Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Press release] Stigmas, once evolutionarily sound, are now bad health strategies

Cannot but think of the New Testament headings, especially of lepers.

Stigmas, once evolutionarily sound, are now bad health strategies.

Stigmatization may have once served to protect early humans from infectious diseases, but that strategy may do more harm than good for modern humans, according to Penn State researchers.

“The things that made stigmas a more functional strategy thousands of years ago rarely exist,” said Rachel Smith, associate professor of communication arts and sciences and human development and family studies. “Now, it won’t promote positive health behavior and, in many cases, it could actually make the situation worse.”

Stigmatizing and ostracizing members stricken with infectious diseases may have helped groups of early humans survive, said Smith, who worked with David Hughes, assistant professor of entomology and biology. Infectious agents thrive by spreading through populations, according to Smith and Hughes, who published an essay in the current issue of Communication Studies.

For early humans, a person who was stigmatized by the group typically suffered a quick death, often from a lack of food or from falling prey to a predator. Groups did not mix on a regular basis, so another group was unlikely to adopt an ostracized person. Infectious disease stigmas may have evolved as a social defense for group-living species, and had adaptive functions when early humans had these interaction patterns.

However, modern society is much larger, more mobile and safer from predators, eliminating the effectiveness of this strategy, according to Smith.

“In modern times, we mix more regularly, travel more widely, and also there are so many people now,” Smith said. “These modern interaction patterns make stigmatization unproductive and often create more problems.”

Hughes studies disease in another successful society, the ants, which have strong stigma and ostracism strategies that serve group interests at the cost to individuals.

“Ants are often held up as paragons of society and efficiency but we certainly do not want to emulate how they treat their sick members, which can be brutal,” said Hughes.

Stigmatization could actually make infectious disease management worse. The threat of ostracization may make people less likely to seek out medical treatment. If people refuse to seek treatment and go about their daily routines, they may cause the disease to spread farther and faster, according to the researchers, who are both investigators in the Center of Infectious Disease Dynamics in Penn State Huck Institutes of the Life Sciences.

Stigmatization may harm a person’s ability to survive a disease. Ostracization may increase stress, lessening the body’s ability to fight off diseases and infections.

“People are very sensitive to rejection and humans worry about being ostracized,” said Smith. “These worries and experiences with rejection can cause problematic levels of stress and, unfortunately, stress can compromise the immune system’s ability to fight off an infection, accelerating disease progression.”

Once applied, a stigma is difficult to remove, even when there are obvious signs that the person was never infected or is cured. Health communicators should make sure they intentionally monitor if their public communication or intervention materials create or bolster stigmas before using them, Smith said.

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March 31, 2014 Posted by | health care, Medical and Health Research News | , , , , , | Leave a comment

Top 100 Selling Drugs of 2013

Top 100 Selling Drugs of 2013.

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

March 28, 2014 Posted by | health care | | Leave a comment

[Report] Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse (OEI-03-13-00030) 03-03-2014

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.

 

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March 28, 2014 Posted by | health care | , , | Leave a comment

Ethics: A Patient’s Right to Not Know

Ethics: A Patient’s Right to Not Know.

Excerpt

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.

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March 26, 2014 Posted by | health care | , , , , , , , , , | Leave a comment

Hepatitis C Cure May Be Too Expensive for Prisoners – Stateline

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.

 

Hepatitis C Cure May Be Too Expensive for Prisoners – Stateline.

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.”

HIV Precedent
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.”

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March 26, 2014 Posted by | health care | , , , , , | Leave a comment

[News item' The patient from the future, here today

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?

 

From the 5 March 2014 UT-San Diego article

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.

 

Read the entire article here

Epatients: The hackers of the healthcare world [O'Reilly Radar]

Meet e-patient Dave – a voice of patient engagement (and related resources)

 

 

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March 21, 2014 Posted by | health care | , , , , , , , | Leave a comment

[News item] British hospital to become first in Europe to use Skype for consultations

From the 21 March 2014 Daily Telegraph article

 

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.”

…….

Skype

Skype (Photo credit: Wikipedia)

 

 

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March 21, 2014 Posted by | health care, Health News Items | , , , , , | Leave a comment

Explore causes of regional variations in premiums | Association of Health Care Journalists

 Explore causes of regional variations in premiums | Association of Health Care Journalists

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).

 

 

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March 14, 2014 Posted by | health care | , | Leave a comment

Explore how changing nursing home culture affects care

From the 28 January 2014 article at Covering Health

 

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.

English: Nursing Home in Goldthorn Hill. This ...

English: Nursing Home in Goldthorn Hill. This area of Wolverhampton has a cluster of nursing homes. (Photo credit: Wikipedia)

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?

 

Read the entire article here

 

Unfortunately, the articles referred to are subscription based only.
For information on how to get them for free or low cost, click here.

 

Articles referred to above

 

  • 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

     

 

 

 

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March 14, 2014 Posted by | health care | , , , , | Leave a comment

What do we know about health care determinants?

Originally posted on healthcareinfonomics:

Image As a nation, we only spend 9% of national health expenditures in embracing healthy behavior. On the other hand, only 6% of health determinates are related to access to services, although 90% of national health expenditures is spent on medical services. [1] Therefore, presumably, providing primary care providers the tools and the means to change and educate patients about their health determinate will have a significant impact on overall spending on medical services.

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March 13, 2014 Posted by | health care | , , | Leave a comment

Drugs For Life; Subcultural Identity

Originally posted on The Kente Weaver:

Watch: http://www.bbc.co.uk/programmes/b01r0h4r

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…

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March 13, 2014 Posted by | health care | , , | Leave a comment

Vaccine-preventable outbreaks

Originally posted on Eideard:

vaccine preventable
Click for interactive map

In what medical century does your nation reside?

Thanks, Mike

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March 13, 2014 Posted by | health care | , , , , , , | Leave a comment

[Reblog] The disturbing confessions of a medical scribe

From the 9 March 2014 KevinMD article

Screen Shot 2014-03-13 at 7.16.13 AM

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”?

 

…..

 

Read the entire article here

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March 13, 2014 Posted by | health care | , , , | Leave a comment

IT maybe be helpful for your health! – Clinical decision support, CPOE get thumbs up from academics

Clinical decision support, CPOE get thumbs up from academics 

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.
Read the entire article here

 

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March 13, 2014 Posted by | health care | , , , , , | Leave a comment

Order or Download Your Free Patient Packet – Tips on How to Talk with your Health Care Provider

Order or Download Your Free Patient Packet | NCCAM

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 PDFBackgrounder: The backgrounder provides information about the importance of health care providers and their patients talking about complementary health practices.Download PDF

 

Order your packet online or call 1-888-644-6226 and use reference code D393.

 

Related Resources

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March 13, 2014 Posted by | health care, Uncategorized | , , , , , , , , , , | Leave a comment

Pill Nation

Pill Nation.

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February 13, 2014 Posted by | health care | | 4 Comments

[News article] The Rise of Medical Identity Theft

From the 7 February 2014 Stateline news article 

By Michael Ollove, Staff Writer

A young woman retrieves a patient’s medical records at the Family Health Center in Louisville, Ky. The theft of personal medical information, whether paper-based or electronic, is a large and growing problem. (Getty)

If modern technology has ushered in a plague of identity theft, one particular strain of the disease has emerged as most virulent: medical identity theft.

Last month the Identity Theft Resource Centerproduced a surveyshowing that breaches of medical records involving personal information accounted for 43 percent of all records breaches involving personal information reported in the United States in 2013. That is a far greater chunk of record breaches than those involving banking and finance, the government and the military or education.

The definition of medical identity theft is the fraudulent acquisition of someone’s personal information – name, Social Security number, health insurance number – for the purpose of illegally obtaining medical services or devices, insurance reimbursements or prescription drugs.

“Medical identity theft is a growing and dangerous crime that leaves its victims with little to no recourse for recovery,” said Pam Dixon, the founder and executive director of World Privacy Forum. “Victims often experience financial repercussions and worse yet, they frequently discover erroneous information has been added to their personal medical files due to the thief’s activities.”

