From the 19 November 2014 EurekAlert
Flexible electronic sensors based on paper — an inexpensive material — have the potential to some day cut the price of a wide range of medical tools, from helpful robots to diagnostic tests. Scientists have now developed a fast, low-cost way of making these sensors by directly printing conductive ink on paper. They published their advance in the journal ACS Applied Materials & Interfaces.
Anming Hu and colleagues point out that because paper is available worldwide at low cost, it makes an excellent surface for lightweight, foldable electronics that could be made and used nearly anywhere. Scientists have already fabricated paper-based point-of-care diagnostic tests and portable DNA detectors. But these require complicated and expensive manufacturing techniques. Silver nanowire ink, which is highly conductive and stable, offers a more practical solution. Hu’s team wanted to develop a way to print it directly on paper to make a sensor that could respond to touch or specific molecules, such as glucose.
The researchers developed a system for printing a pattern of silver ink on paper within a few minutes and then hardening it with the light of a camera flash. The resulting device responded to touch even when curved, folded and unfolded 15 times, and rolled and unrolled 5,000 times. The team concluded their durable, lightweight sensor could serve as the basis for many useful applications.
It is well known that new brand-name drugs are often expensive, but U.S. health care is also witnessing a lesser-known but growing and seemingly paradoxical phenomenon: certain older drugs, many of which are generic and not protected by patents or market exclusivity, are now also extremely expensive. Take the case of albendazole, a broad-spectrum antiparasitic medication. Albendazole was first marketed by a corporate predecessor to GlaxoSmithKline (GSK) outside the United States in 1982 and was approved by the Food and Drug Administration (FDA) in 1996. Its patents have long since expired, but no manufacturer ever sought FDA approval for a generic version. One reason may be that the primary indications for the drug — intestinal parasites, neurocysticercosis, and hydatid disease — occur relatively rarely in the United States and usually only in disadvantaged populations such as immigrants and refugees. In late 2010, the listed average wholesale price (AWP) for albendazole was $5.92 per typical daily dose in the United States and less than $1 per typical daily dose overseas.
Meanwhile, there is little that individual consumers can do. Some drug companies, such as Amedra, offer assistance programs for indigent patients, but these programs often have complicated enrollment processes, and they do not offer an effective general safety net.5 Some patients instead seek to acquire these drugs in other countries, since many of them are widely and inexpensively available outside the United States, but such foreign sources may be of variable quality. Until regulatory and market solutions are implemented to reduce prices for these older drugs, patients requiring such drugs and the physicians treating them will continue to be faced with difficult choices.
From the 6 November 2014 item at HealthWorks Collective
What if we paid for patient recovery rather than just patient services?
What if we paid to treat patients rather than just conditions?
What if we paid to personalize care rather just population health quality measures?
While these questions may sound academic, there is a groundswell of innovative healthcare providers working on the answers. To realign the healthcare system to overall patient recovery and well-being, it will take physicians and other healthcare providers transforming the entire system. The good news is that this is quietly happening from within, with physicians, healthcare systems and health plans working together.
They include the over 500 Accountable Care Organizations, 6,500 providers considering bundled payment pilots and providers signing risk sharing agreements with health plans. Physicians, healthcare systems and insurance plans are sharing data, sharing financial risk and focusing on improving overall patient outcomes and cost.
With little debate or fanfare outside the healthcare industry, Medicare quietly saved $372 million with their versions of the ACO. While some critics predict that ACOs will follow Health Maintenance Organizations (HMOs) demise in the 1990s, ACOs are different. Patients are assigned to ACOs and remain free to go to any provider. ACOs can’t limit care or require patients to see providers in their network. The ACO’s were still able deliver great results even with these two major challenges which they call “churn” (ACO assigned patient turnover) and “leakage” (patients going outside the provider network).
Bundled Payments are just getting started with up to 6,500 providers deciding soon whether to go live Jan 1, 2015 with Medicare’s Bundled Payment for Care Improvement (BPCI) pilot. Provider/Health Plan risk sharing arrangements are expanding rapidly, indicating they are delivering. This surge began when the Affordable Care Act (ACA) started requiring health plans to write rebate checks if they paid out less than 85% of their premiums in medical claims. This encouraged Health Plans to partner and reward providers for improvements in patient outcomes and cost. Health Plans leaders believe that the “blurring of the lines” between providers and health plans is just getting started.
Patient Recovery vs. Patient Services
From the 24 November 2014
That headline appeared in the Minneapolis Star Tribune print edition yesterday. The focus of the article was how difficult it is to obtain medical cost data despite a state law and other efforts to increase transparency.item at HealthNewsReview.org
The same newspaper had a brief column the previous day about open enrollment season for workplace medical benefits, but that column’s final line seemed to conflict with the point of the longer story mentioned above. The shorter column quoted the executive director of the MN Community Measurement group saying that the group’s rankings – “rating doctors on whether they provide optimal care to patients with diabetes, depression and other conditions….can help consumers make informed choices.” The exec said consumers can now ask, “Is there much difference in quality, given the difference you might be asked to pay in price?”
Well, the “Health care consumers in the dark” story drove home the point that consumers can’t get the price answers.
Meantime, it was great to see a JAMA Internal Medicine article about a great piece of journalism on this same topic. The article, by Lisa Aliferis of KQED radio in San Francisco, was entitled, “Variation in Prices for Common Medical Tests and Procedures.” It gives details about the PriceCheck project of KQED, KPPC, and the excellent ClearHealthCosts.com effort run by Jeanne Pinder. Aliferis concludes the article:
“The window is cracked open on health cost transparency. We have been here before—with car sales, with airline tickets. Now, technology in combination with transparency can do the same for health care.
And yes, we have been asked whether people should “shop” for medical treatment in the same way they shop for a new car. If there were a correlation between cost and quality, this might be a reasonable question. Instead, in American health care, money is spent on unnecessary or unproven treatments much too often, and there’s widespread variation in price. People are waking up to these facts.
The money conversation makes the practice of medicine very complicated: the “gotcha” bill and the medication that is not covered challenge the physician-patient relationship. It is time to take off the blindfold and embrace transparency in pricing for medical care and services.”
Next time my physician urges a screening, I’ll wonder if it is because of his concern for my health (most likely- knowing my physician) or his corporation’s interest in profit…
As this article outlines is that physicians in corporations are often
in Catch-22 positions.
thought more highly of business folks until I started working for them. I thought CEOs and boards of directors of companies had a vision, whether to maximize shareholder profit, or to produce a stellar product or provide a singular service, etc. Once the vision was elucidated, everyone worked together like a team to make it happen.
Then I became employed by a large corporation as a family physician to provide medical care. And it’s been one eye opening experience after another ever since. To me, it’s quite simple. The vision of a medical practice should be to provide good medical care while being cost conscious, and maintaining strong patient satisfaction. That’s how all the money gets generated, right? The patient pays his/her premium, part of which gets funneled to our large corporation, who is then tasked to provide care for that patient. How is care provided to that patient? By having a doctor see, talk to, examine and treat that said patient.
OK. So we all know that it’s not quite that simple. Enter primary care 2014, the world of risk adjustment factor (RAF) scores (which entail the corporation getting paid more for sicker patients), electronic health records (EHR), and quality metric incentive payments (the corporation gets more money from insurance companies by meeting certain goals in screening, like colonoscopies, mammograms, etc.). Now health care has become more complicated. But it’s still all based on that interaction we physicians have with our patients. We can’t meet quality metric goals if we don’t see the patients, we can’t determine if they are sicker and therefore require more funds to care for if we don’t see them, and we can’t use EHR if we don’t see the patient. There’s just a bunch of road blocks and distractions added in….
From the 31 October 2014 report
The New York Times recently pulled their reportorial and graphics know-how together to do a one-year assessment of the ACA. It concludes: “After a year fully in place, the Affordable Care Act has largely succeeded in delivering on President Obama’s main promises, an analysis by a team of reporters and data researchers shows. But it has also fallen short in some ways and given rise to a powerful conservative backlash.”
The package consists of seven sections that run the gamut, with some key numbers and charts. Overall it’s a positive but not uncritical look. The cost section is particularly nuanced, noting the challenges of narrow networks and high deductibles.
Most of these topics we’ve considered on this blog over the last few years. But the series provides a nice, compact overview and handy reference going into the second year.
