Primary care survey of the value and effectiveness of the Washington State Opioid Dosing Guideline.

PURPOSE: To evaluate the acceptability and usefulness of the Washington State Opioid Dosing Guideline (Guideline) developed for primary care providers for the treatment of chronic noncancer pain. The Guideline contains innovative tools, such as an online dosing calculator, and recommendations to assist providers, including a "yellow flag" threshold of 120 mg/d morphine equivalent dose (MED) at which specialty consultation is recommended. METHODS: Using a convenience sample, an anonymous web-based survey was conducted among primary care providers in Washington (WA) state. Physician/ administrative leaders in four regional and two statewide healthcare systems and associations distributed the electronic links to primary care providers in their organizations. RESULTS: Six hundred fifty-five (n) providers completed the survey representing 20 percent of the total number contacted. The majority (89 percent) of providers in this sample treat chronic pain patients, and more than half (54 percent) have frequent concerns about addiction, tolerance, and diversion. Forty-five percent had read and applied the Guideline in their practice. The majority of these providers found the Guideline to be helpful and 86 percent find the threshold of 120 mg/d MED dose reasonable or too high. Some key best practices such as tracking pain and function using structured instruments and use of urine drug testing are infrequently used. CONCLUSIONS: Results from this survey suggest that the recommendations and tools given in the Guideline, including the threshold of 120 mg/day MED dose, are acceptable and useful to a large majority of primary care providers in WA state. Substantial additions to the Guideline based on needs identified in this survey were added in June 2010 and wider dissemination is planned.

Increased efficiency in evaluating patients with suspected tuberculosis by use of a dedicated airborne infection isolation unit.

BACKGROUND: The resurgence of tuberculosis (TB) in the 1980s and early 1990s in the United States was also accompanied by numerous hospital outbreaks of TB and nosocomial transmission to health care workers. OBJECTIVE: To determine whether a dedicated airborne infection isolation (AII) unit improves efficiency in "ruling-out" patients suspected of having pulmonary TB. This is important because, to prevent nosocomial transmission of TB, the number and ratio of patients isolated who are subsequently found to have TB is much higher than those "ruled out" and have TB excluded. METHODS: A prospective cohort study was conducted of all patients 18 years and older admitted to respiratory isolation during 3 separate time periods before and after opening of an 26-bed AII unit in a 1000-bed, public, university-affiliated, innercity hospital. RESULTS: A total of 879 patients were admitted during the 3 study periods. Most were black and males (87%, 72%, respectively). The median age was 42 years, and 70% of patients included in the study were HIV positive. Among patients who "ruled out," ie, TB was excluded by having 3 negative AFB smears of respiratory specimens for TB, there was a significant decrease in time from 5.0 days in period I to 3.3 days in period III (P < .0001). In period III, patients who were admitted to rule out TB in areas outside of the AII unit in other wards of the hospital required a significantly longer period to have TB excluded: 5.9 days compared with 3.5 on the AII unit (P = .0015). CONCLUSION: The decrease in isolation time after the opening of the dedicated AII unit demonstrates that a concerted effort to rule patients out by having nurses and respiratory therapists trained in tuberculosis control is efficacious and efficient and results in significant cost savings.