LYME DISEASE:  ISSUES IN DIAGNOSIS AND TREATMENT FOR UNDERSERVED AND RURAL COMMUNITIES
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Presented to the California Senate Committee On Health And Human Services February 25, 2004 Steven Harris, MD PowerPoint PPT Presentation


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LYME DISEASE: ISSUES IN DIAGNOSIS AND TREATMENT FOR UNDERSERVED AND RURAL COMMUNITIES. Presented to the California Senate Committee On Health And Human Services February 25, 2004 Steven Harris, MD.

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Presented to the California Senate Committee On Health And Human Services February 25, 2004 Steven Harris, MD

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Presented to the california senate committee on health and human services february 25 2004 steven harris md

LYME DISEASE: ISSUES IN DIAGNOSIS AND TREATMENT FOR UNDERSERVED AND RURAL COMMUNITIES

Presented to the California SenateCommittee On Health And Human ServicesFebruary 25, 2004Steven Harris, MD


Presented to the california senate committee on health and human services february 25 2004 steven harris md

Rural and underserved populations already feel a loss of control in their lives. Lyme Disease solidifies their powerlessness.

LYME DISEASE IS HAVING A PROFOUND IMPACT ON THE RURAL & UNDERSERVED POPULATIONS

  • Many of these patients go undiagnosed.

  • Most of these patients do not receive adequate treatment even after being diagnosed.

  • We see several of these patients relapsing.

  • End-Game for these patients is

    • to become another disability statistic

    • to become a drain on family and state resources.

    • to lose control over their bodies and cognitive abilities.


Presented to the california senate committee on health and human services february 25 2004 steven harris md

CASE STUDY #1: Patient Remains

Undiagnosed

For

18 years

100%

bullseye

Tick bite w/

rash: Fort Bragg, CA

Athletic, successful, thriving CPA practice

Loss of bladder control

Loss of balance, slow body movements

75%

Diagnosis of ALS after seeing several

specialists from UC Davis and UCSF

Spasticity

, severe fatigue, weakness and use

Health Status

of a cane

ALS specialist in Michigan changes

multisystem

atrophy

diagnosis to

50%

Use of walker, slurred speech, body jerks out

of control.

CPA practice cut down to 15 hours / week

Falls frequently with walker, very minimal control

of movements, speech almost unintelligible,

swallowing difficulty.

CPA practice cut down to 5 hours / week

Lyme

Disease 11/03

Diagnosed with

25%

1986

2003

Timeline

Patient health deteriorated unnecessarily due to physicians

Lyme

unwillingness to consider

as the diagnosis.


Critical questions for the senate committee diagnosis

CRITICAL QUESTIONS FOR THE SENATE COMMITTEE: DIAGNOSIS

  • Is it adequate to allow state licensed physicians to learn about Lyme Disease on their own and arrive at their own personal conclusions regards its presence and proliferation in the State of California?

  • What can be done to improve reporting accuracy of infected ticks and Lyme Disease cases?

  • What is the cost to the State of California for patients who actively have Lyme Disease that go undiagnosed?

  • What are the implications of poor diagnosis on further transmission to spouses, creating a larger population of infected persons?


Presented to the california senate committee on health and human services february 25 2004 steven harris md

Patient health deteriorated unnecessarily due to physicians unwillingness to consider long-term antibiotic treatments at higher than ‘normal’ dosages.

CASE STUDY #2: Patient Receives Inadequate Treatment

100%

Tick bite: Kern CountyHealthy Communications Engineer

Back to 100% HealthFinished antibiotics

Symptoms Return w/in 1 month

Diagnosed with Lyme24 days of antibiotics given

75%

Worsening fatigue, depression and arthritis

Health Status

50%

Severe arthritis, abdominal pain, inability to concentrate, failure at work

25%

Treatment That Patient Received

Treatment Patient Should Have Received

1999

Timeline

2003


Critical questions for the senate committee adequacy of treatment

CRITICAL QUESTIONS FOR THE SENATE COMMITTEE: ADEQUACY OF TREATMENT

  • Can state adopted guidelines for Lyme Disease treatment improve the recovery of patients in underserved & rural populations?

  • What can be done to improve physician education on the most current knowledge and research regarding Lyme Disease?

  • What is the cost to the State of California for patients who do not reduce or eliminate their Lyme Disease symptoms?


Case study 3 patient treatment disrupted due to insurance denial of medical necessity

Patient health deteriorated unnecessarily due to insurance provider’s unwillingness to consider Lyme Disease as chronic and therefore unjustified as a medical need for treatment.

CASE STUDY #3: Patient Treatment Disrupted Due To Insurance Denial Of Medical Necessity

100%

Tick bite: Fallbrook, San Diego County

Patient stabilizes

Trial of medicine stoppage for assessment & testing purposesRapid relapse

75%

Insurance denial of IV treatmentRapid Relapse

IV medication begins rapid recoveryInsurance only pays for 1 month

70% Vision Loss, loss of balance, loss of bladder controlDiagnosed with MS

Health Status

50%

Vision normal after 2 years of treatment

Rapid recovery

Begins to recover after restarting oral meds

25%

Out of pocket medical payments with medical assistance from RocheIV Treatment started again

Lyme Diagnosis and Treatment

1995

Timeline

2003


Critical questions for the senate committee continuity of treatment

CRITICAL QUESTIONS FOR THE SENATE COMMITTEE: CONTINUITY OF TREATMENT

  • Can state adopted guidelines for Lyme Disease treatment improve the continuity of medically necessary care?

  • What can be done to educate insurance providers on the total long-term cost of an untreated Lyme patient versus a treated patient?

  • Do patients have the right to choose between the two schools of thought regarding Lyme treatment?


Case study 4 patient becomes another statistic in state assistance and disability

Patient health deteriorated, becomes unable to work and becomes a major drain on family and state resources.

CASE STUDY #4: Patient Becomes Another Statistic In State Assistance and Disability

Tick bite w/ bullseye rash

Humboldt, CA

Timber Faller

Ex-Marine Sharpshooter


Critical questions for the senate committee end game

CRITICAL QUESTIONS FOR THE SENATE COMMITTEE: END GAME

  • How many patients are unable to work in California due to Lyme Disease?

  • Which occupations are most at risk of contracting Lyme and how does an excess loss of park rangers, firefighters, animal workers and land developers affect state activities and budget allocation?

  • If we can positively affect patient outcomes, decrease disability expenditures and secure the workforce, what are the external and internal obstacles to structuring and implementing a plan?


Presented to the california senate committee on health and human services february 25 2004 steven harris md

California can once again lead the nation in healing the sick and save money!

CALIFORNIA CAN IMPROVE THE ENVIRONMENT FOR LYME DISEASE PATIENTS IN RURAL & UNDERSERVED POPULATIONS

  • Many of these patients go undiagnosed.

  • Increased Physician Education and Mandatory Laboratory Reporting

  • Most of these patients do not receive adequate treatment even after being diagnosed.

  • California Medical Board Support Of Lyme Disease Treatment

  • We see several of these patients relapsing.

  • Lyme Bill Mandating Patient Coverage For Treatment

  • End-Game for these patients is

    • to become another disability statistic

    • to become a drain on family and state resources.

    • to lose control over their bodies and cognitive abilities.

  • Implement All Of The Above AND Increase Resources To Support Early Detection


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