergency Medicine Authors: Amanda McConnell Tags: Clinical Cases Tropical Medicine AIDS art cryptococcoma cryptococcus HIV HIV1 HIV2 PEP PrEP TB toxoplasma tuberculoma Source Type: blogs
Nailed It!
What do you do for a nail from a nail gun in the hand? This procedure is simple, but you have to worry about the aftermath. Complicated issues may arise post-procedure in the days to weeks after extraction, including retained foreign bodies, infection, fractures, disability, pain, nerve damage, tendon rupture, and cosmetic concerns.Removing the nail is only half the battle. Proper removal, treatment, and follow-up should be considered with all foreign bodies in the skin, especially the hand. Being prepared for the possible aftershocks will help your patient have a successful recovery.A 23-year-old man with a nail fro...
Source: The Procedural Pause - June 1, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Tropical Travel Trouble 004 Bloody Diarrhoea
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 004
A medical student who has just returned from their elective in Nepal presents with 1 week of bloody diarrhoea. He has been in the lowlands and stayed with a family in the local village he was helping at. It started three days before he left and he decided to get home on the plane in the hope it would settle. He is now opening his bowels 10x a day with associated cramps, fevers and has started feeling dizzy.
Questions:
Q1. What is dysentery ...
Source: Life in the Fast Lane - March 12, 2018 Category: Emergency Medicine Authors: Neil Long Tags: Clinical Cases Tropical Medicine amoebic dysentery bacillary dysentery e.histolytica entamoeba histolytica shigellosis Source Type: blogs
Learn about Clostridium difficile infection with a Medcomic
Clostridium difficile is a gram-positive anaerobic bacillus which secretes toxins (A and B) that cause diarrhea and pseudomembranous colitis. C. difficile is the most common infectious cause of nosocomial diarrhea. Transmission of C. difficile can occur from contact with contaminated humans and fomites. The organism contains endospores that can survive the acidity of the stomach and reach the large intestine.
C. difficile colonizes the intestinal tract after the normal gut flora has been altered by antibiotic therapy. It can flourish after any antibiotic therapy, but most notably occurs with broad-spectrum antibiotic...
Source: Kevin, M.D. - Medical Weblog - January 9, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jorge-muniz" rel="tag" > Jorge Muniz, PA-C < /a > Tags: Conditions Gastroenterology Infectious Disease Source Type: blogs
Learn about Clostridium difficile infect with a Medcomic
Clostridium difficile is a gram-positive anaerobic bacillus which secretes toxins (A and B) that cause diarrhea and pseudomembranous colitis. C. difficile is the most common infectious cause of nosocomial diarrhea. Transmission of C. difficile can occur from contact with contaminated humans and fomites. The organism contains endospores that can survive the acidity of the stomach and reach the large intestine.
C. difficile colonizes the intestinal tract after the normal gut flora has been altered by antibiotic therapy. It can flourish after any antibiotic therapy, but most notably occurs with broad-spectrum antibiotic...
Source: Kevin, M.D. - Medical Weblog - January 9, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jorge-muniz" rel="tag" > Jorge Muniz, PA-C < /a > Tags: Conditions Gastroenterology Infectious Disease Source Type: blogs
Will CVS-Aetna Merger Lead to “ Separate But Unequal ” Healthcare?
By NIRAN AL-AGBA, MD
Last week, pharmacy giant CVS agreed to purchase Aetna this week for an astounding $69 billion dollar sum. The company allegedly plans to reduce health spending by developing an integrated system touted as “a new front door for health care in America.” This merger is actually an acquisition, entailing transfer of ownership. The central aim of an acquisition is to increase market share, expand the scope of services provided, and improve financial stability. CVS hit the jackpot on all three objectives. While Wall Street investors celebrate, many of us knowledgeable in the delivery of healthcare servi...
Source: The Health Care Blog - December 11, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Aetna CVS Niran Al-Agba Source Type: blogs
Healthcare freebies that can make you, and your wallet, feel a little better
“Take the cookies, bring them home to the kids!” Craig always insists, as he pops a few into my lunch bag. It’s a heartwarming gesture that I love about his Sarasota deli — in addition to the killer turkey on whole wheat. You may not be surprised when local businesses throw in a freebie; they often go the extra mile to thank customers.
But you may be surprised to know that there are lots of free things out there that can help your health. Okay, not cookies, but things with real value when it comes to improving everything from chronic disease to diet and fitness.
Free prescription drugs
Some stores (such as Publix a...
