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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