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Data on incidence, medical spending, and payment sources for poisoning were taken from the 1987 National Medical Expenditure Survey, 1991 US Vital Statistics, the 1992 National Hospital Discharge Survey, and 1992 poison control center surveillance data. Benefits, measured as percentage reductions in medical spending attributable to use of poison control centers, were calculated from analyses of published and unpublished studies of jurisdictions in which services became unavailable. Medical spending (payments) for poisoning treatment totaled $3 billion in 1992. Spending averaged $925 per case. Poison control center services were available for 86% of poisonings As used, they reduced the number of patients who were medically treated but not hospitalized for poisoning by an estimated 350,000 (24%) and the number of hospitalizations by 40,000 (12%) in 1992. The average public call to a poison control center for aid prevented $175 in other medical spending. Poison control centers offer a large return on investment. Despite their proven benefits, many poison control centers are unstably funded and financially strapped, in part because the federal government pays far less than its fair share of center costs.

Background: Poison exposures are a significant public health concern. Despite the impact that regional poison control centers have on reducing morbidity and mortality associated with poison exposures, they are facing a serious financial crisis today resulting in an increased emphasis on their economic justification., Methods: Using decision-analysis techniques, the cost-effectiveness of the treatment of poison exposures with the services of a regional poison control center compared with treatment without access to any poison control center was evaluated. The relative cost-effectiveness was modeled based on 2 outcomes (morbidity and mortality) for each of 4 typical poison exposures. Additionally, analyses were conducted to test the sensitivity of the cost-effectiveness ratios to outcome probability, average inpatient and emergency department costs, and proportion of poison exposures treated on site by the regional poison control center. A societal perspective was adopted., Results: The regional poison control center was substantially more cost-effective than the treatment of poison exposures without the services of a regional poison control center for both outcomes (morbidity and mortality) in each of the poison exposures considered. The results of the sensitivity analyses demonstrated that the outcomes of the decision analyses do not change regardless of the type of poison exposure, outcome considered, clinical outcome probabilities, average inpatient and emergency department costs, and proportion of poison-exposure cases treated on site by a regional poison control center., Conclusions: The regional poison control center is consistently more cost-effective in the treatment of poison exposures with an average cost-effectiveness ratio (cost per successful outcome) approximately half of that achieved without the services of a regional poison control center. Finally, significant cost savings to society are realized for each additional successful outcome obtained with a regional poison control center.

A survey was performed to evaluate health care facility (HCF) usage for poisoning exposures reported to regional poison centers for rural and urban populations. There was no difference in overall percentage of patients managed in a non-HCF vs a HCF, but more patients self-referred to a HCF in rural populations vs urban populations for a poisoning exposure. This may reflect decreased awareness of the poison center by the lay public in rural populations.

The American Association of Poison Control Centers (AAPCC) 1995 annual survey is summarized. A decline in the total number of poison centers was noted (from 104 in 1991 to 83 in 1995). The 83 US poison centers handled 2,431, 599 human exposure cases. Certified centers (44) served 63.1% of the US population, handled 72.5% of all poison exposures handled by poison centers nationally, and achieved higher utilization rates within their regions (10.9 vs 7.4 human exposure cases handled/1,000 population). Certified centers had superior staff credentials as measured, by passing the certification examinations for specialists in poison information or board certification for medical and managing directors. Funding for poison centers in 1995 to-total $74.6 million, although this funding level was recognized to be inadequate as only 63.1% of the population was served by certified centers and utilization of poison centers was not optimal. The annual cost of covering the entire US with adequate poison control services (meeting AAPCC certification standards and with utilization at a level of 15 human exposures per thousand population) is estimated at $120 million. Funding difficulties were prevalent. Thirty-five centers indicated that closure had been a real threat at least once in the previous 5 years. Analysis of cost per human exposure case by center volume demonstrated that economies of scale were achieved when a center handled at least 20,000 to 30,000 human exposure calls/year. Increasing human exposure volume beyond 30,000/year did not lead to a reduction in the average cost per human exposure case.