The Affordable Care Act has raised the stakes. One of the main concerns swirling around the disastrous rollout of federal and state health insurance exchanges last fall was whether the malfunctioning online marketplaces were compromising the confidentiality of Americans’ medical information.  Meanwhile, the law’s emphasis on digitizing medical records, touted as a way to boost efficiency and cut costs, comes amid intensifying concerns over the security of computer networks.

Edward Snowden, the former National Security Agency contractor who has disclosed the agency’s activities to the media, says the NSA has cracked the encryption used to protect the medical records of millions of Americans.

Multiple Motives

Thieves have used stolen medical information for all sorts of nefarious reasons, according to information collected by World Privacy Forum, a research group that seeks to educate consumers about privacy risks. For example:

  • A Massachusetts psychiatrist created false diagnoses of drug addiction and severe depression for people who were not his patients in order to submit medical insurance claims for psychiatric sessions that never occurred. One man discovered the false diagnoses when he applied for a job. He hadn’t even been a patient.
  • An identity thief in Missouri used the information of actual people to create false driver’s licenses in their names. Using one of them, she was able to enter a regional health center, obtain the health records of a woman she was impersonating, and leave with a prescription in the woman’s name.
  • An Ohio woman working in a dental office gained access to protected information of Medicaid patients in order to illegally obtain prescription drugs.
  • A Pennsylvania man found that an imposter had used his identity at five different hospitals in order to receive more than $100,000 in treatment. At each spot, the imposter left behind a medical history in his victim’s name.
  • A Colorado man whose Social Security number, name and address had been stolen received a bill for $44,000 for a surgery he not undergone.

 

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February 9, 2014 Posted by | health care | , , , | 2 Comments

[Press release] Are you big pharma’s new target market?

From the 3 February 2014 EurekAlert

Taking a cue from Apple and Coca-Cola, pharmaceutical firms are humanizing their brands

This news release is available in French.

Montreal, February 4, 2014 — By 2018, it is estimated that the global pharmaceutical market will be worth more than $1.3 trillion USD. To corner their share of profits, established drug companies have to fight fierce competition from generic products, adhere to stringent government regulations and sway a consumer base that is better informed than ever before.

New research from Concordia University’s John Molson School of Business shows that Big Pharma has begun these efforts by embracing “brand personality,” a marketing strategy traditionally employed by consumer-focused companies like Apple, Coca-Cola and Harley-Davidson.

By imbuing their brands with human characteristics, pharmaceutical companies can boost sales by developing direct relationships with their consumers. The result: patients are more likely to ask their physician to prescribe specific brand-name medication.

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“Brand personalities can transform products from being merely functional to having emotional value in the eyes of the consumer,” says marketing professor Lea Katsanis, a co-author of the study that recently appeared in the Journal of Consumer Marketing.

“Pharmaceutical companies give their brands personality traits by relying on physical attributes, practical functions, user imagery and usage contexts. As a result, brand names like Viagra, Lipitor and Prozac become shorthand for the drugs themselves.”

To carry out the study, Katsanis and co-author Erica Leonard, a recent graduate of Concordia’s Master of Science in Marketing program, used an online survey to poll a total of 483 U.S. respondents. They rated 15 well-known prescription medications based on 22 different personality traits, such as dependability, optimism, anxiousness and elegance. The study included blockbuster drugs from Big Pharma companies such as Pfizer, Eli Lilly and GlaxoSmithKline.

The results show that prescription drug brand personality, as perceived by consumers, has two distinct dimensions: competence and innovativeness. Consumers typically applied terms such as dependable, reliable, responsible, successful, stable, practical and solution-oriented” to branded drugs, thus showing a preference for overall competence. Words like unique, innovative and original related to the “innovativeness” of the drug in question.

“Our findings can help marketers better understand how competing brands are positioned and act accordingly to ensure their products remain distinctive. One way of achieving this could be to appropriately focus more on either the competence or innovativeness dimensions,” says Katsanis.

“From a consumer perspective, prescription drug brand personality may make health-related issues more approachable and less intimidating, facilitating physician-patient interactions by making patients more familiar with the medications used to treat what ails them.”

###

Related links:

 

 

Media contact:

Cléa Desjardins
Senior advisor, media relations
University Communications Services
Concordia University
Phone: 514-848-2424, ext. 5068
Email: clea.desjardins@concordia.ca
Web: concordia.ca/now/media-relations
Twitter: twitter.com/CleaDesjardins

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February 5, 2014 Posted by | health care, Health News Items | , , , , | Leave a comment

[Press release] Taking statins to lower cholesterol? New guidelines

From the 4 February 2014 Mayo Clinic Press Release

ROCHESTER, Minn. — Feb. 4, 2014 — Clinicians and patients should use shared decision-making to select individualized treatments based on the new guidelines to prevent cardiovascular disease, according to a commentary by three Mayo Clinic physicians published in this week’s Journal of the American Medical Association.

Journalists:  Sound bites with Dr. Montori are available in the downloads.

Shared decision-making is a collaborative process that allows patients and their clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.

In 2013, the American College of Cardiology and the American Heart Association issued new cholesterol guidelines, replacing previous guidelines that had been in place for more than a decade. The new guidelines recommend that caregivers prescribe statins to healthy patients if their 10-year cardiovascular risk is 7.5 percent or higher.

“The new cholesterol guidelines are a major improvement from the old ones, which lacked scientific rigor,” says primary author Victor Montori, M.D., Mayo Clinic endocrinologist and lead researcher in the Knowledge and Evaluation Research Unit. “The new guidelines are based upon calculating a patient’s 10-year cardiovascular risk and prescribing proven cholesterol-lowering drugs — statins — if that risk is high.”

However, Dr. Montori cautions that the risk threshold established by the guideline panel is somewhat arbitrary. Instead he recommends that patients and their clinicians use a decision-making tool to discuss the risks and benefits of treatment with statins.

“Rather than routinely prescribing statins to the millions of adults who have at least a 7.5 percent risk of having a heart attack or stroke within 10 years, there is an opportunity for clinicians and patients to discuss the potential benefits, harm and burdens of statins in order to arrive at a choice that reflects the existing research and the values and context of each patient,” he says.

“We’re creating a much more sophisticated, patient-centered practice of medicine in which we move the decision-making from the scientist to the patient who is going to experience the consequences of these treatments and the burdens of these interventions,” Dr. Montori explains. “Decision-making tools can democratize this approach and put it in the hands of millions of Americans who have their own goals front and center in the decision-making process.”

Additional authors of the commentary include Henry Ting, M.D., and Juan Pablo Brito Campana, M.B.B.S., both of Mayo Clinic.

 

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February 5, 2014 Posted by | health care | , , , , , , , , | Leave a comment

[Report] Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs

From the 1 January 2014 report at Health Affairs

Abstract

Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power.

This study used private insurance claims data to identify hospitals receiving inpatient prices significantly higher or lower than the median in their market. High-price hospitals, compared to other hospitals, tend to be larger; be major teaching hospitals; belong to systems with large market shares; and provide specialized services, such as heart transplants and Level I trauma care.

High-price hospitals also receive significant revenues from nonpatient sources, such as state Medicaid disproportionate-share hospital funds, and they enjoy healthy total financial margins.

Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U.S. News & World Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates.

Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.

 

 

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February 5, 2014 Posted by | health care | , , , , , , | Leave a comment

[Reblog] Are you a victim of patient profiling?

Very controversial, this posting has 113 comments as of Feb 4, 2014.
Two (or more! ) sides to this.
On a personal level, my medical record very boldly on the first page states two conditions
– Anxiety/Depression (have not needed medication for these conditions in 5 years)
– High Cholesterol ( have disputed the doctor on this, based on how I have read the scientific literature)

So, yes…I feel profiled!

Yet, the doctor is doing the best he can. He can only see patients for 15 minutes. His electronic records are
basically, well, dictated by the group he is in.

On another note, just as I am not defined by my job or resume…
I am also not defined by my medical record!

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From the 4 February 2014 Kevin MD article by Pamela Wible, MD

Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.

Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the uninsured, and patients of color. Like racial profiling by police, patient profiling by physicians is more common than you think.