Here are the seven sections covered, and the nutshell conclusion the Times provided for each.
- Has the percentage of uninsured people been reduced? Yes, the number of uninsured has fallen significantly.
- Has insurance under the law been affordable? For many, yes, but not for all.
- Did the Affordable Care Act improve health outcomes? Data remains sparse except for one group, the young.
- Will the online exchanges work better this year than last? Most experts expect they will, but they will be tested by new challenges.
- Has the health care industry been helped or hurt by the law? The law mostly helped, by providing new paying patients and insurance customers.
- How has the expansion of Medicaid fared? Twenty-three states have opposed expansion, though several of them are reconsidering.
- Has the law contributed to a slowdown in health care spending? Perhaps, but mainly around the edges.
Excerpt from the commentary by M. Christopher Roebuck, PhD, MBA
Johns Hopkins research team reports that major hospitals across the U.S. collectively throw away at least $15 million a year in unused operating room surgical supplies that could be salvaged and used to ease critical shortages, improve surgical care and boost public health in developing countries.
A report on the research, published online Oct. 16 in the World Journal of Surgery, highlights not only an opportunity for U.S. hospitals to help relieve the global burden of surgically treatable diseases, but also a means of reducing the cost and environmental impact of medical waste disposal at home.
The fact of surgical supply waste is nothing new, the researchers note, but say their investigation may be one of the first systematic attempts to measure the national extent of the problem, the potential cost savings and the impact on patients’ lives. While several organizations run donation programs for leftover operating room materials, such efforts would be far more successful if they were made standard protocol across all major surgical centers, the authors say.
“Perfectly good, entirely sterile and, above all, much-needed surgical supplies are routinely discarded in American operating rooms,”
The researchers tracked outcomes among 33 Ecuadorian patients whose surgeries were made possible as a result of the donations. Their analysis showed that donated surgical supplies prevented, on average, eight years of disability per patient.
In the study, materials topping the 19-item surgical supplies list included gauze, disposable syringes, sutures and surgical towels. However, the investigators say, it is important to tailor shipping to the specific needs of each hospital. Matching of donor leftovers to recipient need, they say, will prevent unnecessary shipping costs and avoid creating medical waste locally. In addition, the receiving hospital must have a demonstrated capability and the equipment to clean and sterilize the shipped materials before use in the operating room.
[Repost] Neglect of culture in medicine is ‘single biggest barrier’ to achieving better health | Daily Science News
From the 28 October post
The systematic neglect of culture is the single biggest barrier to advancing the highest attainable standard of health worldwide, say the authors of a major new report on culture and health, led by Professor David Napier, a leading medical anthropologist from University College London (UCL), UK, and published in The Lancet.
Bringing together experts from many different fields, including anthropologists, social scientists, and medics, the Commission is the first ever detailed appraisal of the role of culture in health. The authors argue that cultures of all kinds – not only people’s religious or ethnic identity, but also professional and political cultures – have been sidelined and misunderstood by both medical professionals and society as a whole.
Until now, culture has largely been conceived of as an impediment to health, rather than a central determining feature of it. However, the Commission makes a powerful case to the contrary, showing that culture not only determines health – for example, through its influence on behaviours such as smoking and unhealthy eating – but also defines it through different cultural groups’ understandings of what it means to be well.
Culture is often blamed for clinical malpractice,…
From the 17 October 2014 news article
Every minute counts in the event of an overdose. ETH professor Jean-Christophe Leroux and his team have developed an agent to filter out toxins from the body more quickly and efficiently. It can also be used for dialysis in patients suffering from hepatic failure.
To date, antidotes exist for only a very few drugs. When treating overdoses, doctors are often limited to supportive therapy such as induced vomiting. Treatment is especially difficult if there is a combination of drugs involved. So what can be done if a child is playing and accidentally swallows his grandmother’s pills? ETH professor Jean-Christophe Leroux from the Institute of Pharmaceutical Sciences at ETH Zurich wanted to find an answer to this question. “The task was to develop an agent that could eliminate many different toxic substances from the body as quickly as possible,” he says.
Leroux and his team knew that lipid emulsions can bind to drugs when injected into the blood stream. The researchers pursued this approach in their own studies, developing an agent based on liposomes, which are tiny bubbles with a lipid membrane as an outer layer. Instead of an intravenous injection, the agent is used as a dialysis fluid for so-called peritoneal dialysis. This method of dialysis is less common than haemodialysis, which is mainly used as a long-term form of treatment of kidney failure.
[News article]NerdWallet Health Study: Medical Debt Crisis Worsening Despite Policy Advances – Health
From the 8 October 2014 article
Despite recent advances in health care policy, American households continue to struggle with medical debt, and it’s only getting worse. Americans are putting more of their take-home pay toward medical costs than ever before.
- NerdWallet Health has found that Americans pay three times more in third-party collections of medical debt each year than they pay for bank and credit card debt combined. In 2014, roughly one in five American adults will be contacted by a debt collection agency about medical bills, but they may be overpaying – NerdWallet found rampant hospital billing errors resulting in overcharges of up to 26%.
- NerdWallet found 63% of American adults indicate they have received medical bills that cost more than they expected. At the same time, 73% of consumers agree they could make better health decisions if they knew the cost of medical care before receiving it.
- Between 2010 and 2013, American households lost $2,300 in median income, but their health care expenses increased by $1,814. Out-of-pocket spending is expected to accelerate to a 5.5% annual growth rate by 2023 – double the growth of real GDP.
In a follow-up to last year’s study that found medical debt is the largest cause of personal bankruptcy, NerdWallet Health investigated the mounting financial obstacles facing the American patient.
Obtaining access to private outpatient psychiatric care in the Boston, Chicago and Houston metropolitan areas is difficult, even for those with private insurance or those willing to pay out of pocket. Researchers, who posed on the phone as patients seeking appointments with individual psychiatrists, encountered numerous obstacles, including unreturned calls, and met with success only 26 percent of the time.
From the 14 October 2014 article
he foundation of evidence-based research has eroded and the trend must be reversed so patients and clinicians can make wise shared decisions about their health, say Dartmouth researchers in the journal Circulation: Cardiovascular Quality and Outcomes.
Drs. Glyn Elwyn and Elliott Fisher of The Dartmouth Institute for Health Policy & Clinical Practice are authors of the report in which they highlight five major problems set against a backdrop of “obvious corruption.” There is a dearth of transparent research and a low quality of evidence synthesis. The difficulty of obtaining research funding for comparative effectiveness studies is directly related to the prominence of industry-supported trials: “finance dictates the activity.”
The pharmaceutical industry has influenced medical research in its favor by selective reporting, targeted educational efforts, and incentivizing prescriber behavior that influences how medicine is practiced, the researchers say. The pharmaceutical industry has also spent billions of dollars in direct-to-consumer advertising and has created new disease labels, so-called disease-mongering, and by promoting the use of drugs to address spurious predictions.
Another problem with such studies is publication bias, where results of trials that fail to demonstrate an effect remain unpublished, but trials where the results are demonstrated are quickly published and promoted.
The authors offer possible solutions:
Discussing alternative medicine choices for better health outcomes
In the field of medicine there has often been a divide between those who focus on modern medicine and those who prefer alternative practices. But pediatrician Sunita Vohra is a firm believer there should be room for both.
A new study from Vohra, a professor in the Faculty of Medicine & Dentistry’s Department of Pediatrics at the University of Alberta, and a pediatric physician for Clinical Pharmacology with Alberta Health Services, is giving insight into the use of alternative medicines by pediatric cardiac patients and how effective they are seen to be. “We wanted to know if the use of alternative therapies helped or not, and we wanted to know if it hurt them or not,” she says.
The study, published in the journal CMAJ Open, examined the use of alternative therapies such as multivitamins, minerals, chiropractic care and Aboriginal healing in 176 patients at the Stollery Children’s Hospital in Edmonton, Alberta, and the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, Ontario.
It found 64 per cent of patients at the Stollery Children’s Hospital reported using complementary and alternative medicine products and practices, compared with just 36 per cent at CHEO. Of those patients, Vohra says most had no regrets about their choices.
“The vast majority felt that they had been helped by the complementary therapy that they took and it was extremely unusual for them to report that they felt an adverse event had occurred because of it.”