In summary, I propose a model of poison control service delivery to replace poison control centers. A handful of financially self-sustaining poison consult centers would remain. All other services would be provided by health plans to their members, including those covered under State-funded managed care. The need for continued fundraising efforts would be eliminated. Rather than devoting large sums of money to consolidate the State's 6 centers into 1 large center, I encourage Blue Cross of California to fund the protocol development process that will drive a true restructuring effort for poison control services. In our hearts, if our goal is to ensure continued service provision, then let's take the initiative to re-engineer the way we do business. The risks of doing nothing more than seek continued funding for the existing service delivery model should be painfully obvious by now. If your individual goals include survival for your center, then there's great news. The demand for call centers providing a wide range of advice services is approaching a critical level. Most health and hospital systems are moving to a managed care environment. Health care delivery is quickly moving out of the hospital to ambulatory services. Telemedicine is here--and growing very quickly. Distance learning technology is knocking at the door. There is plenty to do. With sound strategic development, your center will survive--it just won't look or feel the same as its does today. Survival the way it used to be ...uh, except for the computers and stuff.

To determine the extent of and rationale for the use of telephone recording devices by poison centers, a survey was distributed to 93 poison centers in the US during September 1991. Of the 62 respondents, 23 (37%) utilized and 39 did not utilize a telephone recording device. Telephone recording devices were primarily installed to address liability concerns followed by use for quality assurance, staff evaluation and training. The most frequent reason for not using a telephone recording device was the high cost and lack of funds (19) followed by considering it an unnecessary practice (8) and liability concerns (7). Poison centers certified by the AAPCC were more likely to record telephone conversations (p < 0.05) and accounted for 70% of centers with a recording device. A telephone recording device is employed by 1/3 of poison centers primarily to address liability concerns.

Poison control centers in the United States are threatened with closure, and attempts at a cost-benefit analysis of these services have been indeterminate. The purpose of this study was to compare the operating costs of a regional poison control center resulting from public use of its telephone hotline services with those of hypothetical alternative sources of advice and care. We conducted a follow-up telephone survey among 589 public callers to the San Francisco Bay Area Regional Poison Control Center who had been managed at home without medical referral after an unintentional poisoning. All survey respondents were asked what alternative action they would have taken had the poison control center not been available to assist them by telephone consultation. We then surveyed emergency departments and physicians' offices cited as alternatives by the callers to determine their response and charges for evaluating a suspected poisoning case. A total of 464 (79%) of the callers surveyed would have sought assistance from their local emergency health care system had the poison control center not been available. We conservatively estimated that the total charges for such evaluations would be +71,900. Comparatively, the total actual operating cost of services provided by the poison control center for all 589 poisoning cases was +13,547. Most of the study subjects (429 [73%]) had private insurance coverage. Direct public access to these services probably reduces the use of emergency health care resources, thus lowering health care costs.

Study Objective: To determine whether home use of syrup of ipecac is safe and effective in reducing pediatric emergency department visits., Design: Retrospective, multicenter comparison based on secondary use of a large database., Participants: Children younger than 6 years after acute, accidental ingestion of a pharmaceutical product., Interventions: 1990 Data corresponding to the study patients from seven regional poison centers were obtained from the American Association of Poison Control Centers. Poison center management choices (particularly use of syrup of ipecac for home decontamination) and characteristics (distribution of pharmaceutical ingestions managed, work volume per staff, staff experience, and training of decision-making director) were analyzed for their impact on the decision to refer a patient to a health care facility or to manage the patient at home. Statistical techniques included weighted least-squares regression analysis using logistic transformation of dependent variables and the forward selection procedure. Adverse patient outcome was defined as moderate effect, major effect, or death (American Association of Poison Control Centers coding criteria)., Results: In all, 55,436 children were included in the analysis (range, 3,839 to 12,691 per poison center). The distribution of medications ingested was similar among centers. Increased home use of syrup of ipecac, decreased frequency of ingestion of "high-risk" drugs, and increased staff experience were associated with decreased referral to a health care facility (P < .0001 for each variable). The forward selection procedure determined that syrup of ipecac use explained 45% of the variation in the poison center referral rates. The percentage of drugs defined as high-risk accounted for an additional 31%, and staff experience accounted for another 10% of the variation. Outcome of patients was excellent. No child died. Two home-managed patients had a major effect, and 26 had a moderate effect., Conclusion: Centers that recommended home use of syrup of ipecac more frequently were able to manage childhood poisoning more cost-effectively, without a decrease in safety. Although increased home management was strongly associated with syrup of ipecac use, the reason for this relationship cannot be determined from the data. Management by experienced professionals also contributed to cost-effectiveness.

