Arizona physicians often come to a delayed diagnosis or completely miss the right diagnosis when seeing patients with newly acquired Valley fever infections even though the primarily respiratory fungal disease is very common in the state, particularly the corridor between Tucson and Phoenix.
This is due to the fact that Valley fever’s initial symptoms closely mirror those for the flu, and it has been this way for years, according to studies by the Arizona Department of Health Services and the U.S. Centers for Disease Control and Prevention.
Now, the University of Arizona Valley Fever Center for Excellence (VFCE) wants to do something about that. The center has teamed up with Banner Health to develop a Valley fever “clinical practice” guide, an agreed upon set of rules for when primary care, urgent care and emergency room clinicians should do the tests needed to detect this problem earlier.
“This is one of the expected results from the University of Arizona’s medical faculties merging their clinical care with that of Banner Health under the Banner – University Medicine Division that replaced the UA Health Network,” said John N. Galgiani, MD, center director, professor of medicine in the Division of Infectious Diseases at the UA Colleges of Medicine in Tucson and Phoenix, and medical director of the Banner – University Medicine Valley Fever Program. “Because of the merger, it provides a way for the VFCE to help implement all best clinical practices that it knows about for patients with Valley fever and actually get them to get used.”
Developing the Valley fever clinical practice protocols has been a year-long planning process within the Clinical Consensus Group for primary care, Banner Health’s program for guiding routine medical practices across all of its health-care sites. This clinical practice guide is earmarked especially for the ambulatory practices throughout the Phoenix, Casa Grande and Tucson metropolitan areas, where Valley fever is endemic.
Earlier this fall, a webinar was produced by Dr. Galgiani and David M. Valenzuela, MD, a Phoenix-area family practice physician, clinical assistant professor at the UA College of Medicine – Phoenix and the physician executive who heads Banner Medical Group Primary Care. The webinar was designed to give an overview of why Banner is doing this and what the clinical practice covers.
“This clinical practice will change the way Arizona clinicians recognize and manage patients with Valley fever,” Dr. Galgiani said. “Central to this change will be the expanded role of primary care clinicians in earlier diagnosis and management of uncomplicated infections.”
The webinar is now available for viewing below or at this link: https://streaming.biocom.arizona.edu/streaming/28471/event (NOTE: In Google Chrome, you may need to enable/allow Adobe Flash Player to view the video via the preceding link.).
To help physicians not yet familiar with this new clinical practice, Dr. Galgiani and Fariba Donovan, MD, PhD, an assistant professor in the UA Division of Infectious Diseases, research specialist with the VFCE and clinician with Banner – UMC Tucson, will be holding training sessions at individual Banner clinical sites throughout the coming year.
In addition, the VFCE and Banner Health have assembled background information and a clinical practice flow diagram in an online “tool kit” at: https://vfce.arizona.edu/education/banner-valley-fever-clinical-practice-toolbox
While these aids were developed within the Banner Health planning process, they are being made available to clinicians both inside and outside of Banner programs so that these resources could be used throughout Arizona and beyond.
“Although Banner has taken this first step, there is no reason that clinicians everywhere couldn’t do the same thing,” Galgiani said.
EXTRA INFO: Greater Awareness of Valley Fever Needed Nationally, CDC says
Infectious Disease Advisor — Greater nationwide awareness of the fungal infection Valley fever (coccidioidomycosis) is needed, according to a report published in the August 2018 issue of the U.S. Centers for Disease Control and Prevention's Emerging Infectious Diseases.
Kaitlin Benedict, MPH, from the CDC in Atlanta, and colleagues conducted enhanced surveillance in 14 states in 2016 by identifying coccidioidomycosis cases according to the Council of State and Territorial Epidemiologists case definition and interviewing patients about their demographic characteristics, clinical features, and exposures.
The researchers found that among 186 identified patients, median time from seeking health care to diagnosis was 38 days (range, one to 1,654 days). Seven in 10 patients had another condition diagnosed before coccidioidomycosis testing occurred, of whom the vast majority (83 percent) were prescribed antibacterial medications, 43 percent were hospitalized, and 29 percent had culture-positive coccidioidomycosis. The majority of patients from non-endemic states (83 percent) had traveled to a coccidioidomycosis-endemic area.
"Improved coccidioidomycosis awareness in non-highly endemic areas is needed," the authors write. Abstract/Full Text
About UA Valley Fever Center for Excellence
In 1996, the Arizona Board of Regents established the Valley Fever Center for Excellence at the University of Arizona to address problems created by a fungus, Coccidioides, that’s endemic to soils of the U.S. Southwest and the cause of Valley fever. Some cases are mild; some so severe that it spreads past the lungs. It also affects animals, including pets and livestock. The center, which is affiliated with the UA Colleges of Medicine - Tucson and Phoenix through the UA Department of Medicine and Division of Infectious Diseases, works to spread public awareness and education about Valley fever, promote high-quality care for the disease and pursue research to improve treatment therapies and develop a vaccine. Learn more: vfce.arizona.edu
About the UA Department of Medicine
The University of Arizona Department of Medicine is one of six original departments and the largest at the UA College of Medicine – Tucson, with 14 divisions covering medical subspecialties from cardiology to infectious diseases to rheumatology. The faculty includes more than 250 physicians who help train more than 70 fellows in 18 fellowship programs, 130 residents in internal medicine and dermatology, and 450 medical students engaged in clerkships, sub-internships and research opportunities. Affiliated with UA institutes and centers of excellence and collaborative cohorts across the nation and world, the department’s investigators are leading research into development of personalized precision medicine therapies for both basic and complex diseases to improve the lives of people in Arizona and abroad. Learn more: deptmedicine.arizona.edu
About Banner – University Medicine
Banner – University Medicine is the academic arm of Banner Health—one of the largest nonprofit health-care systems in the country, with 28 hospitals in six states: Arizona, California, Colorado, Nebraska, Nevada and Wyoming. With a special emphasis on patient care, research and teaching, Banner – University Medicine includes Banner – University Medical Center Phoenix, Banner – University Medical Center South, Banner – University Medical Center Tucson, Banner Children’s at Diamond Children’s Medical Center, physician clinics and a health plan division. They are affiliated with the University of Arizona Health Sciences colleges in Tucson and Phoenix. When you choose an academic medical center, you are experiencing the future of medicine today.
NOTE TO MEDIA: For educational pamphlets, brochures, images and graphics related to Valley fever—as well as contact information for University of Arizona faculty knowledgeable about the illness—visit the following webpage: UA Expertise on Valley Fever (Coccidioidomycosis)
"New UA/Banner Health Valley Fever Clinical Guidelines to Help Avoid Delays in Diagnosis" | Posted Nov. 14, 2018
“UA Valley Fever Center, ADHS, Tucson’s Pueblo High Host 2018 Youth Awareness Poster Contest” | Posted Oct. 5, 2018
“Patient-Ordered Tests Indicate Valley Fever Uptick in State, UA Infectious Diseases Specialist Says” | Posted June 12, 2018
“Cronkite News Feature on Valley Fever Notes Doctor ‘Lack of Awareness’ Puts Sufferers at Risk” | Posted April 13, 2018