 

We rely on doctors to first do no harm–to safeguard our health–but profiling patients often leads to improper medical care, and distrust of physicians and the health care system, with potential lifelong consequences.

For the first time, people share their stories:

I was once denied pain meds after a fall off a 10-foot porch by the same doc who gave my pretty female friend pain meds after getting two stitches in her finger. I felt like my appearance had something to do with it.” ~ Jay Snider

 

Read the entire article (with 113+ comments) here

 

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February 4, 2014 Posted by | health care | , , , , , | Leave a comment

US Government Program requires drug manufacturers to provide outpatient drugs to eligible health care organizations/covered entities at significantly reduced prices

New to me!

From the US Health Resources and Services Program Web page -  340B Drug Pricing Program & Pharmacy Affairs

The 340B Drug Pricing Program requires drug manufacturers to provide outpatient drugs to eligible health care organizations/covered entities at significantly reduced prices.

The 340B Program enables covered entities to stretch scarce Federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.

Eligible health care organizations/covered entities are defined in statute and include HRSA-supported health centers and look-alikes, Ryan White clinics and State AIDS Drug Assistance programs, Medicare/Medicaid Disproportionate Share Hospitals, children’s hospitals, and other safety net providers. See the full list of eligible organizations/covered entities.

To participate in the 340B Program, eligible organizations/covered entities must register and be enrolled with the 340B program and comply with all 340B Program requirements. Once enrolled, covered entities are assigned a 340B identification number that vendors verify before allowing an organization to purchase 340B discounted drugs.

New registrations are accepted October 1-15, January 1-15, April 1-15 and July 1-15.

Update here, which includes..

HRSA is currently working to formalize existing program guidance through regulation, designed to cover a number of aspects of the 340B Program. The regulation currently under development will address the definition of an eligible patient, compliance requirements for contract pharmacy arrangements, hospital eligibility criteria, and eligibility of off-site facilities. We expect to publish this proposed regulation, which will be open for public comment, by June 2014. In order to ensure that covered entities retain flexibility based on their size, structure, and patient population, HRSA will continue to hold covered entities accountable for implementing those requirements as appropriate for their specific circumstances.

…..

Implemenation page includes

Once a covered equity is enrolled in the 340B Program and included in the covered entities database, it is the covered entity’s responsibility to inform wholesalers and manufacturers of enrollment in order to purchase drugs at the 340B discounted price.

Covered entities may continue to work directly with individual wholesalers and manufacturers and may participate in the 340B Prime Vendor Program (PVP). As the government’s awarded 340B Prime Vendor, Apexus is responsible for securing sub-ceiling discounts on outpatient drug purchases and discounts on other pharmacy related products and services for covered entities electing to join the PVP. For complete information, see the Prime Vendor Program .

Implementation Options

HRSA does not specify how participants should implement the 340B Program. As long as participants comply with all 340B Program requirements, they have flexibility in implementing the 340B Program.

Most covered entities choose one or more of the following options:

  • In-House Pharmacy, in which the covered entity owns drugs, pharmacy and license; purchases drugs; is fiscally responsible for the pharmacy; and pays pharmacy staff.
  • Contract Pharmacy Services, in which the covered entity owns drugs; purchases drugs; pays (or arranges for patients to pay) dispensing fees to one or more contract pharmacies; and contracts with pharmacy to provide pharmacy services.
  • Provider/In-House Dispensing, in which the covered entity owns drugs; employs providers licensed in the state to dispense; holds a license for dispensing for the participating providers; and is fiscally responsible for operating and dispensing costs.
  • Alternative Methods Demonstration Project, in which HRSA Office of Pharmacy Affairs approves a model proposed by the covered entity, such as a network of 340B covered entities.

The 340B Database includes links to

 

 

 

 

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February 2, 2014 Posted by | health care | , , , , , , | Leave a comment

Parents unclear about process for specialist care for kids

Parents unclear about process for specialist care for kids.

No recommendations, but an interesting survey.

From the University of Michigan Press Release

Answers vary about the roles of parents and care providers in referral process, according to U-M’s National Poll on Children’s Health

ANN ARBOR, Mich. – Parents vary widely in views about their responsibilities in getting specialty care for their children, according to a new University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health.

Most children get their health care from a primary care provider, known as a PCP, but when there are signs or symptoms of a more serious illness, the PCP often refer kids to a specialist.

According to this month’s poll, it’s a common occurrence. Among the 1,232 parents surveyed in this poll, 46 percent report that at least one of their children has been referred to a specialist.

But when asked about the process of getting specialist care for their child, parents had a wide range of views, says Sarah J. Clark, M.P.H. , associate director of the National Poll on Children’s Health and associate research scientist in the University of Michigan Department of Pediatrics.

Parents are divided over who is responsible for choosing the specialist: 52 percent say the PCP and 48 percent say the parent. They also differed in who should verify insurance coverage: 55 percent say the PCP and 45 percent say the parent.

Forty percent of parents say the PCP should make sure the wait time isn’t too long for a specialist appointment, but 60 percent say that’s the parents’ responsibility.

“This poll shows a wide range of views about who is supposed to do what, so it’s not unexpected that sometimes the process doesn’t work well,” says Clark. “If a referral is delayed or it doesn’t happen at all, a child’s health can be put at risk.”

The poll also found that parents of children with Medicaid insurance coverage are more likely than parents of privately-insured children to say PCPs should be responsible for choosing the specialist, calling to set up the appointment, and verifying that insurance will cover the specialist care. Clark says this indicates that PCPs should understand that their Medicaid patients may have different expectations about their roles.

Parents also were asked to rank the importance of different characteristics of specialists, and rated the following as very important:

  • knowing how to take care of the child’s specific condition (89%)
  • having training in pediatrics (80%)
  • being affiliated with a highly-rated hospital (62%)
  • being involved in research so child has access to latest treatment (50%)
  • appointment time convenient for the family schedule (43%)
  • drive time to the specialist (38%)
  • other parents recommending the specialist (38%)

“For a parent, hearing that a child needs to see a specialist is often cause for concern. Confusion about their responsibilities for arranging specialty care can add to parents’ anxiety,” says Clark, who also is associate director of the Child Health Evaluation and Research (CHEAR) Unit.

“Primary care providers cannot assume that parents understand their responsibilities around making specialty appointments.  Clear communication — ideally, with instructions written in plain language — will help parents ensure their kids get the care they need.”

Broadcast-quality video is available on request. See the video here:http://www.youtube.com/watch?v=uif7xpr5iy8&feature=youtu.be

Full report: C.S. Mott Children’s Hospital National Poll on Children’s Health

http://mottnpch.org/reports-surveys/seeing-specialists-roles-parents-providers-unclear

 

Website: Check out the Poll’s website: MottNPCH.org. You can search and browse over 80 NPCH Reports, suggest topics for future polls, share your opinion in a quick poll, and view information on popular topics. The National Poll on Children’s Health team welcomes feedback on the website, including features you’d like to see added. To share feedback, e-mailNPCH@med.umich.edu.

Facebook: http://www.facebook.com/mottnpch

Twitter: @MottNPCH

 

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February 1, 2014 Posted by | health care | , , , , , , | Leave a comment

Infection control practices not adequately implemented at many U.S. hospital ICUs, study finds — ScienceDaily

Infection control practices not adequately implemented at many U.S. hospital ICUs, study finds — ScienceDaily.

Date:  January 29, 2014
Source:  Elsevier
Summary:  U.S. hospital intensive care units (ICUs) show uneven compliance with infection prevention policies, according to a study.

From the news article

U.S. hospital intensive care units (ICUs) show uneven compliance with infection prevention policies, according to a study in the February issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

“Establishing policies does not ensure clinician adherence at the bedside,” state the authors. “Previous studies have found that an extremely high rate of clinician adherence to infection prevention policies is needed to lead to a decrease in healthcare-associated infections. Unfortunately, the hospitals that monitored clinician adherence reported relatively low rates of adherence.”

The survey also assessed structure and resources of infection prevention and control programs, evaluating characteristics such as staffing, use of electronic surveillance systems, and proportion of infection preventionists with certification.

