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The burden of treatment compliance (BOTC) is assessed via a point system, which is then converted to an impairment percentage. Points are assigned on the basis of:
Medication usage, per medication, dependent upon the route and frequency.
Dietary modifications.
Frequency of routinely performed procedures
History of prior operative procedure or radiation therapy.
These points are then converted into impairment based upon Table B-1.
Total Points | Impairment (%) |
---|---|
0–1 | 0 |
2–5 | 1 |
6–10 | 2 |
11–15 | 3 |
16–20 | 4 |
21–25 | 5 |
26–30 | 6 |
31–35 | 7 |
36–40 | 8 |
41–45 | 9 |
46 + | 10 |
In most situations, BOTC will not result in the addition of more than 2% to 3% impairment. In chapters using BOTC, points are to be added onto final impairment rating.
Perform the following analysis to determine the point score that will be used in calculating the BOTC due to medication usage.
Assess the dosing frequency and route of administration for each medication used for the condition being rated, and assign points for each using Table B-2a for oral, inhaled, ocular, skin and rectal medications, and Table B-2b for medications administered by an intravenous, subcutaneous, intramuscular, intradermal, or intracavitary route.
Add these to get the total points for medications.
Dosing Frequency | Points |
---|---|
< 1 per day | 0 |
1 to 2 per day | .5 |
3 to 4 per day | 1.0 |
5 to 6 per day | 2.0 |
> 6 per day | 3.0 |
Dosing Frequency | Points - Inhaled | Points - Rectal |
---|---|---|
< 1 per day | 0 | 1.0 |
1 per day | 1.0 | 2.0 |
2 per day | 2.0 | 4.0 |
3 per day | 3.0 | 6.0 |
≥ 4 per day | 4.0 | 8.0 |
Table B-2a and Table B-2b: Points for Frequency and Route of Medications—Per Medication
Notes:
Combination medications are assessed by the total number of medications. For example, combinations of antihypertensives and diuretics count as two medications due to the potential side effects of each.
Medications need to be taken chronically for a chronic condition specific to the organ systems under evaluation. If a medication is being used for two systems it should be counted only once. Each month is arbitrarily considered to be 28 days; the medication must be taken at least 21 days per month to count as a medication that is taken daily.
Medications given to correct a well-documented side effect of a medication used to treat a condition specific to the organ system being rated are also counted unless:
For “prn” – use average frequency based on use, although prn medications must be prescribed by a physician for a chronic condition (such as Imitrex for migraines).
Route of Administration | Points |
---|---|
SC, IM, ID: 1 to 3 times weekly | 1.0 |
SC, IM, ID: 4 to 7 times weekly | 2.0 |
SC, IM, ID: 2 times a day | 3.0 |
SC, IM, ID: 3 times a day | 4.0 |
SC, IM, ID: 4 times a day | 5.0 |
SC, IM, ID: 5 times a day | 6.0 |
Intra-cavitary Reservoir | Based on frequency that reservoir is filled |
Intravenously | 1 point per treatment per day up to 25 points/ month |
Notes: Filling the reservoir once a month or more frequently is assigned 4 points; for filling once every 2–4 months, assign 2 points; for filling the reservoir less frequently, assign 1 point
Many conditions require dietary modification. The degree to which this is necessary varies from patient to patient, as does the degree to which patients comply with these restrictions. Thus, rather than build an allowance for this into the impairment rating, it appears more reasonable to rate it separately. BOTC points are given for dietary modification when the patient is compliant, and are based upon the premise that complying with dietary restrictions restricts ADLs in ways other than those measured by the history and medication use alone.
Modification | Points |
---|---|
Dietary modifications – Minimal | 2.0 |
Dietary modifications – Moderate | 5.0 |
Dietary modifications – Severe | 10.0 |
Certain procedures are not routinely performed on all patients with a given disease. It is consequently unreasonable to assume a default level of impairment based upon the need to undergo these procedures in the rating assigned for these conditions. The need to have undergone procedures such as a laparotomy or radiation therapy for a condition also varies from patient to patient and contributes slightly to impairment. A schema for assigning procedural based impairment is as in Table B-4. Peritoneal dialysis, hemodialysis and ostomy-related impairment are sufficiently intrusive as to warrant the direct assignment of impairment percentages and are covered in specific organ-system chapters.
Procedure | Points |
---|---|
Glucose monitoring: 1 times per day | 1.0 |
Glucose monitoring: 2 times per day | 2.0 |
Glucose monitoring: 3 times per day | 3.0 |
Glucose monitoring: ≥ 4 times per day | 4.0 |
Hemophoresis | 4.0 per episode per month |
Transfusion (monthly) | 2.0 per unit per month |
Exploratory laparotomy | 2.0 (assigned only once) |
Radiation therapy | 2.0 (per body part irradiated) |
Combined Values Table
Burden of Treatment Compliance
B-1: Burden of Treatment Compliance
B-2a: Oral, Intranasal, Ocular, Skin
B-2b: Inhaled, Rectal
B-2c: Points for Subcutaneous, IM, Intradermal, IV, and Intracavitary Medication
B-3: Points Assigned For Dietary Modification
B-4: Points Assigned for Procedures
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