A Bitter Pill
2011; Elsevier BV; Volume: 58; Issue: 2 Linguagem: Inglês
10.1016/j.annemergmed.2011.06.001
ISSN1097-6760
Autores Tópico(s)Emergency and Acute Care Studies
ResumoIn 1988, the state of Louisiana wanted to save some money in its budget and stopped funding its poison control center. The next year, there were 15,000 more emergency department (ED) visits for poisonings, a 42% increase that cost an additional $1.4 million.1King W.D. Palmisano P.A. Poison control centers: can their value be measured?.South Med J. 1991; 84: 722-726Crossref PubMed Scopus (51) Google ScholarIn 1993, facing a budget cut, the Michigan poison control center stopped taking calls from 2 of the 3 area codes it covered. During the following 4 months, Blue Cross Blue Shield of Michigan recorded a 35% increase in outpatient visits for suspected poisonings and a 16% increase in hospitalizations.2Miller T.R. Lestina D.C. Costs of poisoning in the United States and savings from poison control centers: a benefit-cost analysis.Ann Emerg Med. 1997; 29: 239-245Abstract Full Text Full Text PDF PubMed Scopus (113) Google ScholarIn 2004, the Institute of Medicine estimated that every dollar of public funding spent on a poison control center saves $10 that would otherwise have been spent on health care.3Institute of MedicineForging a Poison Prevention and Control System.http://books.nap.edu/openbook.php?record_id=10971Google ScholarGiven those data, it would be reasonable to assume that, in an era of deep concern about federal spending, policymakers view investing in poison control as a way of saving health care funds.Reasonable, but incorrect. In fact, in March 2011, the US poison control system narrowly escaped losing almost all of its federal funding; only last-minute bargaining reduced a proposed 93% cut to 25%.4American Association of Poison Control CentersPoison centers federal appropriations cut by nearly 25 percent in proposed FY 2011 continuing resolution.http://www.aapcc.org/dnn/Portals/0/prrel/pressreleasehr1FINAL3.pdfGoogle Scholar The system's annual appropriation of just under $30 million will be on the block again next fiscal year, and ED personnel are wondering how long it will be until additional poisoning cases start coming through their doors.“Right now, we keep 80% of kids who have a potential poisoning out of the emergency department,” said Lewis Nelson, MD, an associate professor of emergency medicine and director of the medical toxicology fellowship at New York University's School of Medicine. “If there is no poison center for their parents to talk to, where else are they going to go?”The United States' 57 poison control centers receive a roughly 4-to-1 mix of state and federal money. The 2011, and threatened 2012, federal cuts arrive on top of concurrent decreases in state funding. The American Association of Poison Control Centers estimates that most centers have had their budgets cut by an average of 40%.That is, if they have budgets at all. Dr. Nelson's poison control center in Manhattan is one of 2 remaining in New York State, down from 5. Michigan has closed one of its 2. In 2009, the Poison Centers Task Force of the American College of Emergency Physicians (publisher of Annals of Emergency Medicine) surveyed the then-60 US centers; of the 43 who responded, 84% said they were facing cuts.5American College of Emergency PhysiciansPoison centers—an information paper.http://www.acep.org/Content.aspx?id=70370Google Scholar‘Pennywise, Pound Foolish'According to the Centers for Disease Control and Prevention (CDC), poisoning is the second most common cause of injury deaths in the United States, behind motor vehicle crashes and ahead of guns.6Centers for Disease Control and PreventionAge-adjusted death rates for the three leading causes of injury death—United States, 1979-2006.http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5824a6.htmGoogle Scholar So toxicologists perceive a particular disconnection between spending a relatively small amount of money to prevent some of those deaths and incurring a much larger cost if those injuries are not prevented.“It's the definition of ‘penny-wise, pound-foolish,'” said Alan Woolf, MD, MPH, a professor of pediatrics at Harvard Medical School and president of the American Academy of Clinical Toxicology. “More people will go to emergency departments who could otherwise have been triaged away from there, and more cases of poisoning may not be handled correctly in emergency departments or hospitals because health professionals won't have access to toxicological expertise.”Losing a poison center may sound like a problem chiefly for the frantic parent who discovers a toddler has gotten into the cleaning products under the sink, but medical toxicologists point out that calls from the public make up 85% of their traffic at most. The rest originate within EDs, hospitals, and office practices.