The study also found one third of patients and their families did not discuss the use of alternative medicines with their physicians. Vohra believes it shows that patients may be reluctant to discuss their choices if they’re not sure how it will be received by health care providers.
That decision could have important health consequences, says Vohra, who also serves as director of the Complementary and Alternative Research and Education (CARE) program at the University of Alberta, and that patients’ discussing alternative therapies with health professionals is vital in order for them to make informed choices.
“There may be some therapies that help children feel better, but there may be others that, unbeknownst to the family, cause interaction between a specific natural health product and a prescription medicine. In that setting, instead of helping the child get better, harm may actually be happening.”
Vohra stresses the need for open communication and says children’s hospitals in Canada need to do a better job of providing information to patients looking at other avenues to health.
“That communication is essential because the health-care providers and the parents—together we are a team. And everyone’s hope is for that child’s better health.”
Other highlights from the study:
- Multi-vitamins were the most common complementary and alternative medicine products with 71 percent of patients using them, followed by vitamin C (22 per cent), calcium (13 per cent) and cold remedies (11.8 per cent)
- The most common practices include massage (37.5 per cent), faith healing (25 per cent), chiropractic (20 per cent), aromatherapy (15 per cent) and Aboriginal healing (7.5 per cent)
- Almost half (44 per cent) of patients used complementary and alternative medicine products along with conventional treatments. The study’s research was supported by funding from the Sick Kids Foundation and Alberta Innovates Health Solutions.
First, the good news: A new National Center for Health Statistics data brief shows that Americans are living longer. Overall life expectancy rose by 0.1 percent from 2011 to 2012, to 78.8 years, and was highest for non-Hispanic whites and non-Hispanic blacks. Women can expect to live an average of 81.2 years, and men an average of 76.4 years, based on the new analysis.
Now the bad news – a new report released by the Office of the Inspector General in the Department of Health and Human Services found increased costs associated with critical access hospitals. Medicare beneficiaries paid nearly half of the costs for outpatient services at critical access hospitals – a higher percentage of the costs of coinsurance for services received at these facilities than they would have paid at hospitals using Outpatient Prospective Payment System rates.
Critical access hospitals (CAHs) ensure that rural Medicare beneficiaries have access to hospital services. Reimbursement is at 101 percent of their “reasonable costs,” rather than at the predetermined rates set by the Outpatient Prospective Payment System. Medicare beneficiaries who receive services at CAHs pay coinsurance amounts based on CAH charges; beneficiaries who receive services at acute care hospitals pay coinsurance amounts based on OPPS rates.
Here’s a resource for health care costs – and a creative journalistic model of crowdsourcing, data collection, mapping, reporting and blogging.
ClearHealthCosts.com was started by formerNew York Times reporter and editor Jeanne Pinder. She received start-up funding from foundations (Tow-Knight Center for Entrepreneurial Journalism at CUNY and others listed on the website) and ClearHealthCosts now has a team of reporters and data wranglers chipping away at some of the difficult questions that patients need answered: How much is this treatment going to cost me? Can I find a better price?
It’s about shedding light on a health care cost and payment system that, to use Pinder’s word, is “opaque.” Some of what they are doing is specific to a half-dozen cities; other projects are building out nationally.
The data collected by ClearHealthCosts focuses on elective or at least nonemergency procedures such as imaging, dental work, vasectomy, walk-in clinics, screening (mammograms and colonoscopy) and blood tests. Much of the data is crowdsourced, and focused on New York area, including northern New Jersey and other suburbs; the San Francisco and Los Angeles areas; and Houston, Dallas-Fort Worth, Austin and San Antonio in Texas.
- Hospital Compare US government website managed by Medicare and Medicaid services. Links include, Quality payment, Medicare’s Hospital value-based purchasing programs, Hospital readmission reduction programs, voluntary reporting from American College of Surgeons, American College of Cardiology readmission measure etc.
Allows one to compare the quality of care at over 4,000 Medicare-certified hospitals in the country
- Joint Commission Quality Check The Joint Commission is an accredition/certification program based on performance standards. Quality Check® includes information on US health care organizations.
DALLAS – July 9, 2014 – There has been a sharp increase in the number of cancer patients at UT Southwestern Medical Center using MyChart, the online, interactive service that allows patients to view laboratory and radiology results, communicate with their healthcare providers, schedule appointments, and renew prescriptions.
Over a six-year period, the number of patients actively using MyChart each year increased five-fold, while the number of total logins each year increased more than 10-fold, according to a study by Dr. David Gerber, Associate Professor of Internal Medicine, and Dr. Simon J. Craddock Lee, Assistant Professor of Clinical Sciences.
“This pattern suggests that not only are far more patients using this technology, but also that they are using it more intensively,” Dr. Gerber said.
These findings, published in the Journal of Oncology Practice, are noteworthy because no prior study has systematically examined the use of electronic patient portals by patients with cancer, even though use of this technology is surging nationwide, creating new terrain in clinical care and doctor-patient relationships.
In 2009, Congress allotted $27 billion to support the adoption of Electronic Medical Records. The Department of Health and Human Services began allocating the funding in 2011. UT Southwestern started offering these services years earlier.
“I was struck by the immediacy of the uptake and the volume of use,” Dr. Gerber said. “I suspected that the volume would be high. I did not think that it was going to be multi-fold higher than other patient populations.”
Use of MyChart was greater among cancer patients than among another other patient groups except for children with life threatening medical conditions, according to the study.
“We undertook this study because we suspected that the volume of electronic portal use might be greater among patients with cancer than in other populations,” Dr. Gerber said.
While the study did not directly compare use patterns with non-cancer groups, the average use in the current study was four to eight times greater than has been reported previously in primary care, pediatric, surgical subspecialty, and other populations.
Dr. Gerber explained that patient use of electronic portals to receive and convey information may have particular implications in cancer care. Laboratory and radiology results may be more likely to represent significant clinical findings, such as disease progression.
“I think we are still learning how patients understand and use the complex medical data, such as scan reports, that they increasingly receive first-hand electronically,” Dr. Gerber said.
Furthermore, symptoms reported by patients with cancer may be more likely to represent medical urgencies. Notably, the study found that 30 percent of medical advice requests from patients were sent after clinic hours.
From the 7 July 2014 article
Kansas pharmacists say a bill that went into effect this past week will improve patient care by allowing them to enter into agreements with physicians to do things like monitor and change medication levels without new orders.
Greg Burger, a pharmacist at Lawrence Memorial Hospital who helped push for the bill, said studies have shown reductions in cost and improvements in care when pharmacists have the authority to adjust medication levels, provide the right antibiotics for certain infections and adjust for drug allergies without waiting for a doctor’s say-so.
“There’s all kinds of things we do in hospitals now that we’re hoping to expand out to where pharmacists might be in clinics,” Burger said.
From the 1 July 2014 KevinMD article
I often hear people talking about their doctors. I overhear it restaurants, nail salons, while walking down the street. I hear what people think of their doctors, what their doctors said or what they didn’t say, why people were disappointed by or validated by their doctors. I hear people analyzing, criticizing, and surmising about this relationship quite a bit, and I don’t blame them. The relationship you have with your doctor is a critical one, and yet it is fraught with misunderstanding, disappointment, and distrust. People didn’t used to doubt their doctors the way they do today, and I believe the essence of the doctor-patient relationship has degraded in our culture.
In large part, I believe this is due to technology.
The Mayo Clinic recently announced they have partnered with Apple to create what they call the Health Kit. Although the details are still unknown, the product is supposedly one that will allow patients to become more involved in their health care, from diagnosis to treatment delivery. This has always been the doctor’s job, but with the technology booming, it is no surprise that the next step would be computerized health care.
So is this a good thing, or a bad thing? I have mixed feelings, and I think the results will be mixed as well. Statistics show that positive relationships and supportive interactions with others are crucial parts of living a healthy life. Can a computer ever truly replace that je ne se quoi that occurs between a doctor and a patient? In my own practice, I would like to believe that the interaction between my patients and myself is part of what leads to healing. I don’t believe a computer could do that as well as I can.