Healthcare-associated infections, or HAIs, are infections that people acquire while they are receiving treatment for another condition in a healthcare setting. Many of these infections occur in the ICU setting and are associated with an invasive device such as central line, ventilator, or indwelling urinary catheter. At any given time, about 1 in every 20 inpatients has an infection related to hospital care. The estimated annual costs associated with HAIs in the U.S. are up to $33 billion.

 

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February 1, 2014 Posted by | health care | , , , , , , , , | Leave a comment

Things Physicians and Patients Should Question – With Lists From Choosing Wisely

Screen Shot 2014-02-01 at 5.27.47 AMThings Physicians and Patients Should Question | Choosing Wisely.

Ever wonder if a medical test or procedure was right for you?
Maybe you read about it, hear it on the news, or came across it on the Internet.

Here’s Web site that just might help in discussions with your health care provider.

From the Choosing Wisely site

Choosing Wisely® aims to promote conversations between physicians and patients by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

In response to this challenge, national organizations representing medical specialists have been asked to “choose wisely” by identifying five tests or procedures commonly used in their field, whose necessity should be questioned and discussed. The resulting lists of “Five Things Physicians and Patients Should Question” will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments.

This concept was originally conceived and piloted by the National Physicians Alliance, which, through an ABIM Foundation Putting the Charter into Practice grant, created a set of three lists of specific steps physicians in internal medicine, family medicine and pediatrics could take in their practices to promote the more effective use of health care resources. These lists were first published inArchives of Internal Medicine. 

Recognizing that patients need better information about what care they truly need to have these conversations with their physicians, Consumer Reports is developing patient-friendly materials and is working with consumer groups to disseminate them widely.

Choosing Wisely recommendations should not be used to establish coverage decisions or exclusions. Rather, they are meant to spur conversation about what is appropriate and necessary treatment. As each patient situation is unique, physicians and patients should use the recommendations as guidelines to determine an appropriate treatment plan together.

From the List at Choosing Wisely, by the ABIM Foundation

United States specialty societies representing more than 500,000 physicians developed lists of Five Things Physicians and Patients Should Question in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.

These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.

Choosing Wisely recommendations should not be used to establish coverage decisions or exclusions. Rather, they are meant to spur conversation about what is appropriate and necessary treatment. As each patient situation is unique, physicians and patients should use the recommendations as guidelines to determine an appropriate treatment plan together.

In collaboration with the societies, Consumer Reports has created resources for consumers and physicians to engage in these important conversations about the overuse of medical tests and procedures that provide little benefit and in some cases harm.

Specialty Society Lists of Five Things Physicians and Patients Should Question (for physicians):

Patient-Friendly Resources from Specialty Societies and Consumer Reports:

and more!

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February 1, 2014 Posted by | health care | , , , , , , , , | Leave a comment

Potential Effects of the Affordable Care Act on Income Inequality | Brookings Institution

Potential Effects of the Affordable Care Act on Income Inequality | Brookings Institution.

From the 27 January 2014 Brookings Institute post
The Affordable Care Act (aka “Obamacare”) was designed to expand health insurance coverage and hold down the cost of insurance, but it will also change incomes of many Americans according to initial projections of Brookings Senior Fellows Henry Aaron and Gary Burtless.

In their new, preliminary paper “Potential Effects of the Affordable Care Act on Income Inequality,” Aaron and Burtless find sizeable income gains in the bottom quarter of the income distribution offset by small losses spread across higher income groups. Their estimates are highly sensitive to the definition of income. They discussed their paper in a recent event, joined by three other economists in a panel discussion.

The Affordable Care Act (aka “Obamacare”) was designed to expand health insurance coverage and hold down the cost of insurance, but it will also change incomes of many Americans according to initial projections of Brookings Senior Fellows Henry Aaron and Gary Burtless.

In their new, preliminary paper “Potential Effects of the Affordable Care Act on Income Inequality,” Aaron and Burtless find sizeable income gains in the bottom quarter of the income distribution offset by small losses spread across higher income groups. Their estimates are highly sensitive to the definition of income. They discussed their paper in a recent event, joined by three other economists in a panel discussion.

January 30, 2014 Posted by | health care | , , , , | Leave a comment

Health Care Consumerism: Patients Still Lack Agency at the Point of Care | Health care and the digital revolution

Health Care Consumerism: Patients Still Lack Agency at the Point of Care | Health care and the digital revolution.

From the 27 January 2013 post at Health care and the digital revolution – A graduate student’s take on health care going digital – Claudia Paz

Something we have been hearing a lot of lately is how this is the moment for the healthcare consumer (see, Bloomberg Review videoMedCity Article, Forbes article on trends to be excited about).  Basically, people are noting that EMR’s and patient portals, the proliferation of health and wellness related mobile apps, and greater transparency across the system, will all lead to a new age of health care where patients have the information and tools to savvily navigate a streamlined healthcare delivery system oiled by customer reviews, online tools, and digital gadgets. Think Yelp and MenuPages meets healthcare.

While all of the trends listed above are exciting leaps forward, not enough attention is being paid to the patient’s needs at the point of care. Research on patient activation andshared or participatory decision making all points to the following:

Empowered patients who actively participate in decisions about their health and treatment options are more likely to be compliant with their medications, make less risky and more cost effective decisions, and are more confident in the management of their health outcomes.

For the purposes of this blog, I am focusing on the concept of a patient as an active participant at the point of care. From my own personal experience, it seems that “doctor knows best” remains the dominant paradigm. Instead of having a conversation about treatment options, the pros and cons of alternatives, variations in costs and side affects, I am more often than not prescribed a medication or treatment option and sent about my day. If I feel like knowing more about the medication (that I have already agreed to take), I usually conduct research after the appointment.

,,,,,

 

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January 30, 2014 Posted by | health care | , , , , , | Leave a comment

[Reblog] Journalist explains what to expect from new mental health parity rules

From the 27 January 2014 post at Covering Health – Monitoring the pulse of health care journalism

by | January 27, 2014

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Michelle AndrewsMichelle Andrews

Later this year, health plans will be under new mental health parity rules affecting how insurers should cover patients with mental health and substance abuse disorders.

Michelle Andrews, a health policy reporter and columnist for Kaiser Health News, explains the issue in a new tip sheet,  “Mental health parity rule clarifies standards for treatment limits, coverage of intermediate care.”

These rules, governing the limits that health insurers can place on coverage for patients needing mental health and substance abuse care, will be important to consumers for several reasons. One reason involves what services health plans must provide when covering mental health benefits –keep in mind that health plans do not need to offer mental health care. But if they do, they need to cover inpatient and outpatient services, emergency room care and prescription drugs, Andrews reports. Also, the rules prohibit health insurers from setting limits on treatment that are more restrictive than the limits set on a plan’s medical-surgical coverage, she adds.

In addition, intermediate-level mental health services, such as residential treatment and intensive outpatient services for patients needing substance abuse treatment or mental health care, should be covered at the same level as the insurer covers residential and intensive outpatient services for medical-surgical patients, Andrews adds. Often patients needing mental health and substance abuse care require residential or intensive outpatient treatment.

The new parity rules also do not allow health insurers to charge higher co-payments, deductibles, or out-of-pocket maximums for mental health and substance abuse treatment without setting similar co-payment, deductibles, and out-of-pocket limits for medical-surgical coverage.

 

 

Read the entire article here

January 28, 2014 Posted by | health care | , , , , | Leave a comment

[Reblog] Healthstyles: Pre-operative Fasting–Too Long?

Fasting instructions for healthy pre surgical patients should be based on the known differences in gastric transit times of clear liquids, full liquids, and other foods.