“An emergency physician may recognize the poison the patient has been exposed to but not know how to treat to current methods because he or she sees this once a year or once every 5 years,” said Richard Dart, MD, PhD, director of the Rocky Mountain Poison and Drug Center and president of the American Association of Poison Control Centers. “Snakebite, for instance: You can make a diagnosis, but where do you find antivenom? And when you get that drug you've never used before, what do you tell your pharmacy about how to mix it up? Those are questions we can help with.”All those questions are answered by live personnel: board-certified toxicologists, nurses, and pharmacists. That makes accounting for budget cuts particularly difficult because personnel are poison centers' main expense.At the Georgia Poison Center in downtown Atlanta, half a block from the overloaded ED of Grady Memorial Hospital, one recently resigned staff member has not been replaced—“and if we have another person leave, we might not fill that, either,” said Robert Geller, MD, the center's medical director and a professor of pediatrics at Emory University School of Medicine.A part-time staff member who left also has not been replaced, he added. “Come summer, we'll have to juggle vacations to cover shifts. I fully expect our average time to answer a call will go up.”No National RemedyOne proposal floated during the budget debate in March called for doing away with almost all poison center personnel and concentrating resources in a single national center.7Hudson W. In poison emergencies, who'll answer your call?.http://edition.cnn.com/2011/HEALTH/03/22/poison.control.risk.closure/index.htmlDate: March 22, 2011Google Scholar That was considered by the Institute of Medicine in its 2004 report “Forging a Poison Prevention and Control System.”3Institute of MedicineForging a Poison Prevention and Control System.http://books.nap.edu/openbook.php?record_id=10971Google Scholar The institute rejected the idea, saying that with no redundancy in the system, poison control advice could be shut down by a single power interruption or natural disaster. (The American College of Emergency Physicians task force criticized the proposal for depriving emergency medicine of toxicology training sites, as well as coordination with emergency medical services.5American College of Emergency PhysiciansPoison centers—an information paper.http://www.acep.org/Content.aspx?id=70370Google Scholar)Gutting or closing regional poison centers would also deprive public health departments of the telephone help that poison centers provide on the side, Dr. Dart said. His own center currently runs the advice line for passengers returning from Japan who, when they pass through US immigration checkpoints, are perceived to have been exposed to radiation. Dr. Nelson's center ran the influenza advice line for the New York City Department of Health and Mental Hygiene during the 2009 H1N1 “swine” flu epidemic. Other locations have managed call centers and conducted public health surveillance for hepatitis epidemics, major foodborne-illness outbreaks, and the aftermath of the 2010 Gulf of Mexico oil spill.Poison centers also increasingly are providing advice for emergency personnel encountering a rapidly increasing problem: toxicities from prescription drug abuse. ED visits for overdoses of opioid analgesics more than doubled between 2004 and 2008, according to CDC data, and visits for benzodiazepine abuse increased by 90%.8Centers for Disease Control and PreventionEmergency department visits involving nonmedical use of selected prescription drugs—United States, 2004.MMWR Morb Mortal Wkly Rep. 2010; 59: 705-709PubMed Google ScholarThat poison control centers fill those roles is well known in emergency and primary care medicine, but that knowledge has not percolated up to policymakers. Whether those roles are worth protecting will be examined again soon, when the 2012 fiscal year budget comes up for debate. And as in March, poison control experts expect their funding to be imperiled and are struggling now with how to argue for their services to be supported.View Large Image Figure ViewerDownload Hi-res image Download (PPT) In 1988, the state of Louisiana wanted to save some money in its budget and stopped funding its poison control center. The next year, there were 15,000 more emergency department (ED) visits for poisonings, a 42% increase that cost an additional $1.4 million.1King W.D. Palmisano P.A. Poison control centers: can their