Lyme Disease: Issues In Diagnosis And Treatment For Underserved And Rural Communities

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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
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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.

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(No Transcript)
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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?

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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
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Treatment That Patient Received
Treatment Patient Should Have Received
Timeline
1999
2003
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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?

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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
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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
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Out of pocket medical payments with medical
assistance from RocheIV Treatment started again
Lyme Diagnosis and Treatment
Timeline
1995
2003
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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?

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CASE STUDY 4 Patient Becomes Another Statistic
In State Assistance and Disability
Tick bite w/ bullseye rash Humboldt, CA Timber
Faller Ex-Marine Sharpshooter
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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?

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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