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From the 23 January 2014 post at HealthCetera – CHMP’s Blog
     Center for Health Media & Policy at Hunter College (CHMP): advancing public conversations about health & health
policy

This week on Healthstyles, I'm rebroadcasting an important interview that I did with Dr. Jeannette Crenshaw, RN, DNP, two years ago about what the evidence suggests is appropriate for pre-operative fasting--what should you not eat or drink and for how long before surgery.
Unfortunately, little attention is paid to this topic. Most people are told to fast for much longer periods of time than is necessary, and this can lead to dehydration and other adverse effects.
Tune in tonight on WBAI (www.wbai.org; 99.5 FM), or click here to listen anytime: Crenshaw

[The broadcast is about 22 minutes long, but very informative]

For those interested, the broadcast is based on her article Pre-operative Fasting – Will the Evidence Ever be put into Practice? 

Highlights from the article

  • Overview: Decades of research support the safety and health benefits of consuming clear liquids, including those that are carbohydrate rich, until a few hours before elective surgery or other procedures requiring sedation or anesthesia.
    Still, U.S. clinicians routinely instruct patients to fast for excessively long preoperative periods. Evidence-based guidelines, published over the past 25 years in the United States, Canada, and throughout Europe, recommend liberalizing preoperative fasting policies.
    To improve patient safety and health care quality, it’s essential that health care professionals abandon outdated preoperative fast- ing policies and allow available evidence to guide preanesthetic practices.

Preoperative fasting practices in the United States often disregard both the guidelines of the American Society of Anesthesiologists (ASA)1, 2 and the most current available evidence on the subject.

A PRACTICE BASED ON MYTH

The U.S. practice of requiring an extended fast before scheduled anesthesia or sedation is based primarily on the following three myths8-12:

• Myth: Overnight fasting from all solids and liquids is the optimal approach to reduce the risk of pul- monary aspiration during anesthesia.

• Myth: Gastric emptying time is the same for clear liquids as for full liquids (those that are not transpar- ent, such as milk, creamed soup, and nonstrained fruit juice) and solids.

• Myth: Clear liquids ingested up to two hours be- fore surgery increase the risk of vomiting and pul- monary aspiration.

 

The ASA (American Society of Anesthesiologists) recommends that healthy patients

 

  • consume clear liquids up to two hours before elective surgery or conscious sedation but cautions that their guidelines aren’t intended for women in labor and may need to be modified for patients with conditions that affect gastric emptying or fluid volume and those in whom airway management may be difficult.3-5
  • Evidence gathered throughout the world over the past 25 years not only supports the ASA guidelines, but establishes the health benefits of preoperative carbohydrate loading (through the consumption of carbohydrate-rich clear liquids) the evening before and the morning of surgery.6, 7

Clear liquids leave the stomach almost immediately, while full liquids and solids remain for significantly longer periods. It’s long been established that patients who drink clear liquids a few hours before surgery have significantly lower gastric volumes and similar or higher pH values compared with those who fast overnight, suggesting that drinking clear liquids may stimulate gastric emptying and dilute acidic gastric secretions, thereby lowering the risk of pulmo- nary aspiration and increasing patient safety.15-1 

Screen Shot 2014-01-26 at 6.36.06 AM

  • In addition to discomforts such as thirst, hunger, anxiety, drowsiness, and dizziness, excessive preoperative

    fasting may have adverse physiologic effects, including dehydration, insulin resistance, postoperative hy- perglycemia, muscle wasting, and a weakened immune response.18, 23-25 Clear liquids, taken alone, may be in-sufficient to ward off such effects. Emerging evidence suggests that, in addition to offering clear liquids up until two hours before anesthesia or sedation, the best way to avert the harmful consequences of preoperative fasting is to prescribe a carbohydraterich clear bev-erage to be consumed two to three hours before the scheduled procedure

  • The author also details reasons for resistance by the medical community and research needs (as for patients who are not healthy and/ or have stomach and breathing issues).

 

So, does one take the law into one’s hands, so to speak? The radio interview seems to suggest be careful if you drink clear liquids up to two hours before the surgery and/or drink a carbohydrate beverage.  Best not to tell the health care providers, perhaps on the day of surgery.

 

 

 

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January 26, 2014 Posted by | health care | , , , | Leave a comment

[Reblog] Measuring Quality of Care for Older Adults With Serious Illness

From he 22 January 2014 post at HealthAffairsBlog

by Laura Hanson, Anna Schenck, and Helen Burstin

Editor’s Note: This post is the third in a periodic Health Affairs Blog series on palliative care, health policy, and health reform. The series features essays adapted from and drawing on an upcoming volume, Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, in which clinicians, researchers and policy leaders address 16 key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value. 

In the United States, value is the new health care imperative – improving quality while controlling costs.  We spend nearly twice the rate of comparable nations, yet have poorer health outcomes.  In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA), mandating a new emphasis on paying for value, not volume.

Our greatest opportunity to enhance value in US health care is to improve quality of care for older adults with serious illness – the group who uses the most health care services. Serious illness, in which patients are unlikely to recover, stabilize, or be cured, is life-altering for patients and family caregivers.  It includes advanced, symptomatic stages of diseases such as congestive heart failure, chronic lung disease, cancer, kidney failure, and dementia. Serious illness may also refer to the cumulative consequences of multiple conditions progressing over time, causing functional decline or frailty.

We’ve made important progress in understanding high quality care for this population of patients.  Researchers have asked patients with serious illness and their families how they define high quality care.  Especially in serious illness, patients want control over treatment through shared decision-making.   Even when there is no cure, most patients still want health care that helps them live longer – but only if they can also get help with function, physical comfort, and attention to family, emotional and spiritual needs.

We know what types of health care help patients and families cope with serious illness.  A 2012 report to the Agency for Healthcare Research and Quality finds evidence for three types of care to improve health outcomes:

  1. Expert pain and symptom treatment
  2. Communication to engage patient preferences for treatment decisions
  3. Interdisciplinary palliative care

We’ve developed quality measures to understand how often real-world care lives up to these ideals.

……

 

Read the entire article here

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January 26, 2014 Posted by | health care | , , , , , | Leave a comment

[Reblog] Saying No to “Know Your Numbers” campaigns – Health News Watchdog blog

Saying No to “Know Your Numbers” campaigns – Health News Watchdog blog.

Saying No to “Know Your Numbers” campaigns

Posted by Gary Schwitzer in Health care journalismRisk communication

4 COMMENTS

“Know Your Numbers” campaigns can serve a useful purpose.

But they can also be guilty of non-evidence-based fear-mongering.  They can fuel obsessions with numbers that fully-informed people might just as soon not know anything about. There can be harm living our lives worrying about numbers, test results – making ourselves sick when we are, in fact, healthy.

Here’s a screenshot of just a tiny part of a Google search result of “Know Your Numbers” campaigns.  The list goes on and on and on.

The most recent that I saw was in the January 2014 edition of Prevention magazine.  It’s entitled, “Know Your Numbers: The 5 Health Stats You Should Know.”

While we acknowledge the prestige of the Cleveland Clinic and its chief wellness officer, we point out that there is a lot of debate in medical science circles about what is laid out in this Preventionmagazine piece. For example:

“There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion”

So if 140/90 is where this group starts thinking about treatment, and if even the American Heart Association says normal is “less than 120/80,” what we have with an announcement that 115/75 is “ideal” is mission creep, medicalizing normal blood pressure, or disease-mongering. Where does this “ideal” come from?  It may only be a few points of difference, but with a few points, thousands of Americans suddenly become “less than ideal”…or, as we often call them, patients. One minute they’re healthy.  And then – voila – with a prestigious organization’s spokesman proclaiming a new “ideal” – they’re sick, abnormal, patients.

  • Cholesterol.  Hmmm.  Let’s see what the Cleveland Clinic website says about LDL and HDL. The Clinic’s own website says the LDL goal value should be less than 130 for people who don’t have heart or blood vessel disease or high risk.  And since a Prevention magazine article reaches a broad audience, that’s the crowd we’re talking about. And the Clinic website says HDL goal value should be greater than 45.  So the Prevention magazine targets of LDL under 100 and HDL over 50 are again mission creep, medicalizing normal blood tests, or disease-mongering.  Please note:  we could (but won’t herein) write volumes about much broader questions about being obsessed over LDL or HDL numbers, which are surrogate markers that don’t tell people everything they need to know.
  • This is the one that bugs me the most.  The article lists C-reactive protein as one of the “5 health stats you should know.”  What you should know is that the US Preventive Services Task Force does not share in that endorsement.  The USPSTF states that “the current evidence is insufficient to assess the balance of benefits and harms of using the (the test) to screen asymptomatic men and women with no history of coronary heart disease (CHD) to prevent CHD events.” Even a brief look at other guidelines by other groups shows that the promotion of this test as a “stat you should know” is not as simple and uncomplicated as the Prevention magazine article makes it out to be.