value be measured?.South Med J. 1991; 84: 722-726Crossref PubMed Scopus (51) Google Scholar In 1993, facing a budget cut, the Michigan poison control center stopped taking calls from 2 of the 3 area codes it covered. During the following 4 months, Blue Cross Blue Shield of Michigan recorded a 35% increase in outpatient visits for suspected poisonings and a 16% increase in hospitalizations.2Miller T.R. Lestina D.C. Costs of poisoning in the United States and savings from poison control centers: a benefit-cost analysis.Ann Emerg Med. 1997; 29: 239-245Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar In 2004, the Institute of Medicine estimated that every dollar of public funding spent on a poison control center saves $10 that would otherwise have been spent on health care.3Institute of MedicineForging a Poison Prevention and Control System.http://books.nap.edu/openbook.php?record_id=10971Google Scholar Given those data, it would be reasonable to assume that, in an era of deep concern about federal spending, policymakers view investing in poison control as a way of saving health care funds. Reasonable, but incorrect. In fact, in March 2011, the US poison control system narrowly escaped losing almost all of its federal funding; only last-minute bargaining reduced a proposed 93% cut to 25%.4American Association of Poison Control CentersPoison centers federal appropriations cut by nearly 25 percent in proposed FY 2011 continuing resolution.http://www.aapcc.org/dnn/Portals/0/prrel/pressreleasehr1FINAL3.pdfGoogle Scholar The system's annual appropriation of just under $30 million will be on the block again next fiscal year, and ED personnel are wondering how long it will be until additional poisoning cases start coming through their doors. “Right now, we keep 80% of kids who have a potential poisoning out of the emergency department,” said Lewis Nelson, MD, an associate professor of emergency medicine and director of the medical toxicology fellowship at New York University's School of Medicine. “If there is no poison center for their parents to talk to, where else are they going to go?” The United States' 57 poison control centers receive a roughly 4-to-1 mix of state and federal money. The 2011, and threatened 2012, federal cuts arrive on top of concurrent decreases in state funding. The American Association of Poison Control Centers estimates that most centers have had their budgets cut by an average of 40%. That is, if they have budgets at all. Dr. Nelson's poison control center in Manhattan is one of 2 remaining in New York State, down from 5. Michigan has closed one of its 2. In 2009, the Poison Centers Task Force of the American College of Emergency Physicians (publisher of Annals of Emergency Medicine) surveyed the then-60 US centers; of the 43 who responded, 84% said they were facing cuts.5American College of Emergency PhysiciansPoison centers—an information paper.http://www.acep.org/Content.aspx?id=70370Google Scholar ‘Pennywise, Pound Foolish'According to the Centers for Disease Control and Prevention (CDC), poisoning is the second most common cause of injury deaths in the United States, behind motor vehicle crashes and ahead of guns.6Centers for Disease Control and PreventionAge-adjusted death rates for the three leading causes of injury death—United States, 1979-2006.http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5824a6.htmGoogle Scholar So toxicologists perceive a particular disconnection between spending a relatively small amount of money to prevent some of those deaths and incurring a much larger cost if those injuries are not prevented.“It's the definition of ‘penny-wise, pound-foolish,'” said Alan Woolf, MD, MPH, a professor of pediatrics at Harvard Medical School and president of the American Academy of Clinical Toxicology. “More people will go to emergency departments who could otherwise have been triaged away from there, and more cases of poisoning may not be handled correctly in emergency departments or hospitals because health professionals won't have access to toxicological expertise.”Losing a poison center may sound like a problem chiefly for the frantic parent who discovers a toddler has gotten into the cleaning products under the sink, but medical toxicologists point out that calls from the public make up 85% of their traffic at most. The rest originate within EDs, hospitals, and office practices.