Here’s the problem, though. Doctors are inundated with demands from insurance companies, paperwork, accountability measures, and check lists upon checklists required for medical records, billing, and measurable use. This situation worsened several years ago, with the mandatory implementation of Electronic Medical Records, and then even worse since the implementation of the Affordable Care Act.
These changes have also affected patients, many of whom have had to drop doctors they have had for many years because those doctors didn’t take the new insurance. The message, whether stated outright or not by advocates or detractors of the new systems, is that this doctor-patient relationship is not really all that important.
From the 1 July 2014 Think Progress article
The vaccines that children receive when they’re young are quite safe, and the vast majority of them don’t lead to serious side effects, according to asweeping new review of 67 recent scientific studies on childhood vaccinations. The analysis, published on Tuesday in the journal Pediatrics, also found no link between vaccines and autism — effectively debunking a common myth that dissuades some parents from inoculating their children.
The new report is specifically intended to ease parents’ concerns about vaccines, as persistent misconceptions about vaccination have recently spurred a rise in infectious diseases. In order to reassure people who may be worried that their kids’ shots aren’t safe, the federal governmentcommissioned the RAND Corporation to review everything that scientists know about the 11 vaccines recommended for children under the age of six.
Like any medical intervention, vaccines are not without their potential risks. In some rare cases, certain shots can increase kids’ risk of fevers, seizures, and gastrointestinal problems. But the RAND researchers found that those adverse reactions are incredibly unlikely.
From the 7 July 2014 Huffington Post article
On Monday, the Supreme Court ruled that corporations cannot be required to provide their employees with coverage for contraception, a decision that medical groups like the American College of Obstetricians and Gynecologists — this country’s leading group of professionals providing health care to women — have called “profoundly” disappointing.
“This decision inappropriately allows employers to interfere in women’s health care decisions,” the group said in a statement.
“Contraceptives are essential health care for women and should not be treated differently than other, equally important parts of comprehensive care for women, including well-woman visits, preconception care visits, cervical and breast cancer screenings and other needed health care services,” ACOG added.
Because that’s the thing about birth control. For many women across the United States, of all different religious, political and socioeconomic backgrounds, it’s an absolutely essential part of how they stay healthy. From pain management and menstrual cycle regulation to straight-up family planning, here are just some of the ways that birth control has been a very, very good thing in the lives of real women.
[Magazine Article] Hospitals Are Mining Patients’ Credit Card Data to Predict Who Will Get Sick – Businessweek
From the 3 July article
Imagine getting a call from your doctor if you let your gym membership lapse, make a habit of buying candy bars at the checkout counter, or begin shopping at plus-size clothing stores. For patients of Carolinas HealthCare System, which operates the largest group of medical centers in North and South Carolina, such a day could be sooner than they think. Carolinas HealthCare, which runs more than 900 care centers, including hospitals, nursing homes, doctors’ offices, and surgical centers, has begun plugging consumer data on 2 million people into algorithms designed to identify high-risk patients so that doctors can intervene before they get sick. The company purchases the data from brokers who cull public records, store loyalty program transactions, and credit card purchases.
Information on consumer spending can provide a more complete picture than the glimpse doctors get during an office visit or through lab results, says Michael Dulin, chief clinical officer for analytics and outcomes research at Carolinas HealthCare. The Charlotte-based hospital chain is placing its data into predictive models that give risk scores to patients. Within two years, Dulin plans to regularly distribute those scores to doctors and nurses who can then reach out to high-risk patients and suggest changes before they fall ill. “What we are looking to find are people before they end up in trouble,” says Dulin, who is a practicing physician.
From the 6 July 2014 article
In 1992, shortly after Gerd Gigerenzer moved to Chicago, he took his six-year-old daughter to the dentist. She didn’t have toothache, but he thought it was about time she got acquainted with the routine of sitting in the big reclining chair and being prodded with pointy objects.
The clinic had other ideas. “The dentist wanted to X-ray her,” Gigerenzer recalls. “I told first the nurse, and then him, that she had no pains and I wanted him to do a clinical examination, not an X-ray.”
These words went down as well as a gulp of dental mouthwash. The dentist argued that he might miss something if he didn’t perform an X-ray, and Gigerenzer would be responsible.
But the advice of the US Food and Drug Administration is not to use X-rays to screen for problems before a regular examination. Gigerenzer asked him: “Could you please tell me what’s known about the potential harms of dental X-rays for children? For instance, thyroid and brain cancer? Or give me a reference so I can check the evidence?”
The dentist stared at him blankly……
Most common prescription drugs among adults are those for cardiovascular disease and high cholesterol
About half of all Americans reported taking one or more prescription drugs in the past 30 days during 2007-2010, and 1 in 10 took five or more, according to Health, United States, 2013, the government’s annual, comprehensive report on the nation’s health.
This is the 37th annual report prepared for the Secretary of the Department of Health and Human Services by the Centers for Disease Control and Prevention’s National Center for Health Statistics. The report includes a compilation of health data from state and federal health agencies and the private sector.
This year’s report includes a special section on prescription drugs. Key findings include:
- About half of all Americans in 2007-2010 reported taking one or more prescription drugs in the past 30 days. Use increased with age; 1 in 4 children took one or more prescription drugs in the past 30 days compared to 9 in 10 adults aged 65 and over.
- Cardiovascular agents (used to treat high blood pressure, heart disease or kidney disease) and cholesterol-lowering drugs were two of the most commonly used classes of prescription drugs among adults aged 18-64 years and 65 and over in 2007-2010. Nearly 18 percent (17.7) of adults aged 18-64 took at least one cardiovascular agent in the past 30 days.
- The use of cholesterol-lowering drugs among those aged 18-64 has increased more than six-fold since 1988-1994, due in part to the introduction and acceptance of statin drugs to lower cholesterol.
- Other commonly used prescription drugs among adults aged 18-64 years were analgesics to relieve pain and antidepressants.
- The prescribing of antibiotics during medical visits for cold symptoms declined 39 percent between 1995-1996 and 2009-2010.
- Among adults aged 65 and over, 70.2 percent took at least one cardiovascular agent and 46.7 percent took a cholesterol-lowering drug in the past 30 days in 2007-2010. The use of cholesterol-lowering drugs in this age group has increased more than seven-fold since 1988-1994.
- Other commonly used prescription drugs among those aged 65 and older included analgesics, blood thinners and diabetes medications.
- In 2012, adults aged 18-64 years who were uninsured for all or part of the past year were more than four times as likely to report not getting needed prescription drugs due to cost as adults who were insured for the whole year (22.4 percent compared to 5.0 percent).
- The use of antidepressants among adults aged 18 and over increased more than four-fold, from 2.4 percent to 10.8 percent between 1988-1994 and 2007-2010.
- Drug poisoning deaths involving opioid analgesics among those aged 15 and over more than tripled in the past decade, from 1.9 deaths per 100,000 population in 1999-2000 to 6.6 in 2009-2010.
- The annual growth in spending on retail prescription drugs slowed from 14.7 percent in 2001 to 2.9 percent in 2011.
Health, United States, 2013 features 135 tables on key health measures through 2012 from a number of sources within the federal government and in the private sector. The tables cover a range of topics, including birth rates and reproductive health, life expectancy and leading causes of death, health risk behaviors, health care utilization, and insurance coverage and health expenditures.
The full report is available at www.cdc.gov/nchs
30-day readmissions can be reduced by almost 20 percent when specific efforts are taken to prevent them, a review has found. Key among these are interventions to help patients deal with the work passed on to them at discharge. “Effective approaches often are multifaceted and proactively seek to understand the complete patient context, often including in-person visits to the patient’s home after discharge,” says the lead author.
To put this problem into context, studies estimate that 1 in 5 Medicare beneficiaries is readmitted within 30 days of a hospitalization, at a cost of more than $26 billion a year. “Patients are sent home from hospitals because we have addressed their acute issues,” says Dr. Leppin. “They go home with a list of tasks that include what they were doing prior to the hospitalization and new self-care tasks prescribed on discharge. Some patients cannot handle all these requests, and it is not uncommon for them to be readmitted soon after they get home. Sometimes these readmissions can be prevented.”
From the 27 March 2014 KevinMD article by Pamela Wible, MD
Tom is diabetic, asthmatic, and broke. He’s back for a checkup.
“I take my metformin every morning with my grits,” he says, “but I don’t need no refill. I just got me some metformin XR.”
