September 21, 2022
Dear fellow community PCPs,
I hope all of you are doing well as we move into fall. There are a lot of updates, and I appreciate you taking the time to review.
CCATC – Please share the new CCATC information with your practice team. A multidisciplinary group at CCHMC has been working for months designing the new Cincinnati Children’s Admission and Transfer Center. The purpose of CCATC is to improve the efficiency and safety of admissions and transfers to CCHMC. The first phase begins Oct 17. Effective on that date, community providers will use a new number 513-636 XFER (9337) to contact CCHMC about admissions or transfers. This line will also be used for PPL and Statline. The current numbers for these services (513-636-7997 and 513-803-1111) will remain active for some time as the systems are transitioned. Look for additional updates in future issues of Synapse and the Weekly Vitals email.
PCP Survey – This fall Therese Martin and the Physician Outreach team will again ask for your feedback in the bi-annual Community Provider Survey. Thanks to CPAC member Dr. Pierre Manfroy who worked with Therese to make it as brief and meaningful as possible. Just so you know, our CPAC group and POE work together to use this data to prioritize our work for the next year.
Resident and PCP Meet and Greet – Last week we hosted our fourth annual Resident and PCP Meet and Greet (in person this year) to allow residents to meet representatives from community primary care sites. We had 18 PCPs and 12 residents. Thanks to all who attended!
RSV – Regional CDC data has indicated we are entering an early RSV season. National AAP guidance supports the use of palivizumab when levels begin to approach typical (pre-COVID) fall/winter levels. The Ohio Department of Medicaid announced effective 8/25/22 palivizumab administration should begin early. KY Medicaid followed effective 10/1/22. Commercial payors typically follow. Based on this, the CCHMC NICU follow-up clinic will be using the following guidelines for this season:
1. <29 weeks and <1 year of age (as of 8/25/22 for Ohio and 10/1/22 for KY)
2. 29-32 weeks and < 1 year of age (as of 8/25/22 OH, 10/1/22 KY) with BPD/CLD (defined as oxygen use >21% for the first 28 days (CPAP should qualify too)
3. Children over 1 year as of 8/25/22 OH 10/1/22 KY with a diagnosis of BPD AND on oxygen or chronic steroids (including inhaled) 6 months prior to season
4. Others may qualify based on circumstances (ie Hemodynamically significant CHD less than one year of age) - see AAP guidelines for more information
Preterm infants who are followed by NICU Follow-up Clinics at CCHMC should be identified through those clinics. If you need to reach the nursing team regarding NICU follow-up patients, you can call 513-636-3882 (CCHMC) and 513-862-3285 (Good Samaritan).
Mental Health – As with prior years, the ED and Inpatient Psychiatry services have seen an increase in census as school begins. We have attached a few resources that may be helpful in locating more intensive services either at CCHMC or in other community centers:
CCHMC Continuum of Care Guide (Levels of Care, including IOP or PHP)
Best Point Behavioral Health Immediate Care Flyer
Substance Abuse and Mental Health Administration (SAMHA) Resource Locator - On-line, sortable, resource for finding community substance use, therapy, and crisis care.
COVID-19 – The return to school brought an increase in cases for those ages 0-19, but recent data suggests this may be peaking. Regionally, ICU and admissions continue a slow decline. PCP offices in our community began providing bivalent COVID-19 vaccine to eligible patients while simultaneously beginning influenza vaccination efforts.
Speaking of Flu – While no one knows what the impact will be, we all realize there is the potential for a more typical flu season this year. While it is not necessarily predictive, the 2022 southern hemisphere had an earlier start and higher circulation compared to other pre-pandemic seasons.
The AAP recommendations for the 2022-23 season were published this month HERE. The AAP also has a great toolkit for encouraging flu vaccination with posters and social media posts for practice use HERE.
When talking with new team members and families, it may be helpful to remind them that in a typical flu season in the US, millions of children are symptomatic from flu (missed school/work), thousands are hospitalized (and some are critical); and tragically between 100-200 children die from flu. Flu vaccination remains the best protection against infection. Unfortunately, over the last couple of years, flu vaccination rates have fallen in children.
Some key changes in the AAP statement to note:
1. Vaccine composition updated with new H3N2 A strain and Victoria lineage B strain
2. Age indication for Flucelvax quadrivalent (cell-based vaccine) lowered to 6 months
3. Age indication for peramivir IV treatment lowered to 6 months
4. Age indication for baloxavir lowered to 5 years for treatment and prophylaxis
5. Discussion of evidence-based strategies to increase immunization
Additionally, antiviral treatment is again recommended as early as possible for any patient with confirmed or suspected influenza who is hospitalized, has severe or complicated disease, or is at high risk of influenza complications. It can be considered for previously healthy outpatients with flu if it can be initiated within 48 hours of illness onset.
Thanks again for all you are doing to keep kids in our region healthy.
Shelly
Shelly F. Voet MD
Pediatric Associates PSC
CCHMC Executive Community Physician Leader