Source: Harvard Health Blog - November 27, 2017 Category: Consumer Health News Authors: Heidi Godman Tags: Health Health care Managing your health care Source Type: blogs
Think your child has a penicillin allergy? Maybe not.
Follow me on Twitter @drClaire
Allergies to penicillin are the most commonly reported medication allergy. This can be a real problem; if you are allergic to penicillin, it’s not just penicillin you can’t take. You can’t take amoxicillin and other antibiotics that are extremely similar, and it’s iffy whether or not you can take cephalosporins (such as cephalexin or cefdinir), a whole other really useful and commonly used class of antibiotics.
See, that’s the thing: with most common infections such as ear infections, strep throat, or skin infections, if we can’t give you penicillin we end up with limited choices....
Source: Harvard Health Blog - July 11, 2017 Category: Consumer Health News Authors: Claire McCarthy, MD Tags: Asthma and Allergies Children's Health Drugs and Supplements Infectious diseases Parenting Safety Source Type: blogs
4 ways to avoid mistakes with liquid medicines
Follow me on Twitter @drClaire
Measuring liquid medication should be easy, right? You just pour out the amount you need.
It turns out, though, that it’s not so easy — and that lots of parents and caregivers do it wrong. In a study just published in the journal Pediatrics in which parents were asked to measure out some liquid doses, 84% made at least one measuring error, and 29% made a large error, measuring at least twice the prescribed dose.
So the next time you measure out some acetaminophen or amoxicillin, here are four must-dos to be sure you do it right:
1. Don’t use a spoon. Even if it says “1 teaspoon,” do...
Source: Harvard Health Blog - June 27, 2017 Category: Consumer Health News Authors: Claire McCarthy, MD Tags: Children's Health Drugs and Supplements Parenting Source Type: blogs
Taking medicines like you ’re supposed to: Why is it so hard?
It’s so hard to remember to take your medicine, let alone take it correctly (with food, on an empty stomach, not at the same time as other things you’re taking, at night, without grapefruit juice… the list seems endless). There are so many barriers and distractions that can get in the way. Many people aren’t thrilled about having to take medications because they worry about side effects, or they’re having side effects, or they just don’t like the idea of needing to take medicine. If it’s for prevention, like aspirin to prevent strokes, or to treat an “invisible” condition like high blood pressure, they ma...
Source: Harvard Health Blog - May 10, 2017 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Behavioral Health Drugs and Supplements Managing your health care Source Type: blogs
Oldie but Goodie Pediatric Clinical Concepts
A number of older clinical concepts may be unfamiliar to younger clinicians, but these clinical concepts are useful in pediatric medicine. Some of these concepts showed up in the medical literature for the first time nearly a century ago. Physicians should feel free to question the potential value and validity of older clinical concepts that aren't at the forefront of medical education, but my experience of more than 30 years practicing pediatrics and emergency medicine has repeatedly affirmed to me that these are valuable in emergency medicine.Parenteral DiarrheaThe concept of parenteral diarrhea has been around for...
Source: M2E Too! Mellick's Multimedia EduBlog - March 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Oldie but Goodie Pediatric Clinical Concepts
A number of older clinical concepts may be unfamiliar to younger clinicians, but these clinical concepts are useful in pediatric medicine. Some of these concepts showed up in the medical literature for the first time nearly a century ago. Physicians should feel free to question the potential value and validity of older clinical concepts that aren't at the forefront of medical education, but my experience of more than 30 years practicing pediatrics and emergency medicine has repeatedly affirmed to me that these are valuable in emergency medicine.Parenteral DiarrheaThe concept of parenteral diarrhea has been around for...
Source: M2E Too! Mellick's Multimedia EduBlog - March 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Finding the tick in time could save you from Lyme!
“Doesn’t it typically happen during the summer?” asked a worried lady that had walked into my clinic in November with a growing circular rash on her wrist. She was referring, of course, to Lyme disease, that scourge of outdoor enthusiasts. While the peak season for Lyme disease is indeed summer, the ticks that transmit it are active March through December. And, while this may be off-season for the ticks, it is a good time to catch up on how to stay safe in the not-so-distant spring.
What is Lyme disease, and how do you treat it?
Lyme disease is caused by a bacterium called Borrelia burgdorferi which is spread to peop...
Source: Harvard Health Blog - February 24, 2017 Category: Consumer Health News Authors: Meera Sunder, MBBS, MRCOG Tags: Health Infectious diseases Prevention Source Type: blogs
