Colleagues,
I closed the survey on March 9, 2016, after being open for 2
weeks, and we got 58 responses, maybe 59 if someone (Warner) answered the survey
as well as sending an email. Not everyone answered every question, so
percentages may not add to 100.
Disclaimer: For the sake of brevity, I did not ask
demographic questions, so I cannot report the interests/experience of those
responding. I think that SurveyMonkey blocks repeat responses from the
same email, but if you are like me, you have more than one address, so reader be
wise.
As for work-related LTBI (post-exposure or
surveillance-related),
1. Regarding OH coverage of treatment & monitoring for
LTBI,
a.
43% covered by work comp (not in Minnesota
unless active disease but yes, in the great state of California)
b.
26% cover out of OH budget
c.
17% refer elsewhere after
counseling
d.
10% other: Dept of Health (for 3
respondents)
e.
4% bill the employee’s health
insurance
2. If OH covers cost, does
OH treat and monitor or refer elsewhere?
a. 52% done in OH
b. 17% paid for by OH but contracted out.
c. 25% referred elsewhere, payment determined by treating
provider
d. 6% (in this case 3 respondents) do not provider treatment
& monitoring
3. If you do provide
treatment & monitoring, what treatment is offered?
a. 63% any of the recommended treatment protocol, including
rifapentine
b. 17% INH only; employee responsible for other
protocols
c. 14% INH or rifampin only; employee responsible for other
protocols
d. 6% INH ony but OH will pay for other treatments
to be done elsewhere.
As for treatment and monitoring of NEW employees with
untreated LTBI (NOT work-related),
4. How do you handle new employees with untreated LTBI?
a. 66% do risk assessment & counseling but refer elsewhere for
treatment & monitoring.
b. 28% do risk assessment & counseling and offer the same treatment
& monitoring as for work-related cases.
c. 0% do risk assessment only.
d. 6% other: DOH, PMD (2)
5. If you refer elsewhere for LTBI, to whom do you send the
employee?
a. 27% employee’s local health dept.
b. 18% employee’s primary care provider
c. 14% ID specialist
d. 2% (1 respondent; I think it was me) occupational
medicine specialist
d. 37% other: hodgepodge of options, usually combos of
PMD, health dept, TB clinic, or just none.
6. If you refer elsewhere and do not pay for LTBI treatment &
monitoring, how does the other provider bill for services?
a. 54% local health dept.
b. 42% no clue
c. 15% provider uses usual E & M
billing
d. 2% (1 respondent) provider bills for a nursing
protocol
e. 2% (1 respondent) provider charges for the service
outside of E & M billing
Take-home messages for me:
1.
Work-related TB is paid for by work comp or the
employer (OHS); new employees are on their own but may be covered by health
department or primary provider.
2.
OHS is capable of managing their work-related cases of
LTBI but only about ¼ of OHS will manage the new employees.
3.
Occ docs are not the treaters of choice when referred
out from OHS. Health department is the most common place for
referrals.
I would be happy to hear your interpretation. I hope
that we all learned from this exercise.
Cheers,
Bill Buchta
William G. Buchta,
MD,
MS, MPH
Assistant
Professor, Mayo Clinic College of Medicine
Mayo
Clinic, Division of Preventive, Occupational, and Aerospace Medicine
200 First
St,SW,Rochester, MN 55905
Phone: 507-266-0354 Fax:
507-284-4251
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mission-driven worldwide leader in health care for 150
years
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