Please note that almost exactly 2 years ago we wrote, “Cleveland Clinic’s Top 5 Tests for 2012 clash with many guidelines.” C-reactive protein was on that list as well.

And you may be interested in some of my past articles about “Know Your Numbers” campaigns:

Comments

Laurence Alter posted on January 13, 2014 at 10:00 am

Dear Gary & Staff:

1. “Live by the numbers; die by the numbers”
2. “The facts speak for themselves”

Live by the first expression or idiom; die by the second one.

Fine physicians give subtlety and nuance behind “the numbers.”

Laurence Alter

Reply

Gary Schwitzer posted on January 13, 2014 at 12:06 pm

Laurence,

Thanks for your note, but for the umpteenth time, there is no staff.

There wasn’t even any staff when we had funding. So there certainly isn’t any staff in the unfunded era.

Whereas I once had help from as many as almost 40 different part-time contributors, they were not staff, just very limited part-time contributors.

It’s just me, flying solo these days.

Reply

Gwyneth Olwyn posted on January 14, 2014 at 10:50 pm

Dear Gary By Himself:

1. Live by the numbers, die anyway.
2. Unequivocally one death per person.

There is no subtlety or nuance to be had for fine physicians in an era of standard of care and fear of litigation from failing to screen aggressively for potential disease.

Therefore a person needs to know ahead of getting his or her numbers checked whether he or she is ready to inadvertently become a patient based on numbers and that the treatments to change those numbers may have little to no evidence to support them.

Reply

shaun nerbas posted on January 20, 2014 at 3:01 pm

It seems that the patient must look out for themselves, ask questions, and not just accept the standard script of medical people. I had an MI 4 years ago (stent placed in the LAD which was nearly 100% blocked ) , but in the 2.5 months before that I saw 4 different doctors who told me nothing was wrong. I had normal LDL and total cholesterol,but I did have low HDL, which I had recently raised up to a ” nearly normal ” value using niacin. I walked for 1.5 hours a day, but in that 2.5 month period before the MI, while walking, I started to get increasing shortness of breath, indigestion, and a pain in my upper back, between the shoulder blades. My doctor gave me Nexium . My doctor didn’t think it was my heart. He based that on having two relatives of his with heart disease, my normal ECG, and my normal cholesterol numbers. I saw other doctors, as my shortness of breath got worse, but again, they didn’t think it was my heart. Then one day I got the symptoms while eating lunch. I went to the local hospital,who after being in communication with a larger specialized hospital, sent me to that larger center, which put the stent in. I eventually learned that over 62% of MIs happen to people with ” normal cholesterol ” . How is it possible that the cholesterol numbers used by lay doctors are so useless for diagnosis ? Does heart disease have multiple causes or do we just not have a good understanding of how do diagnose and track it ? I almost never see this inadequacy discussed by the experts ! Subsequent to my MI I became a vegan to improve my diet to remove saturated fat, which along with a grandmother who had a heart problem, were, in my mind, the reasons for my heart disease. My cardiologist acted as if I was misguided with the vegan approach, which he felt was a path almost nobody could follow.. ….. just take the statins. Maybe Cardiology is a very lucrative occupation that keeps us coming back…..see you next time ! Sorry for being so cynical, but that’s how I feel.

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January 24, 2014 Posted by | health care, Health News Items | , , , , , | Leave a comment

[News article] Little-known aspect of Medicaid now causing people to avoid coverage

From the 23 January 2014 Washington Post article

Add this to the scary but improbable things people are hearing could happen because of the new federal health-care law: After you die, the state could come after your house.

The concern arises from a long-standing but little-known aspect of Medicaid, the state-federal program that provides health coverage to millions of low-
income Americans. In certain cases, a state can recoup its medical costs by putting a claim on a deceased person’s assets.

after the Affordable Care Act made it mandatory for most people to carry health insurance, Oregon’s Medicaid office decided to change its approach because people scared about asset recovery were not signing up for coverage. New rules that took effect last year state that asset recovery now applies only to long-term care.

“We needed to take another look at heath insurance coverage from the point of view of it not being a public benefit that’s voluntary,” Mohr Peterson said.

Other states have taken a much more lax approach to asset recovery in the past, hesitant to target poor people whose only valuable asset might be the farm that has been in their family for generations. Experts say there are no good, recent national data on how asset recovery is applied, with states differing drastically and working on a case-by-case basis.

It wouldn’t make sense for a state to pursue a claim on the property of a new Medicaid recipient under the health-care law, said Matt Salo, executive director of the National Association of Medicaid Directors.

“There’s no way any state is going to see it as cost-effective or politically sensible to do that,” he said. “It’s a scare tactic.”

Still, when it comes to something as central to middle-class identity as a home and what people can pass on to their heirs, it is perhaps not surprising that some people are not taking any chances.

..

after the Affordable Care Act made it mandatory for most people to carry health insurance, Oregon’s Medicaid office decided to change its approach because people scared about asset recovery were not signing up for coverage. New rules that took effect last year state that asset recovery now applies only to long-term care.

“We needed to take another look at heath insurance coverage from the point of view of it not being a public benefit that’s voluntary,” Mohr Peterson said.

Other states have taken a much more lax approach to asset recovery in the past, hesitant to target poor people whose only valuable asset might be the farm that has been in their family for generations. Experts say there are no good, recent national data on how asset recovery is applied, with states differing drastically and working on a case-by-case basis.

It wouldn’t make sense for a state to pursue a claim on the property of a new Medicaid recipient under the health-care law, said Matt Salo, executive director of the National Association of Medicaid Directors.

“There’s no way any state is going to see it as cost-effective or politically sensible to do that,” he said. “It’s a scare tactic.”

Still, when it comes to something as central to middle-class identity as a home and what people can pass on to their heirs, it is perhaps not surprising that some people are not taking any chances.

,,,,

 

Read the entire article here

 

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January 24, 2014 Posted by | health care | , , , , | Leave a comment

[Journal Article] Search engines cannot diagnose through symptom searching – only 14% accuracy

Ever enter your symptoms into a search engine (as Google) to find what was the cause? And bring the results to your health care provider?  Believe that search engines can correctly diagnose your symptoms?
A  medical researcher not only was thinking along these  lines. He also set up a system to see if search engines could diagnose symptoms accurately.

The results were published in a scientific paper.**

Here are some remarks from medical librarians at their discussion group.

  • They don’t address the problem with these search engines of bias: Google,
    Bing, track what you’ve searched on, they aren’t ‘anonymous’ engines, thus
    biasing the results. A different computer, with different previous user
    will give different results with these search engines. Flawed article,
    in my opinion. Too bad, it is interesting.
  • This article is very interesting. While it is about validating the instrument for analyzing the webpages, they found that only 14% of the website gave a correct diagnosis. Seventy percent came up with the diagnosis as part of a differential. It sort of scares me that many medical students and other healthcare students might use search engines to find differentials. One implication is that patients who bring in webpages may actually hold the appropriate differential in their internet printout. Physicians might consider that information. The article is NOT an open access journal. The abstract does not discuss the findings of accuracy since they were testing the scoring system.

My thoughts? Familydoctor.org (American Academy of Family Physicians) has great advice
Our symptom checker flowcharts allow you to easily track your symptoms and come to a possible diagnosis.
Remember,  be sure to consult with you doctor if you feel you have a serious medical problem.

As a medical librarian, we counsel people to use any information they find as a resource when consulting with their health care provider. Information on the internet may be outdated, flawed, and sometimes even wrong.
Also, the health care providers views you as a whole person, not just a narrow set of symptoms.  They use not only your symptoms, but other factors as health history, current and past treatments, and environmental factors to work toward a treatment plan.