To identify the significant inputs, activities, and outputs of a regional poison control center, a production model is described and its potential application to the conduct of economic evaluations delineated. The model can help the researcher identify the significant inputs (costs) incurred through the provision of poison control center services. These inputs directly influence the activities that the poison center is capable of undertaking. Activities undertaken by a poison center are intermediate steps between the inputs and outputs, and serve to convert the various inputs into associated outputs. They form the basis for determining the outputs produced by the poison center services. The outputs derived from poison center services provide the conceptual framework for assessing the effectiveness of a poison center in an economic analysis. Also described are potential applications of the production model in conducting poison center cost-effectiveness and cost-benefit analyses.

Poison information centers have traditionally served two major functions: the dissemination of poison information and poison prevention education. These functions facilitate the ultimate missions of the poison information centers which are to prevent accidental poisonings and to decrease morbidity and mortality associated with toxic exposures. Education must be directed at the potential and actual consumers of poison information centers services to prevent poisonings and to create awareness of how to use the poison information centers in the event of accidental or intentional poisoning. The target population can be identified from poison center statistics generated by the American Association of Poison Control Centers Toxic Exposure Surveillance System which define patient and caller demographics. Analysis of American Association of Poison Control Centers Toxic Exposure Surveillance System for ten years was used to identify the ten most common and ten most lethal poisons. This information indicates the most appropriate topics for education. These data also provide direction regarding poison center penetrance into specific geographic regions and identifies special needs of those individuals. Poison information centers are very costly to operate and the utilization of epidemiologic data can help to direct education efforts in the most cost-effective fashion.

A highly sophisticated network of poison information centers exists in Florida, one each in the northern, central and southern regions of the state. These 24-hour-a-day centers are staffed by nurses and pharmacists who provide assessment, triage and management advice about a wide range of exposures. Toxicologists are available when in-depth consultation is needed. As most cases can be safely managed at home, costly visits to the emergency room are averted, resulting in significant overall health-care savings. These centers also provide educational programs for the public and health professionals and compile epidemiologic statistics.

The quality and effectiveness of a regional poison information center (RPIC) are directly related to the skills and experience of the professional staff of specialists in poison information and to having the appropriate number of individuals in order to accurately and concisely respond to the thousands of telephone calls concerning acute/chronic poisoning emergencies. Since RPICs are traditionally small departments, the loss of even 1 key staff member can cause devastating results. A realistic appraisal of the actual costs associated with employee turnover was done at our RPIC and considered the following items: Advertising and recruiting expenses; interviewing expenses; processing costs; orientation and training expenses; and overtime costs including fringe benefits and premium shift differentials. The over-all tangible costs related to turnover of an individual who is certified or qualified to be certified as a specialist in poison information is approximately $17,486. The specific cost categories included advertising/recruiting, $326; interviewing expenses, $360; orientation and training, $9,250; processing, $350; overtime monies, $7,200. The less tangible effects of turnover cannot be strictly measured in dollars, but can be reflected in reduced quality assurance factors, increased sick time, and decreased morale. While staff salaries and benefits usually account for 75% to 85% of a RPIC's operating budget, and since external sources of revenue do not offset the operational expenses, it is becoming increasingly difficult to remain competitive in today's current professional salary climate. While the loss of talent and its cumulative effect on quality is impossible to quantitatively measure, we have attempted to calculate the real financial burden associated with replacing personnel.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetaminophen is the pharmaceutical most frequently ingested by small children. Although past research has allowed the safe management of 90% of these ingestions at home, several thousand are still referred to emergency departments annually. With the goal of further reducing the number of unnecessary referrals, the risk/benefit considerations of alternate referral strategies were analyzed. In a retrospective poison center chart review study from 11 centers, the records of children between the ages 1 and 6 years who acutely ingested acetaminophen and were referred to a hospital for determination of serum acetaminophen concentration in 1986 and 1987 were identified using the database of the American Association of Poison Control Centers. Risk of hepatic injury was assigned on the basis of the Rumack-Matthew acetaminophen toxicity nomogram. The cohort was stratified in terms of the amount ingested and whether a pediatric or adult preparation was ingested. The direct cost of an evaluation was estimated from four centers. Sensitivity, specificity and direct cost of each risk identification strategy were calculated. Eight hundred sixty six of 2091 patients had a timed serum acetaminophen concentration recorded. Of these, three patients had results in the "probable risk" area of the nomogram. A referral reduction strategy which would refer only children who ingest 200 mg/kg or more of an adult preparation could eliminate 82% of referrals without missing any of these "probable risk" patients. Six other children were determined to have serum acetaminophen concentrations in an area of the nomogram labeled "possible risk". No referral reduction strategy explored identified all of these patients. The average charge for an emergency department evaluation in 1992 was $272.00. These data suggest that children less than six years of age who ingest pediatric acetaminophen products other than those from packages containing greater than 30 tablets or who ingest less than 200 mg/kg of an adult preparation may be safely managed at home without referral to a hospital. This strategy would result in significant cost savings and prevent unnecessary inconvenience to many patients and families.