“An emergency physician may recognize the poison the patient has been exposed to but not know how to treat to current methods because he or she sees this once a year or once every 5 years,” said Richard Dart, MD, PhD, director of the Rocky Mountain Poison and Drug Center and president of the American Association of Poison Control Centers. “Snakebite, for instance: You can make a diagnosis, but where do you find antivenom? And when you get that drug you've never used before, what do you tell your pharmacy about how to mix it up? Those are questions we can help with.”All those questions are answered by live personnel: board-certified toxicologists, nurses, and pharmacists. That makes accounting for budget cuts particularly difficult because personnel are poison centers' main expense.At the Georgia Poison Center in downtown Atlanta, half a block from the overloaded ED of Grady Memorial Hospital, one recently resigned staff member has not been replaced—“and if we have another person leave, we might not fill that, either,” said Robert Geller, MD, the center's medical director and a professor of pediatrics at Emory University School of Medicine.A part-time staff member who left also has not been replaced, he added. “Come summer, we'll have to juggle vacations to cover shifts. I fully expect our average time to answer a call will go up.” According to the Centers for Disease Control and Prevention (CDC), poisoning is the second most common cause of injury deaths in the United States, behind motor vehicle crashes and ahead of guns.6Centers for Disease Control and PreventionAge-adjusted death rates for the three leading causes of injury death—United States, 1979-2006.http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5824a6.htmGoogle Scholar So toxicologists perceive a particular disconnection between spending a relatively small amount of money to prevent some of those deaths and incurring a much larger cost if those injuries are not prevented. “It's the definition of ‘penny-wise, pound-foolish,'” said Alan Woolf, MD, MPH, a professor of pediatrics at Harvard Medical School and president of the American Academy of Clinical Toxicology. “More people will go to emergency departments who could otherwise have been triaged away from there, and more cases of poisoning may not be handled correctly in emergency departments or hospitals because health professionals won't have access to toxicological expertise.” Losing a poison center may sound like a problem chiefly for the frantic parent who discovers a toddler has gotten into the cleaning products under the sink, but medical toxicologists point out that calls from the public make up 85% of their traffic at most. The rest originate within EDs, hospitals, and office practices. “An emergency physician may recognize the poison the patient has been exposed to but not know how to treat to current methods because he or she sees this once a year or once every 5 years,” said Richard Dart, MD, PhD, director of the Rocky Mountain Poison and Drug Center and president of the American Association of Poison Control Centers. “Snakebite, for instance: You can make a diagnosis, but where do you find antivenom? And when you get that drug you've never used before, what do you tell your pharmacy about how to mix it up? Those are questions we can help with.” All those questions are answered by live personnel: board-certified toxicologists, nurses, and pharmacists. That makes accounting for budget cuts particularly difficult because personnel are poison centers' main expense. At the Georgia Poison Center in downtown Atlanta, half a block from the overloaded ED of Grady Memorial Hospital, one recently resigned staff member has not been replaced—“and if we have another person leave, we might not fill that, either,” said Robert Geller, MD, the center's medical director and a professor of pediatrics at Emory University School of Medicine. A part-time staff member who left also has not been replaced, he added. “Come summer, we'll have to juggle vacations to cover shifts. I fully expect our average time to answer a call will go up.” No National RemedyOne proposal floated during the budget debate in March called for doing away with almost all poison center personnel and concentrating resources in a single national center.7Hudson W. In poison emergencies, who'll answer your call?.http://edition.cnn.com/2011/HEALTH/03/22/poison.control.risk.closure/index.htmlDate: March 22, 2011Google Scholar That was considered by the Institute of Medicine in its 2004 report “Forging a Poison Prevention and Control System.”3Institute of MedicineForging a Poison Prevention and Control System.http://books.nap.edu/openbook.php?record_id=10971Google Scholar The institute rejected the idea, saying that with no redundancy in the system, poison control advice could be shut down by a single power interruption or natural disaster. (The American College of Emergency Physicians task force criticized the proposal for depriving emergency medicine of toxicology