Keeping Patients In Your Practice: A New Paradigm For Treating Infections

Author(s): 
Andrew Rice, DPM, FACFAS

   QMedRx has introduced a simplified referral form. The referral algorithm is a process flow chart that is simple and largely involves the office staff after the direction of the podiatric physician. The flow chart addresses the use of empiric therapy prior to final culture and the use of culture and sensitivity results to guide decision-making on selecting the appropriate antibiotic. The discharge from hospital algorithm is also very simple for hospitalized patients. In using this algorithm, we can guide the patient through this process and facilitate continued care with our home infusion company of choice.

Why DPMs Should Be Involved With Home Infusion Therapy

   Home infusion therapy is a common choice in other medical fields for diagnoses as disparate as parenteral nutrition, pain management, cancer chemotherapy and the treatment of infectious diseases. However, less than 3 percent of our membership consider home infusion therapy as point of care.

   Managing the home infusion therapy from point of care through conclusion allows the DPM to completely manage the patient’s lower extremity infectious disease process. This also enables the DPM to oversee and coordinate the relationship between the consulting infectious disease specialist, the clinical pharmacist and IV nursing team. Perhaps this gives us the greatest advantage to treat the patient’s infection with our unsurpassed experience.

   In addition, we will likely reduce our own medicolegal liability as we are better able to prevent poor outcomes when we are able to closely monitor the healing process. In the past, we would refer our patients out of our practice to a MD or DO for IV management of intravenous antibiotics and patient disease management. In this model, I am suggesting more of a consultation process with infectious disease specialists and subsequent medical management of this patient by the podiatric physician.

   Historically, referring the patient out of your practice for IV management of the infectious disease has potentially led the referred infectious disease physician to refer the patient to an orthopedic surgeon, general surgeon or other physician. This may result in a loss of continuity of care and increasing medical liability to the podiatric physician, who truly is the expert in the management of the foot and ankle condition being treated.

   Referring your patient out of your practice also can cause confusion, a loss of trust in terms of the patient-podiatric physician relationship and a possibly less than superior outcome for the patient.

   By maintaining the relationship with your patients and guiding their medical care, you will make the decision whether further intervention, surgery and other medical consultations would be necessary.

   The podiatric physician should choose the consulting physician. The potential benefits are really the one-stop, one-doctor concept, in which the DPM guides the patient throughout the process of infectious disease management and forms a stronger bond with this patient whether the issue is a postoperative infection, diabetic limb preservation, acute cellulitis or another cause. The DPM can arrange for hospital consultations for PICC line placement, clinical pharmacy consultation, dosage and preparation. When appropriate, one can choose the infectious disease consultant physician of choice.

   In many cases, podiatric physicians report additional practice revenue with office visits and consultations as well as starting the initial infusion within their office. Often the home infusion therapy nurse is present to provide the initial training to the patient. Follow-up visits for monitoring the infusion therapy as well as the PICC line assessment are reimbursable and are separate from wound management or the postoperative management global period.

In Conclusion

   With national data collection, practitioners will contribute and build their best practices. Providing the information to produce evidence-based medicine documentation will give us accurate and reproducible positive disease-specific outcomes. Most importantly, this information will keep the standard of care at the highest level for our patients.

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