To illustrate costs associated with poison center closure a survey of lay callers to the poison center and emergency department costs was conducted. For 21 days all callers to a Regional Poison Information Center receiving home treatment were asked the type of health insurance coverage the patient had. This information was documented on the medical record and tabulated. Health care costs were determined by surveying local hospitals. Of the callers, 1,276 (43%) provided insurance information: 928 (73%) of the patients were covered by private insurers; 258 (20%) received state medical assistance and 90 (7%) had no medical coverage. The average emergency department cost of an ingestion exposure was $210.75, ocular $172.22, and inhalation $298.03. In the absence of a Regional Poison Information Center responding to 61,000 calls annually, the state would incur a debt ranging from 1.27 to 2.20 million dollars if 60% of those covered under state assistance went to the emergency department. Private insurers would forfeit 4.58 to 7.93 million dollars per year. These cost estimates consider only the emergency department charges, not unnecessary admissions. State government and private insurers clearly are the financial beneficiaries of poison center services which save several times their operating costs.

Poison information center funding is a continuous problem and is growing more critical as cost containment effects the health care industry. Although a limited number of poison centers are partially funded by governmental agencies, general poison center operational support is derived from a variety of sources, and there is significant pressure upon centers to identify alternative funding sources. Affiliated members of our member hospital treatment network have provided one revenue source, but not all hospitals within our service region have subscribed. Furthermore, hospitals outside of our service region have utilized the service without any financial responsibility despite recommendations to use their local center. Therefore, to provide an incentive for local hospitals to subscribe to the service and to dissuade hospitals from outside of the region from using the service, we implemented a toxicology consultative fee for service on all calls emanating from non-member hospitals. In just 19 mo, recruitment of 16 new member hospitals has generated $65,150 additional revenue. Non-member hospitals electing not to affiliate but to remunerate for toxicology consultations (226 cases) have generated $20,400 (98% collection rate). A startling 95% reduction in calls from hospital outside of region has resulted since this fiduciary initiative began. New revenue totaling $85,550 has been generated by establishment of a toxicology consultation fee, and our staff is now able to dedicate priceless time and resources to the poison information needs of the residents of our region.

Most regions of the United States are served by poison control centers that provide 24-hour toxicologic guidance resulting in the home management of most poison exposures. It has been suggested that without public access to a poison control hotline the majority of poison-exposed patients would seek medical care in emergency departments or other outpatient visits. This study compares the patterns of community response to poison exposure in Louisiana before and after the discontinuance of the state poison control service, and also compares these patterns to the situation in Alabama, which maintained poison center services throughout the study period. After discontinuance of the poison control service in Louisiana, poison exposure cases had up to four times the rate of "self-referral" to health care facilities and less than half the rate of home management when compared to Alabama cases. Before the closing of the Louisiana center, Alabama and Louisiana triage patterns for poison exposures were nearly identical. The maximum annual cost attributable to unnecessary outpatient service utilization in Louisiana was estimated to be $1.4 million, an amount more than three times the annual poison control center state appropriation.