“How did you get extended release? They’re super expensive.”
“Well, my neighbor runs a tattoo shop. We live behind her store. Her doc switched her up to insulin, so she gave me her old meds—a big sackful in the alley. That’s gonna last me another year.”
Prescriptions dispensed behind a tattoo parlor? Wow. I’m constantly impressed by my patients’ ingenuity. One gal this week told me she’s on her deceased grandfather’s antidepressants. Another gets his pharmaceuticals from the farm supply store. I’m just glad to know he doesn’t have fleas.
“Are you good on your inhalers?” I ask.
“Well, the cheapest inhaler is 52 bucks. So I basically can’t afford to breathe. On Craigslist, I found some for ten bucks. I contacted the guy, and he met me at the Walmart gas station in a black Jaguar. I went to the door. He asked if I was Tom. Then he said, ‘You know this is illegal.’”
And from one of the comments
Considering the high prices that pharmaceutical companies are allowed to legally charge in the US, this kind of thriving illegal underground market does not surprise me at all. It may be wrong and potentially dangerous, but it’s also wrong for Big Pharma to price millions of Americans out of being able to buy the drugs they need legally. Think of that huge segment of the population as “what the market can’t bear.”
mHealth still untapped resource for docs
People cite privacy concerns for lack of adoption
For the most part, providers are still wary over the mHealth movement. And this caution just might be preventing them from big care improvement opportunities, say the findings of a new study.
The study, commissioned by mobile professional services firm Mobiquity, finds some 70 percent of consumers use mobile apps every day to track physical activity and calorie intake, but only 40 percent share that information with their doctor.
[See also: mHealth market scales to new heights.]
Privacy concerns and the need for a doctor’s recommendation are the two factors hindering the use of mobile and fitness apps for mHealth reasons, say officials with the Boston-based Mobiquity, which produced “Get Mobile, Get Healthy: The Appification of Health and Fitness.”
That, officials said, means the healthcare community has to take a more active role in promoting these types of apps and uses.
“Our study shows there’s a huge opportunity for medical professionals, pharmaceutical companies and health organizations to use mobile to drive positive behavior change and, as a result, better patient outcomes,” said Scott Snyder, Mobiquity’s president and chief strategy officer, in a press release. “The gap will be closed by those who design mobile health solutions that are indispensable and laser-focused on users’ goals, and that carefully balance data collection with user control and privacy.”
[See also: FCC creates mHealth task force.]
The study, conducted between March 5 and 11, focused on 1,000 consumers who use or plan to use health and fitness mobile apps.
According to the study:
- 34 percent of mobile health and fitness app users say they would use their apps more often if their doctor recommended it
- 61 percent say privacy concerns are hindering their adoption of mobile apps. Other concerns include time investment (24 percent), uncertainty on how to start (9 percent) and not wanting to know about health issues (6 percent).
- 73 percent said they are more healthy because they use a smartphone and apps to track health and fitness
- 53 percent discovered, through an app, that they were eating more calories than they realized
- 63 percent intend to continue or increase their mobile health tracking over the next five years
- 55 percent plan to try wearable devices like pedometers, wristbands or smartwatches
- Using a smartphone to track health and fitness is more important than using the phone for social networking (69 percent), shopping (68 percent), listening to music (60 percent) or even making/receiving phone calls (30 percent).
“We believe 2014 is the year that mobile health will make the leap from early adopters to mainstream,” Mobiquity officials said in their introduction to the survey. “The writing is on the wall: from early rumors about a native health-tracking app in the next version of Apple’s iPhone operating system to speculation that Apple will finally launch the much-anticipated iWatch, joining Google, Samsung and Pebble in the race to own the emerging wearables market.”
[See also: Realizing the mHealth promise.]
The American physician’s problem with pain is less cosmic and more concrete. For physicians today in nearly every specialty, the problem of pain is how to treat it responsibly, stay on the good side of the Drug Enforcement Administration (DEA), and still score high marks in patient satisfaction surveys.
If a physician recommends conservative treatment measures for pain–such as ibuprofen and physical therapy–the patient may be unhappy with the treatment plan. If the physician prescribes controlled drugs too readily, he or she may come under fire for irresponsible prescription practices that addict patients to powerful pain medications such as Vicodin and OxyContin.
The janitor approached my office manager with a very worried expression. ”Uh, Brenda…” he said, hesitantly.
“Yes?” she replied, wondering what janitorial emergency was looming in her near future.
“Uh…well…I was cleaning Dr. Lamberts’ office yesterday and I noticed on his computer….” He cleared his throat nervously, “Uh…his computer had something on it.”
“Something on his computer? You mean on top of the computer, or on the screen?” she asked, growing more curious.
“On the screen. It said something about an ‘illegal operation.’ I was worried that he had done something illegal and thought you should know,” he finished rapidly, seeming grateful that this huge weight lifted.
Relieved, Brenda laughed out loud, reassuring him that this “illegal operation” was not the kind of thing that would warrant police intervention.
Unfortunately for me, these “illegal operation” errors weren’t without consequence. It turned out that our system had something wrong at its core, eventually causing our entire computer network to crash, giving us no access to patient records for several days.
The reality of computer errors is that the deeper the error is — the closer it is to the core of the operating system — the wider the consequences when it causes trouble. That’s when the “blue screen of death” or (on a mac) the “beach ball of death” show up on our screens. That’s when the “illegal operation” progresses to a “fatal error.”
The Fatal Error in Health Care
Yeah, this makes me nervous too.
We have such an error in our health care system. It’s absolutely central to nearly all care that is given, at the very heart of the operating system. It’s a problem that increased access to care won’t fix, that repealing the SGR, or forestalling ICD-10 won’t help.
It’s a problem with something that is starts at the very beginning of health care itself.
The health care system is not about health.
For any solution to have a real effect, this core problem must be addressed. The basic incentive has to change from sickness to health. Doctors need to be rewarded for preventing disease and treating it early. Rewards for unnecessary tests, procedures, and medications need to be minimized or eliminated. This can only happen if it is financially beneficial to doctors for their patients to be healthy.
Originally posted on Empathic Urbanite:
“By 2030, 230,000 people who need more than 20 hours of care a week will not have a relative to provide it, the think tank said.”
This is an IPPR report, so it’s solid evidence that our society, culture and especially government needs to start supporting care agencies and offering much better individual training and organisational opportunities if we are to meet this massive challenge. And don’t forget, when we talk about older people in the future, it’s not a report about some vague ‘other’, this time, we are talking about ourselves!
View original 129 more words
Originally posted on Medication Health News:
For additional information, please see the news analysis in the New York Times.
Image courtesy of [ddpavumba]/FreeDigitalPhotos.Net
Originally posted on Johns Hopkins University Press Blog:
Today is the fifth and final in a series of brief podcast excerpts from The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss. This bestselling title by Nancy L. Mace, M.A., and Peter V. Rabins, M.D., M.P.H., is in its fifth edition and is now available in an audio edition.
Podcast #5: Excerpt from Chapter 10: Getting Help
In this excerpt from Chapter 10, Dr. Rabins focuses on the need for caregivers to have outside help and have time away from the responsibilities of caregiving. He describes how to find good information on available services, how to seek and accept help from friends and neighbors, and how to address problems you may encounter.
You can find this podcast and the rest of the series of podcasts here.
These podcasts are excerpted from a Johns Hopkins University Press audio…
View original 107 more words
Originally posted on Metro News:
Thousands of seniors in Ontario nursing homes are on a powerful mix of antipsychotics and sedatives, according to a new provincial Health Ministry report that surfaced after a recent Torstar News Service investigation.
The report, commissioned by the ministry and co-authored by a leading doctor and scientist, sheds new light on the widespread use of powerful prescription drugs among the vulnerable elderly.
“These drugs are prescribed so commonly because they are perceived to be benign. That’s not true,” said Dr. David Juurlink, a drug safety expert who co-authored the report. “These drugs are inherently dangerous.”
Last week, Torstar revealed that some long-term-care homes, often struggling with staffing shortages, are routinely doling out antipsychotics to calm and “restrain” wandering, agitated and sometimes aggressive patients.