training sites, as well as coordination with emergency medical services.5American College of Emergency PhysiciansPoison centers—an information paper.http://www.acep.org/Content.aspx?id=70370Google Scholar)Gutting or closing regional poison centers would also deprive public health departments of the telephone help that poison centers provide on the side, Dr. Dart said. His own center currently runs the advice line for passengers returning from Japan who, when they pass through US immigration checkpoints, are perceived to have been exposed to radiation. Dr. Nelson's center ran the influenza advice line for the New York City Department of Health and Mental Hygiene during the 2009 H1N1 “swine” flu epidemic. Other locations have managed call centers and conducted public health surveillance for hepatitis epidemics, major foodborne-illness outbreaks, and the aftermath of the 2010 Gulf of Mexico oil spill.Poison centers also increasingly are providing advice for emergency personnel encountering a rapidly increasing problem: toxicities from prescription drug abuse. ED visits for overdoses of opioid analgesics more than doubled between 2004 and 2008, according to CDC data, and visits for benzodiazepine abuse increased by 90%.8Centers for Disease Control and PreventionEmergency department visits involving nonmedical use of selected prescription drugs—United States, 2004.MMWR Morb Mortal Wkly Rep. 2010; 59: 705-709PubMed Google ScholarThat poison control centers fill those roles is well known in emergency and primary care medicine, but that knowledge has not percolated up to policymakers. Whether those roles are worth protecting will be examined again soon, when the 2012 fiscal year budget comes up for debate. And as in March, poison control experts expect their funding to be imperiled and are struggling now with how to argue for their services to be supported. One proposal floated during the budget debate in March called for doing away with almost all poison center personnel and concentrating resources in a single national center.7Hudson W. In poison emergencies, who'll answer your call?.http://edition.cnn.com/2011/HEALTH/03/22/poison.control.risk.closure/index.htmlDate: March 22, 2011Google Scholar That was considered by the Institute of Medicine in its 2004 report “Forging a Poison Prevention and Control System.”3Institute of MedicineForging a Poison Prevention and Control System.http://books.nap.edu/openbook.php?record_id=10971Google Scholar The institute rejected the idea, saying that with no redundancy in the system, poison control advice could be shut down by a single power interruption or natural disaster. (The American College of Emergency Physicians task force criticized the proposal for depriving emergency medicine of toxicology training sites, as well as coordination with emergency medical services.5American College of Emergency PhysiciansPoison centers—an information paper.http://www.acep.org/Content.aspx?id=70370Google Scholar) Gutting or closing regional poison centers would also deprive public health departments of the telephone help that poison centers provide on the side, Dr. Dart said. His own center currently runs the advice line for passengers returning from Japan who, when they pass through US immigration checkpoints, are perceived to have been exposed to radiation. Dr. Nelson's center ran the influenza advice line for the New York City Department of Health and Mental Hygiene during the 2009 H1N1 “swine” flu epidemic. Other locations have managed call centers and conducted public health surveillance for hepatitis epidemics, major foodborne-illness outbreaks, and the aftermath of the 2010 Gulf of Mexico oil spill. Poison centers also increasingly are providing advice for emergency personnel encountering a rapidly increasing problem: toxicities from prescription drug abuse. ED visits for overdoses of opioid analgesics more than doubled between 2004 and 2008, according to CDC data, and visits for benzodiazepine abuse increased by 90%.8Centers for Disease Control and PreventionEmergency department visits involving nonmedical use of selected prescription drugs—United States, 2004.MMWR Morb Mortal Wkly Rep. 2010; 59: 705-709PubMed Google Scholar That poison control centers fill those roles is well known in emergency and primary care medicine, but that knowledge has not percolated up to policymakers. Whether those roles are worth protecting will be examined again soon, when the 2012 fiscal year budget comes up for debate. And as in March, poison control experts expect their funding to be imperiled and are struggling now with how to argue for their services to be supported.
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