Related Resources

   Online symptom checkers (Standford Health System)

**  Abstract from PubMed.
Full text of article not available online for free.
Might be available for free or low cost at a local public, medical, or academic libary.
Call ahead and ask for a reference librarian.
Many medical and academic libraries offer some help to the public.

Int J Med Inform. 2014 Feb;83(2):131-9. doi: 10.1016/j.ijmedinf.2013.11.002. Epub 2013 Nov 19.

The accuracy of Internet search engines to predict diagnoses from symptoms can be assessed with a validated scoring system.

Shenker BS.

Author information

  • Rutgers Robert Wood Johnson Medical School and Rutgers Robert Wood Johnson Family Medicine Residency at CentraState, United States. Electronic address: bshenker@centrastate.com.
Abstract

PURPOSE:To validate a scoring system that evaluates the ability of Internet search engines to correctly predict diagnoses when symptoms are used as search terms.METHODS:We developed a five point scoring system to evaluate the diagnostic accuracy of Internet search engines. We identified twenty diagnoses common to a primary care setting to validate the scoring system. One investigator entered the symptoms for each diagnosis into three Internet search engines (Google, Bing, and Ask) and saved the first five webpages from each search. Other investigators reviewed the webpages and assigned a diagnostic accuracy score. They rescored a random sample of webpages two weeks later. To validate the five point scoring system, we calculated convergent validity and test-retest reliability using Kendall’s W and Spearman’s rho, respectively. We used the Kruskal-Wallis test to look for differences in accuracy scores for the three Internet search engines.RESULTS:A total of 600 webpages were reviewed. Kendall’s W for the raters was 0.71 (p<0.0001). Spearman’s rho for test-retest reliability was 0.72 (p<0.0001). There was no difference in scores based on Internet search engine. We found a significant difference in scores based on the webpage’s order on the Internet search engine webpage (p=0.007). Pairwise comparisons revealed higher scores in the first webpages vs. the fourth (corr p=0.009) and fifth (corr p=0.017). However, this significance was lost when creating composite scores.CONCLUSIONS:The five point scoring system to assess diagnostic accuracy of Internet search engines is a valid and reliable instrument. The scoring system may be used in future Internet research.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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January 24, 2014 Posted by | health care | , , , , , , , , , , | Leave a comment

[Press Release] Greatest economic burden shouldered by African-American and Hispanic men

From the 22 January 2014 press release

Greatest economic burden shouldered by African-American and Hispanic men

African-American men incurred $341.8 billion in excess medical costs due to health inequalities between 2006 and 2009, and Hispanic men incurred an additional $115 billion over the four-year period, according to a new study by researchers at the Johns Hopkins Bloomberg School of Public Health. The study, published this week in the International Journal of Men’s Health, looks at the direct and indirect costs associated with health inequalities and projects the potential cost savings of eliminating these disparities for minority men in the U.S.

“Health disparities have a devastating impact on individuals and families, and they also affect society as a whole,” said Roland J. Thorpe, Jr., PhD, lead author of the study and Assistant Professor at the Johns Hopkins Bloomberg School of Public Health and Director of the Program for Research on Men’s Health in the Johns Hopkins Center for Health Disparities Solutions. “Quantifying the economic impact of health inequalities among men highlights how enormous a societal problem this is.”

Researchers used data from the Agency for Health Care Research and Quality’s 2006-2009 Medical Expenditure Panel Survey (MEPS) to determine the prevalence of a variety of health statuses and conditions (for example, fair/poor health, obesity, diabetes, heart disease) among each racial/ethnic group (African American, Asian, Hispanic and white). This information was incorporated in statistical models to estimate the total direct medical costs and the proportion of costs incurred due to health disparities for each group. The direct medical expenditures for African-American men over the four-year period totaled $447.6 billion; and 5.4 percent, or $24.2 billion, were excess costs attributed to health disparities. There were no excess direct costs due to health disparities for the other racial/ethnic groups over the four year period.

The indirect costs of lower worker productivity due to illness and premature death were calculated using data from MEPS and the CDC’s National Vital Statistics System. Over the four-year period, these factors cost the economy a total of $436.3 billion—lower worker productivity due to illness contributed $28 billion in excess costs, and premature death contributed $408.3 billion. Of the total indirect costs, African-American men accounted for $317.6 billion, or 72 percent; indirect costs totaled $115 billion for Hispanic men and $3.6 billion for Asian men.

“These stark findings underscore the fact that we can’t afford to overlook men’s health disparities that exist in this country,” added Thorpe. “The cost to society—both moral and economic—is staggering.”

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January 23, 2014 Posted by | health care | , , , | Leave a comment

[Press release] Health disparities among US African-American and Hispanic men cost economy more than $450 billion

From the 22 January 2014 press release

Greatest economic burden shouldered by African-American and Hispanic men

African-American men incurred $341.8 billion in excess medical costs due to health inequalities between 2006 and 2009, and Hispanic men incurred an additional $115 billion over the four-year period, according to a new study by researchers at the Johns Hopkins Bloomberg School of Public Health. The study, published this week in the International Journal of Men’s Health, looks at the direct and indirect costs associated with health inequalities and projects the potential cost savings of eliminating these disparities for minority men in the U.S.

“Health disparities have a devastating impact on individuals and families, and they also affect society as a whole,” said Roland J. Thorpe, Jr., PhD, lead author of the study and Assistant Professor at the Johns Hopkins Bloomberg School of Public Health and Director of the Program for Research on Men’s Health in the Johns Hopkins Center for Health Disparities Solutions. “Quantifying the economic impact of health inequalities among men highlights how enormous a societal problem this is.”

Researchers used data from the Agency for Health Care Research and Quality’s 2006-2009 Medical Expenditure Panel Survey (MEPS) to determine the prevalence of a variety of health statuses and conditions (for example, fair/poor health, obesity, diabetes, heart disease) among each racial/ethnic group (African American, Asian, Hispanic and white). This information was incorporated in statistical models to estimate the total direct medical costs and the proportion of costs incurred due to health disparities for each group. The direct medical expenditures for African-American men over the four-year period totaled $447.6 billion; and 5.4 percent, or $24.2 billion, were excess costs attributed to health disparities. There were no excess direct costs due to health disparities for the other racial/ethnic groups over the four year period.

The indirect costs of lower worker productivity due to illness and premature death were calculated using data from MEPS and the CDC’s National Vital Statistics System. Over the four-year period, these factors cost the economy a total of $436.3 billion—lower worker productivity due to illness contributed $28 billion in excess costs, and premature death contributed $408.3 billion. Of the total indirect costs, African-American men accounted for $317.6 billion, or 72 percent; indirect costs totaled $115 billion for Hispanic men and $3.6 billion for Asian men.

“These stark findings underscore the fact that we can’t afford to overlook men’s health disparities that exist in this country,” added Thorpe. “The cost to society—both moral and economic—is staggering.”

 

 

 

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January 23, 2014 Posted by | health care | , , , | Leave a comment

[Reblog] Aging Parent Hospitalizations and Observation Status

Originally posted on As Our Parents Age:

Just when you think that you have settled the most significant adult child-aging parent issues — when you and your parents have spoken about medical care support, finances, and the range of their end-of-life wishes — along comes another concern to worry about, and it’s one that may be completely out of our control.

Medicare ObservationWe now need to be concerned about the possibility of a parent entering a hospital and assigned to observation status for several days. Observation means that, rather than being officially admitted as a patient, the person is there to be watched, sort of like an out-patient, but not really an out-patient. The problem is, it’s difficult to discover what status a hospital assigns a patient  — the two look almost alike with nurses, doctors, hospital rooms, blood pressure checks, etc.  Admission and observation do not look that different to the patient and family, and apparently many hospitals…

View original 787 more words

January 23, 2014 Posted by | health care | , | Leave a comment

What does it take to make healthcare more accessible? – GE Step Ahead Initiative – Moneycontrol

What does it take to make healthcare more accessible? – GE Step Ahead Initiative – Moneycontrol.