At close to 300 homes, Torstar found, more than a third of the residents are on the drugs, despite warnings that the medications can kill elderly patients…
View original 867 more words
A new report from the The United Hospital Fund and AARP Public Policy Institute finds that spouses who act as the primary family caregiver routinely perform complex medical and nursing tasks without adequate in-home support from health care professionals, especially when compared with non-spousal family caregivers.
“Wedding vows include the promise to be there “in sickness and in health”, but we should not expect spouses to do things that can make nursing students tremble without offering them instructions and support. They should not have to do this important work at home alone. They need and deserve support from professionals, other family members, and the community,” Reinhard said.
It’s unclear why spouses receive less help, but Reinhard and co-authors Carol Levine and Sarah Samis of the United Hospital Fund theorize that choice, lack of awareness about resources, financial limitations, or fear of losing independence play a role. The report calls for additional research to help tailor interventions that support but do not supplant the primary bond between spouses.
Hypothyroid medication levothyroxine (Synthroid, AbbVie) was the nation’s most prescribed drug in 2013, whereas the antipsychotic aripiprazole (Abilify, Otsuka Pharmaceutical) had the highest sales, at nearly $6.5 billion, according to a new report from research firm IMS Health on the top 100 selling drugs in the United States.
Following levothyroxine as most prescribed were the cholesterol-lowering drug rosuvastatin (Crestor, AstraZeneca), the proton-pump inhibitor esomeprazole (Nexium, AstraZeneca), and the antidepressant duloxetine (Cymbalta, Eli Lilly).
Rounding out the top 10 most prescribed drugs in 2013 (in order) were the asthma drugs albuterol (Ventolin, HFA) and fluticasone propionate/salmeterol (Advair Diskus, GlaxoSmithKline), the antihypertensive valsartan (Diovan, Novartis), the attention deficit drug lisdexamfetamine dimesylate (Vyvanse, Shire), the antiepileptic pregabalin (Lyrica, Pfizer), and the chronic obstructive pulmonary disease drug tiotropium bromide (Spiriva, Boehringer Ingelheim).
Table 1. Top 100 Drugs by Sales
Rank Drug (brand name) Sales, 2013
1 Abilify $6,460,215,394
2 Nexium $6,135,667,614
3 Humira $5,549,996,855
4 Crestor $5,310,818,889
5 Cymbalta $5,219,860,418
6 Advair Diskus $5,121,312,668
7 Enbrel $4,681,201,645
8 Remicade $4,098,233,242
9 Copaxone $3,697,182,238
10 Neulasta $3,580,364,758
11 Rituxan $3,288,614,045
12 Lantus Solostar $3,005,681,663
13 Spiriva Handihaler $2,998,207,542
14 Atripla $2,856,818,557
15 Januvia $2,843,496,907
16 Avastin $2,688,414,938
17 Lantus $2,556,825,619
18 Oxycontin $2,534,909,675
19 Lyrica $2,415,254,835
20 Epogen $2,280,696,834
21 Celebrex $2,237,658,764
22 Truvada $2,235,712,145
23 Diovan $2,169,819,482
24 Herceptin $1,938,804,857
25 Gleevec $1,896,982,614
26 Lucentis $1,859,463,484
27 Namenda $1,856,822,750
28 Vyvanse $1,743,115,521
29 Zetia $1,710,526,476
30 Symbicort $1,563,242,161
31 Levemir $1,547,629,745
32 Suboxone $1,450,554,130
33 Novolog Flexpen $1,377,221,614
34 Novolog $1,349,403,122
35 Avonex $1,240,754,136
36 Seroquel Xr $1,226,532,019
37 Viagra $1,196,812,385
38 Alimta $1,192,134,813
39 Humalog $1,184,189,487
40 Nasonex $1,137,402,455
41 Victoza 3-Pak $1,104,811,637
42 Cialis $1,086,355,583
43 Gilenya $1,059,346,323
44 Flovent Hfa $1,050,009,900
45 Procrit $1,030,419,958
46 Isentress $1,014,678,055
47 Xarelto $996,441,091
48 Prezista $992,087,940
49 Janumet $987,663,598
50 Stelara $965,072,892
51 Neupogen $958,807,372
52 Orencia $957,680,500
53 Renvela $955,330,199
54 Reyataz $934,879,388
55 Vesicare $933,311,254
56 Dexilant $916,401,204
57 Tecfidera $879,673,483
58 Humalog Kwikpen $879,632,962
59 Synthroid $858,725,708
60 Vytorin $858,576,112
61 Lunesta $851,791,226
62 Pradaxa $836,573,805
63 Benicar $832,276,970
64 Evista $823,647,433
65 Xolair $821,783,471
66 Aranesp $809,245,700
67 Prevnar 13 $806,129,346
68 Sensipar $786,320,942
69 Xgeva $785,725,436
70 Invega Sustenna $779,834,172
71 Zytiga $775,269,249
72 Avonex Pen $768,655,140
73 Synagis $767,786,422
74 Betaseron $767,648,290
75 Xeloda $754,133,787
76 Ventolin Hfa $745,629,470
77 Zyvox $726,184,205
78 Afinitor $721,629,719
79 Gardasil $710,208,856
80 Zostavax $705,140,729
81 Incivek $701,317,408
82 Sandostatin Lar $697,961,265
83 Aciphex $683,359,951
84 Benicar Hct $681,353,719
85 Bystolic $681,318,227
86 Treanda $679,052,250
87 Focalin Xr $660,161,202
88 Erbitux $648,984,405
89 Tamiflu $641,134,799
90 Tarceva $640,597,157
91 Pristiq $632,619,542
92 Complera $630,039,312
93 Cubicin $628,034,439
94 Velcade $621,800,823
95 Strattera $616,604,042
96 Viread $599,074,197
97 Stribild $598,844,153
98 Welchol $573,939,710
99 Combivent Respimat $573,179,772
100 Xifaxan $569,762,570
Source: IMS National Prescription Audit, IMS Healt
[Report] Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse (OEI-03-13-00030) 03-03-2014
More than half of Part D plan sponsors did not report data on potential fraud and abuse between 2010 and 2012. Of those sponsors that did report data, more than one-third did not identify any incidents for at least one of their reporting years. In total, sponsors reported identifying 64,135 incidents of potential fraud and abuse between 2010 and 2012. Sponsors’ identification of such incidents varied significantly, from 0 to almost 14,000 incidents a year.
CMS requires sponsors to conduct inquiries and implement corrective actions in response to incidents of potential fraud and abuse; however, 28 percent of Part D plan sponsors reported performing none of these actions between 2010 and 2012. Although CMS reported that it conducted basic summary analyses of the data on potential fraud and abuse, it did not perform quality assurance checks on the data or use them to monitor or oversee the Part D program.
WHAT WE RECOMMEND
We recommend that CMS (1) amend regulations to require sponsors to report to CMS their identification of and response to potential fraud and abuse; (2) provide sponsors with specific guidelines on how to define and count incidents, related inquiries, and corrective actions; (3) review data to determine why certain sponsors reported especially high or low numbers of incidents, related inquiries, and corrective actions; and (4) share sponsors’ data on potential fraud and abuse with all sponsors and law enforcement. CMS did not concur with the first recommendation, partially concurred with the second and fourth recommendations, and concurred with the third recommendation.
Writing in Science, the chair of the Presidential Commission for the Study of Bioethical Issues notes it is increasingly common for physicians and medical researchers to discover a disease that was not the original target of a medical test or screening.
Amy Guttman Ph.D. notes these surprise clinical test results are called incidental and secondary findings. Guttman explains the surprise discovery of an unexpected illness from screening and similar tests is called an ‘incidental’ finding. Guttman adds when clinicians deliberately seek to discover a second or third disease in addition to the primary target, these results are called ‘secondary’ findings.
Guttman, who is the president of the University of Pennsylvania, writes (and we quote): ‘Improved technologies are making incidental and secondary findings increasingly common. They are becoming a growing certainty in clinical practice as well as in the distinct contexts of research and direct-to-consumer testing’ (end of quote). For example, Guttman notes an array of unexpected clinical findings may be generated by new CT scans intended to detect lung cancer in heavy smokers. The increased screening will occur because of recent recommendations from the U.S. Preventive Services Task Force, which we discussed in last week’s podcast.
Guttman writes before CT scans or other medical tests, clinicians should alert patients about the possibility of surprise findings regardless whether screening deliberately seeks (or accidentally finds) new, unexpected illnesses.
