March 25, 2020

An Update from our Quality Council and Chief Medical Officer:

The American Academy of Dermatology (AAD) has updated its website and revised some guidance related to the COVID-19 crisis.

Most importantly is a revision of the iPledge requirements regarding pregnancy testing that better allow for TeleDerm visits for Accutane patients. https://www.aad.org/member/practice/managing/coronavirus – iPLEDGE . Dr. Forney in GA has been using this type of modified approach for years with remote college students and her experience has been very positive and we appreciate her guidance.

The AAD has provided a new COVID-19 guidance for patients on biologic medications. https://assets.ctfassets.net/1ny4yoiyrqia/PicgNuD0IpYd9MSOwab47/07b614658aff5fc6ccc4c0bd910509a3/Biologics_and_COVID_19_FINAL_V2.pdf . It also provides information for dermatologists treating lupus patients needing hydroxychloroquine, which may become in short supply. https://www.aad.org/member/practice/managing/coronavirus – HCQ .

The AAD has also developed a compilation of guidance on safety measures during COVID-19 for dermatology clinics based upon CDC and WHO guidance. These mirror our QDP and QC recommendations to date.  https://assets.ctfassets.net/1ny4yoiyrqia/4LNCNjucOonbQx7aC970x/bbedbab0754efecbb6ef0ca00ef43b26/COVID-19_Preparedness_032420.pdf

OSHA has also updated their recommendations for clinics operating in a pandemic.  https://assets.ctfassets.net/1ny4yoiyrqia/7kzJPY5S3uLHV1rZ7zweCX/5cc524c2366d694104bf7f986972b6a6/COVID-19_OSHA_Guidance.pdf

Finally, we include the AAD’s informational update on Current status of COVID-19 and risks to health care personnel. https://assets.ctfassets.net/1ny4yoiyrqia/1d1Q7G7zWzuhl7qEDclJml/037c137365fa1e790d2fb137cfaa61c5/COVID-19_Status_and_Risk_032420.pdf

The following notice was sent from the North Carolina Medical Board in response to news of providers accumulating potentially effective medications for personal or family use. This applies to all medical professionals in any region or market and while I have absolutely no concerns about our QDP clinicians, we are obliged to share this message.

Over the past several days, NCMB and other health regulatory boards have received reports of clinicians inappropriately prescribing chloroquine, azithromycin and other medications, apparently for use in the event of a future COVID-19 illness.

While I feel sure that most licensed physicians and physician assistants would never misuse their prescriptive authority in this way, I feel compelled to state two of the most compelling arguments against “preemptive” prescribing:

  • Prescribing in order to stockpile medication – whether for personal/family use or to assist patients – is not an acceptable medical practice. Further, it is inconsistent with the ethics of the medical profession;
  • Inappropriately prescribing for possible COVID-19 treatment strains the current supply of prescription medications, making it more difficult for patients with conditions such as lupus or rheumatoid arthritis to obtain needed treatment.

We know these remain challenging times and many practices have temporarily discontinued in-office care. We look forward to resuming these services as soon as possible. For those still offering urgent and necessary dermatologic services, the Quality Council continues to monitor government health agencies and specialty society recommendations for ongoing guidance.

 

Thank you and stay well,

 

John G. Albertini, MD