Title: Lyme Disease: Issues In Diagnosis And Treatment For Underserved And Rural Communities
1LYME 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
2LYME 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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4CRITICAL 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?
5CASE 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
Timeline
1999
2003
6CRITICAL 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?
7CASE 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
Timeline
1995
2003
8CRITICAL 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?
9CASE STUDY 4 Patient Becomes Another Statistic
In State Assistance and Disability
Tick bite w/ bullseye rash Humboldt, CA Timber
Faller Ex-Marine Sharpshooter
10CRITICAL 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?
11CALIFORNIA 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