Guttman notes while some persons will ask a physician to tell them about whatever clinical tests discover, some patients do not want to learn about incidental or secondary findings.
As a result, the Presidential Bioethics Commission recommends physicians and medical practitioners need to know a patient’s health priorities and tolerance to manage surprising results prior to clinical testing. Guttman writes (and we quote) ‘A patient who does not wish to learn about information related to the primary purpose of the test should not undergo the test. If a patient wishes to opt out of receiving incidental or secondary findings that are clinically significant and actionable, then clinicians should exercise their discretion whether to proceed with testing’ (end of quote).
Guttman notes health care providers should explain both the risks and rewards of finding unexpected illnesses that can occur from a new generation of sophisticated clinical tests, such as human genome screenings. While false positive findings are among the risks, Guttman explains the rewards include the detection of diseases and illness that could be clinically actionable.
In terms of biomedical ethics, Guttman concludes (and we quote):’ In keeping with shared decision-making, clinicians live up to their highest calling when they discuss how they will handle incidental findings with their patients’ (end of quote). While the Presidential Bioethics Commission provides more specific recommendations in their report, their overall intent is to improve patient-provider disclosure and communication as well as help patients anticipate the possibility of unexpected findings from routine testing.
The Commission’s report is available at bioethics.gov.
Meanwhile, a link to a website that explains some of the ethical issues associated with patient and provider health decision making (from Beth Israel Medical Center) is available in the ‘specific conditions’ section of MedlinePlus.gov’s medical ethics health topic page.
Similarly, a link to a website that explains some of the ethical issues associated with patient and provider treatment decisions (also from Beth Israel Medical Center) can be found in the ‘specific conditions’ section of MedlinePlus.gov’s medical ethics health topic page.
MedlinePlus.gov’s medical ethics health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. You can sign up to receive updates about medical ethics as they become available on MedlinePlus.gov.
To find MedlinePlus.gov’s medical ethics health topic page type ‘medical ethics’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘medical ethics (National Library of Medicine).’ MedlinePlus.gov additionally contains a health topic page on talking with your doctor, which provides tips to enhance provider and patient communication.
Surely, as one of the wealthiest countries in the world, we can find a way to provide basic health care for all.
And this includes prisoners, they too are human beings.
If used widely, a new generation of antiviral drugs has the potential to wipe out the deadly hepatitis C virus in the United States. But the high price of the drugs might prevent their use in prisons, which house as many as one-third of those who are infected.
The drugs cost anywhere from about $65,000 to $170,000 for a single course of treatment—between three and nine times more than earlier treatments. Ronald Shansky, former medical director of the Illinois prison system and founder of the Society of Correctional Physicians, described that price as “extortionarily high, criminal.”
States and municipalities typically pay for prisoner health care out of their corrections budgets. When effective HIV treatments emerged in the late 1990s, those budgets grew to accommodate the cost of the drugs, said Edward Harrison, president of National Commission on Correctional Health Care, which sets standards for prisoner health care.
But the new hepatitis C medications present a much bigger challenge. “The prevalence of HCV [hepatitis C) is 10 times greater than HIV and the cost of treatment is probably 10 times greater than a year’s worth of treating HIV,” said Anne Spaulding of Emory University, one of the leading researchers on hepatitis C in prisons.
The new hepatitis C drugs and others in the pipeline could be the “straw that breaks the back of corrections” and force large-scale changes in penal systems. Already, as a result of a U.S. Supreme Court decision, California has had to reduce its prison population by tens of thousands because of inadequate health care. Spaulding said she can foresee the high costs of medicine could force cuts in prison populations across the United States.
Another possibility, she said, would be to create a different mechanism for paying for prison health care, perhaps by extending Medicaid to jail and prison populations.
One thing is clear: The goal of eradicating hepatitis C won’t be achieved unless the campaign involves prisons.
“Because of these new drugs, the conversation about eliminating hepatitis C is finally happening,” said Ninburg of the Hepatitis Education Project. “But if it’s going to be eliminated, we are going to have to address hep C in the correctional setting.”
Two thoughts on disparities highlighted in the article
What about folks who do not have the background and access to resources to self diagnose? In all countries, “developed” (as USA, most of Europe) and “developing” (asmuch of Africa, parts of Asia…)
Is it ethical for some health information to be physician/research access only?
By 1997, those irregular heartbeats became common, leading to “hundreds and hundreds” of serious episodes, capable of causing death. She eventually received an ICD, an implanted cardioverter-defibrillator, which would shock her heart back into the proper rhythm.
Goodsell began studying her condition, drawing back on her own education. While she has no medical degree, Goodsell had been a pre-med student at UC San Diego, where she met Charles, who was studying chemistry. She dropped out after falling in love with nature during a trip to Peru.
Looking for that unifying theory, Goodsell delved into genomics, searching for mutations that could encompass her symptoms. She found it with a gene called LMNA, that codes for making proteins called lamins that stabilize cells. Defects in these proteins can cause a form of Charcot-Marie-Tooth disease, damaging nerves in the extremities and causing muscle wasting, including in the hands.
Symptom after symptom checked with the mutation. But to be sure, she needed a genetic test, and her Mayo doctors resisted.
Taking the research into self-therapy, Goodsell researched risk factors associated with the disease, examining what goes on at a molecular level. She changed her diet: Out went sugars, out went gluten and any food with additives. And out went a beloved snack.
“I used to eat bowls of jalapeño peppers. I discontinued.”
But she added certain fats she had previously avoided, such as omega-3 fatty acids and nuts, which are rich in fats.
“Cell membranes are fat, and we need fat — good fat,” she said. “I was advised to start eating fat.”
Goodsell said her symptoms improved. Control over her hands improved enough to allow her to eat with chopsticks and to resume kitesurfing.
Goodsell’s doctor wrote up her case history, listing her as co-author “because he said I had done the lion’s share of the work.” The study is to be presented at an upcoming meeting of the Heart Rhythm Society.
- Are you an ePatient? (enbloommedia.com)
- The Rise of the e-Patient: Slideshow (ScienceRoll)“It’s always good to see the trends about the growing number and importance of e-patients. Lee Rainie, director of the Pew Internet Project, presented this wonderful overview of the Project’s health findings at Providence St. Joseph Medical Center in Burbank, CA, on January 12.”
- Why patients are turning less to media and friends for health information (jflahiff.wordpress.com)
- Can differential diagnosis be crowdsourced to Facebook Friends?(medgadget)
- ePatient Connections: A Patient Checks In. (sixuntilme.com)
- From E-patient Hackers to Health Games on Mobiles (scienceroll.com)
- The end of social – O’Reilly Radar (queuniversidade2.wordpress.com)
- Meet e-patient Dave – a voice of patient engagement (and related resources) (jflahiff.wordpress.com)
- 2020 Vision: The ePatient Evolution Over the Next 10 Years (prweb.com)
- ePatients Come Together to Brainstorm and Share (brassandivory.org)
- 6 P’s Of Social Health (socialmediaclub.org)
- The Rise of the ePatient – presentation by Pew Internet Project (casesblog.blogspot.com)
A hospital in Staffordshire is set to become the first in Europe where doctors consult with their patients via Skype
A hospital is set to become the first in Europe to tackle waiting times by getting overworked doctors to consult with their patients via Skype.
Managers at the University Hospital of North Staffordshire claim using the online video calling service could reduce outpatient appointments by up to 35 per cent.
They argue that using Skype will help free up consultants’ time and car parking spaces – while also helping patients who are unable to take time off work.
If approved, they would become the first UK hospital to use Skype to consult with patients.
The proposals, by Staffordshire’s biggest hospital, also include doctors treating patients via email consultations……..
“The key issue for doctors will be to recognise when this mode of consultation is not sufficient to properly assess the patient and address the problem, and to arrange a face-to-face consultation instead.”
Excerpts from the 4 March 2014 blog item
The regional variations are more complicated. It’s not as simple as labor costs in New York being higher than those in Arkansas.
Competition is a big factor. The highest prices aren’t necessarily in a big city. Some of the highest rates are in rural areas with few health care providers and scant competition to drive prices down.