State and federal law provided the impetus to develop a coordinated statewide poison system in Massachusetts. To achieve this objective the Commissioner of the Department of Public Health established a Statewide Poison Committee, composed of poison control representatives, physicians, nurses, and pharmacists. After a year of regular meetings, a structure for a statewide poison system was developed, meetings, a structure for a statewide poison system was developed, and as January 1978 this System has been operational in Massachusetts. The structure is based on the Department of Public Health contracting with an incorporated institution to implement the Statewide System, which consists of one information center available to the public and professionals as well as a network of all 112 acute care hospitals in the State as "member institutions." Educational institutions" are further designated with a responsibility of professional and public education in various geographic areas throughout the State. The System is responsible for providing comprehensive poison information, treatment, public education, professional education, data collection, and research. A senior Advisory Board representing institutions with major contributions to the System as well as a Coordinating Committee representing diverse geographic and professional interests serve in an advisory capacity to the System. Funding is broad-based and includes federal, state, and private institutional support.

We asked 187 sequential eligible callers to our poison center (PC) what action they would have taken if the PC had not existed, and about their health insurance, if any. Callers eligible for this study were those not requiring medical care other than dilution or reassurance during the 24 hour follow up period. Most callers would have either called their physician or ER, or gone directly to a physician's office or to an ER without calling first. Assuming a cost of $25 for a physician's office visit, $100 for a ER visit, and no charge to the patient for calling their physician or pharmacist, and using our actual PC cost per case of $10, direct medical costs to the consumer were reduced by PC use by 75 to 80% for all such callers. This information supports ongoing cost effectiveness of PC provision of poison information services.

Since its inception in 1972, the San Diego Poison Center has made considerable progress towards achieving its goal of developing a poison care system which will decrease incidence, morbidity, and cost of poisonings. A systems approach has been developed to care for patients at all levels of severity. Subregional centers have been identified and linked to the poison center. Education of the region's emergency medical personnel and the public have been actively pursued. Calls to the center have increased from 6829 in 1972 to 25,949 in 1976. Eighty-five percent of poisoning calls in 1976 were managed at home over the telephone. A follow-up call at 24 hours for each case revealed that less than 1% sought additional medical care. The percent of all emergency department visits resulting from poisoning in a tracer group (children under age 12 leaving emergency department asymptomatic) dropped from 6.1% in 1971 to 1.9% in 1976. The percent of hospital admissions due to poisoning in children under 10 years also dropped by 40% between 1971 and 1974. Estimated cost savings to the community by preventing emergency department visits alone each year covers the cost of operation of the poison center itself.

The Oregon Poison Center has developed a unique partnership with a chain drug store corporation which sponsors the Center's poison prevention, public awareness, and professional education programs. Termed the Poison Prevention and Public Awareness Program, this affiliation offers significant financial support to the Oregon Poison Center on a continuing basis. It establishes an integral role for the drug stores in poison control activities. In addition, the program provides a mechanism for customer capture and reaps significant public and professional relation benefits for the corporation. This presentation describes the materialization of the affiliation, including the development of the program proposal, its presentation to potential participants, and the selection of a chain drug store corporation.

Funding problems seem to be an ever present obstacle for Regional Centers. To date, there has not been an effective solution for many, if not all, the centers. An often raised suggestion is the direct solicitation of the users of the services of the Poison Center. On March 1, 1985, the Blodgett Regional Poison Center (BRPC) initiated a direct solicitation project. For most BRPC calls involving a "patient", a packet containing informational and educational materials was mailed to the caller. This packet also included a letter requesting a donation to BRPC to help defray operational expenses. The letter suggested a $10.00 donation, or any amount the individual could afford. Results through the first 5 months of this project are presented with copies of all materials used in the solicitation.

Poison information centers have been developed to serve the poison information, treatment, and prevention education needs of the residents within their regions. These services are generally provided and funded by hospital-based centers. A limited number of centers receive local and state government financial support. In general poison information centers are nonrevenue-generating and rely upon these sources of fiscal support. As cost containment within the health care industry becomes more critical, poison centers are falling victims to budget cuts and even being eradicated in the interest of saving money. The private sector has provided grants to poison centers, but this represents a short term solution to a long term problem--the need for consistent funding. Business and industry have been overlooked as a source of potential revenue. Our poison center has developed an extensive program of services for the private sector. These include providing 24-hour-a-day poison information service on their behalf; developing a workers' right-to-know program; identifying epidemiologic trends with their products, preparing exposure reports; etc. These services are provided for a specific fee which is determined by anticipated call volume, number of products to be included, medical and legal liability, etc. By providing services to the private sector, we have reduced the financial liability of our poison center by over 25%.