Narrow networks, where there are fewer doctors and hospitals, or at least fewer name-brand hospitals, are also a factor. Not all consumers want these – although some are willing to make that tradeoff to save money.There also may be fewer insurers offering coverage in the exchanges in some areas. Even where competition is minimal, the medical loss ratio in the Affordable Care Act limits how much profit an insurer can make or at least limits how much of the premium people pay can be used for nonmedical purposes – including profit. They have to rebate the money if they don’t meet MLR.
Local health care history and how it has affected incentives and efficiency is a factor. For instance, Minnesota, which has some of the lowest premiums, has been working on delivery system, integrated care and managed care for years.
Also, regional oddities – such as a mountainous section of Colorado that has to medevac people by helicopter – can play a role in why one section of a state pays more than others.
Jordan Rau of Kaiser Health News has written about the cheapest and most expensive markets nationally. Katie Kerwin McCrimmon of Health News Colorado has written about the controversy in Colorado about why people in one community pay more than people in an adjacent community. (Here and here).
Any journalist who covers nursing homes should check out this month’s special supplement in The Gerontologist, the Gerontological Society of America’s journal. It focuses on the two-decade long effort to change nursing home culture and many of the articles and studies raise important questions about whether enough progress has been shown.
For example, this study finds that nursing homes that are considered culture change adopters show a nearly 15 percent decrease in health-related survey deficiency citations relative to comparable nonadopting homes. This study looks at what is meant by nursing home culture change – the nature and scope of interventions, measurement, adherence and outcomes. Harvard health policy expert David Grabowski and colleagues take a closer look at some of the key innovators in nursing home care and what it might mean for health policy – particularly in light of the Affordable Care Act’s directive to provide more home and community-based care. Other articles look at the THRIVE study, mouth care, workplace practices, Medicaid reimbursement, and more policy implications.
Any of these studies — or several taken together — can serve as a jumping off point for local coverage. Are there nursing homes in your community that are doing things differently? Have any instituted policies or processes that show improvements in care coordination, outcomes, quality, or other key measures? Are there homes that are resisting change? Why? Which one(s) best exemplify person-centered care? How do these changes affect the workforce?
Nursing Home Compare from CMS provides the data behind complaints, violations, quality, and cost, among other metrics. This article in The Philadelphia Inquirer is a great example of interweaving research with personal narrative. Another approach might be to look at trends in the city, state, or region. How are nursing homes marketing themselves to consumers? To referral sources? Have their business models changed?
Experts on all sides have been talking about culture change for more than a decade. And in 2008, a Commonwealth Fund report explored culture change in nursing homes. Has the time finally come, for real?
Unfortunately, the articles referred to are subscription based only.
For information on how to get them for free or low cost, click here.
Transforming Nursing Home Culture: Evidence for Practice and Policy
- What Does the Evidence Really Say About Culture Change in Nursing Homes?
- A “Recipe” for Culture Change? Findings From the THRIVE Survey of Culture Change Adopters
- High-Performance Workplace Practices in Nursing Homes: An Economic Perspective
- Medicaid Capital Reimbursement Policy and Environmental Artifacts of Nursing Home Culture Change
- Building a State Coalition for Nursing Home Excellence
Implications for Policy: The Nursing Home as Least Restrictive Setting
Originally posted on healthcareinfonomics:
Originally posted on The Kente Weaver:
BY: BBC Video Documentary, Think Aloud.
Here’s a short video interview with anthropologist Joseph Dummit, author of the book “Drugs For Life” in which he tackles the pervasiveness of America’s pharmaceutical market in its economy and society. Dummit explores in detail, America’s increasing medicalization and the emergence of the ‘expert patient’ who shifts the dynamic of the patient-doctor relationship because this ‘expert patient’ is now equipped with ‘knowledge’ about his own health, what kind of lifestyle is healthy and to some extent the ‘medical know-how’ of how to treat certain conditions ‘off-the-counter’.
Dummit argues that Pharmaceutical companies have come to occupy a predominant role in American society, changing the discourse about what is “healthy” and what isn’t through their huge marketing campaigns and their capitalistic drive. What I find most interesting in his argument is the fact that he shows how these direct-to-consumer advertising mechanisms not only affect patients…
View original 390 more words
As a medical scribe working with a large, well-known scribe company, unnamed to protect my job, it makes me proud reading all the articles published about how much having a scribe benefits a physician, especially in the emergency department. I enjoy my job immensely and I am grateful for the opportunity to learn and engage in patient care. However, as a pre-medical student working next to several other doctor-hopefuls in a high stress environment, being a scribe frustrates me on an ethical level.
Let’s examine the structure and reasoning that has made medical scribe programs so successful. When EMR systems were first introduced, there was resistance, but it gave way to the push for efficiency. The biggest benefit of EMRs is easy: risk management. By allowing for documentation of every little part of a patient’s care, EMRs significantly decrease the risk of mistakes slipping through the cracks. It allows for better defense of the physician’s medical decisions, even months down the line.
For example, a physician I worked with was asked to go to court for a patient who had been assaulted by her boyfriend. The patient had been seen several months ago in the ED. Few physicians would be able to remember all the details of an encounter so long ago. His testimony was therefore entirely based on the medical chart, written by me and approved by him. The EMR allowed for comprehensive, detailed documentation of test results, discussions with the patient, and interactions with the police.
Unfortunately, such comprehensive medical records take time and effort to write. Physicians complain that they were becoming little more than data entry specialists, dedicating large portions of the time they should be spending with patients to clicking buttons. In comes the scribe. Usually students or recent graduates interested in becoming a medical provider, we become the physician’s right hand. Scribes are purported to decrease physician burnout considerably and increase ED efficiency. Better documentation also leads to better billing, so hospitals make more money. The physicians I work with, in a hospital who has been using scribes for over 3 years now, have all been grateful for the program.
Sounds great, right? The winning combination of EMRs and scribes. The road to increased efficiency, increased Press-Ganey scores, increased billing accuracy, increased fraud, increased profits for the administration. Happiness abounds.
How many of you missed the “increased fraud”?
From the 22 January 2014 news article at EHRIntelligence
Formal academic studies about the implementation of clinical decision support (CDS) and computerized provider order entry (CPOE) are generally positive, according to a study of studies targeting the meaningful use of EHRs and associated technologies. The report, published in the Annals of Internal Medicine, found that for the most part, health IT implementations were successful in reducing adverse events and increasing efficient and effective processes of care. However, many key aspects of IT adoption have been underreported, including the reasons why implementations go awry, leading to significant gaps in the ability to study the industry’s progress.Funded by the ONC, the research team found that at least 78% of studies focused on medication safety found positive effects from CPOE use. The automated dose calculation features of the software helped reduce dosage errors anywhere between 37% and 80%.Fifty-eight of the articles reviewed by the researchers addressed efficiency questions, and found that health IT was able to reduce costs in 85% of cases, even though a large number of studies also reported increased time and effort spent on electronic documentation. Clinical decision support was associated with a 30% increase in adherence to infection prevention guidelines in one study, and a “substantial decline” in venous thromboembolism for patients in another.Overall, positive findings from CDS and CPOE projects included shorter emergency department turnaround times, more time for clinicians to interact with patients, and better chronic disease management. However, when individual studies reported negative or mixed findings, there were few clues in the literature as to why the problems manifested themselves or how to correct them.
From the Web page
Order or Download Your Free Patient Packet
As part of the Time To Talk campaign, NCCAM has developed a packet of helpful materials to help you begin a dialogue with your health care providers. Order your packet online or call 1-888-644-6226 and use reference code D393.
Each packet contains:
- Backgrounder: The backgrounder provides information about the importance of health care providers and their patients talking about complementary health practices.Download PDF
- TELL tip sheet: This sheet provides tips for talking with health care providers.Download PDF
- Patient wallet card: This card will help to keep track of all medications, including dietary supplements and other complementary health products, and will be a handy reference during visits to your health care provider.Download PDF
- Get the Facts: Are You Considering Complementary and Alternative Medicine? This fact sheet will assist you in your decision making about using CAM.Download PDF
Order your packet online or call 1-888-644-6226 and use reference code D393.
- Patient involvement (including questions to ask your doctor) from US AHRQ (Association for Healthcare Research and Quality)
- Diagnosis and Treatment (including Quick Tips When Talking with your Doctor) from US AHRQ