[Not endorsing GE, this article is for informational purposes only]

Excerpt from the [January 2014?] article at money control.com by Gopi Katragadda

I spent quality time in the recent weeks with a small working group developing an understanding of affordable healthcare. As a part of this exercise, I visited several hospitals and met with technology providers. Also, I researched a good amount of literature on the future of healthcare across the globe. I was surprised to learn that affordable healthcare is a significant problem not only in the emerging economies, but in the western world as well. In the US, as an example, 27% of the population has serious problems paying their medical bills. In India, lower unit costs for healthcare are accomplished through higher throughput; however, cost in general and accessibility in rural areas still remain areas of concern.

Based on my observations so far, mobility, simplicity, and automation are the three primary axes of making healthcare more accessible.

Read the entire article here

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January 23, 2014 Posted by | health care | Leave a comment

[Reblog] The hallucinated demons of intensive care « Mind Hacks

The hallucinated demons of intensive care 

From the 7 January 2014 article at Mind Hacks

Screen Shot 2014-01-23 at 4.03.52 AM

http://www.maquet.com/images/
thumbs/320_Solutions_Intensive_Care.jpg

I’ve got an article in The Observerabout the psychological impact of being a patient in intensive care that can include trauma, fear and intense hallucinations.

This has only been recently recognised as an issue and with mental disorders being detected in over half of post-ICU patients it has sparked a serious re-think of how ICU should be organised to minimise stress.

Some of the most spectacular experiences are intense hallucinations and delusions that can lead to intrusive and surreal flashbacks that can have effects long after the person has become medically stable.

Wade interviewed patients about the hallucinations and delusions they experienced while in intensive care. One patient reported seeing puffins jumping out of the curtains firing blood from guns, another began to believe that the nurses were being paid to kill patients and zombify them. The descriptions seem faintly amusing at a distance, but both were terrifying at the time and led to distressing intrusive memories long after the patients had realised their experiences were illusory.

Many patients don’t mention these experiences while in hospital, either through fear of sounding mad, or through an inability to speak – often because of medical breathing aids, or because of fears generated by the delusions themselves. After all, who would you talk to in a zombie factory?

One of the interesting aspects is how standard ICU care is incredibly stressful and uncomfortable experience. I quote Hugh Montgomery, a professor of intensive care medicine, who says “If you think about the sort of things used for torture you will experience most of them in intensive care”!

Anyway, more at the link below.
Link to ‘When intensive care is just too intense’ in The Observer.

 

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January 23, 2014 Posted by | health care, Psychology | , , | Leave a comment

[News article] Seniors moving to homecare based services face more hospital risk

Seniors moving to homecare based services face more hospital risk.

From the 8 January 2014 ScienceDaily article

Screen Shot 2014-01-23 at 3.55.44 AM

… Aging-in-Place House Plans by Nicolleli Architects. [not an endorsement]

Seniors want greater access to home- and community-based long-term care services. Medicaid policymakers have been happy to oblige with new programs to help people move out of expensive nursing homes and into cheaper community or home care. It seems like a “win-win” to fulfill seniors’ wishes while also saving Medicaid programs money, but a new study of such transitions in seven states finds that the practice resulted in a 40 percent greater risk of “potentially preventable” hospitalizations among seniors dually eligible for Medicaid and Medicare.

“We are trying to move people into the community and I think that is a really great goal, but we aren’t necessarily providing the medical support services that are needed in the community,” said Andrea Wysocki, a postdoctoral scholar in the Brown University School of Public Health and lead author of the study published online in the Journal of the American Geriatrics Society. “One of the policy issues is how do we care for not only the long-term care needs when we move someone into home- and community-based settings but also how do we support their medical needs as well?”

Wysocki said her finding of a higher potentially preventable hospitalization risk for seniors who transitioned to community- or home-based care suggests that some medical needs are not as well addressed in community settings as they are in nursing homes. More vigilant and effective treatment for chronic, already-diagnosed ailments such as chronic obstructive pulmonary disease could prevent some of the hospitalizations that occur.

There are two likely reasons why care in home and community settings is not as effective in preventing hospitalizations, Wysocki said.

[One]Nursing homes provide round-the-clock care by trained nurses and doctors, but workers with much less medical training provide community- and home-care services.

[Two] In addition, while Medicaid pays for long-term care, Medicare pays for medical care, meaning that Medicaid programs do not have a built-in financial incentive to prevent hospitalizations. Home- and community-based care is less expensive for Medicaid regardless of the medical outcome.

Read the entire article here

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January 23, 2014 Posted by | health care, Uncategorized | , | Leave a comment

Newly published survey shows drug shortages still have major impact on patient care

Newly published survey shows drug shortages still have major impact on patient care.

According to newly published results from a survey of pharmacy directors, drug shortages remain a serious problem for patient safety. Nearly half of the responding directors reported adverse events at their facilities due to drug shortages, including patient deaths.

Screen Shot 2014-01-22 at 5.24.47 AMIn 2009, the American Society of Health-System Pharmacists put drug shortage management guidelines in place for health care providers to try and minimize negative impacts patient care, and in 2011, following an Executive Order from President Barak Obama on reducing drug shortages, the U.S. Food and Drug Administration (FDA) increased its efforts to prevent and resolve drugs shortages. While the FDA recently reported that the number of new shortages in 2012 was down to 117, from 251 in 2011, drug shortages are still having a major impact on patient care.

A common practice to help mitigate the problems caused by a drug shortage is to use an alternative medication when possible. Even when alternate medication can be used, there can be many unintended consequences and additional side effects. In general, drug shortages have been known to cause, or contribute to a variety of issues, which were also represented in the newly published survey responses including:

  • Medication errors (such as wrong dose, wrong drug, wrong frequency),
  • Increased institutional costs,
  • Cancelled care, and
  • Delayed treatment.

In addition to the more well-known impacts, the new JMCParticle revealed that nearly 10 percent of the reported adverse patient outcomes were increased readmissions due to drug shortage related treatment failures.

Read the entire article here

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January 22, 2014 Posted by | health care | | Leave a comment

Study: Providing dental insurance not enough to induce americans to seek care

Study: Providing dental insurance not enough to induce americans to seek care.

 

English: ADA/Dental Health on US postage stamp

English: ADA/Dental Health on US postage stamp (Photo credit: Wikipedia)

Providing people with dental insurance does not necessarily mean that they will use it and seek dental care, according to a new study from the University of Maryland School of Dentistry, published online in the American Journal of Public Health. The research suggests that outreach and education are needed to ensure that people value their dental health and use their coverage to seek appropriate dental care. The study has particular value in this era of health reform, and the researchers hope that policymakers will use the findings in designing future programs and initiatives, according to first author Richard J. Manski, DDS, MBA, PhD, professor and chief of Dental Public Health at the University of Maryland School of Dentistry.

 

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January 22, 2014 Posted by | health care | , , , | Leave a comment

Does taking multiple medicines increase risk of being admitted to hospital? Yes and no

Does taking multiple medicines increase risk of being admitted to hospital? Yes and no.

From the 14 January 2014 article

Patients with a single illness who take many drugs have an increased risk of being admitted to hospital, but for patients with multiple conditions, taking many medicines is now associated with a near-normal risk of admission. This is the key finding of work published in the British Journal of Clinical Pharmacology. Doctors call the situation where people take many drugs ‘polypharmacy’, a state of affairs that is becoming increasingly common in part because we have more elderly people and also a rising number of people are being diagnosed with multiple health conditions.

Dr Payne says that previous studies have missed the different effect that polypharmacy has in different people because they used overly simplistic approaches when looking at the effect of taking many drugs at once. He points out that their new work demonstrates the need for more sophisticated and nuanced approaches when measuring the impact of polypharmacy in future clinical research.

Medicine drugs

Medicine drugs (Photo credit: Wikipedia)

Dr Payne says that previous studies have missed the different effect that polypharmacy has in different people because they used overly simplistic approaches when looking at the effect of taking many drugs at once. He points out that their new work demonstrates the need for more sophisticated and nuanced approaches when measuring the impact of polypharmacy in future clinical research.

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January 22, 2014 Posted by | Consumer Health, health care | , , , , | Leave a comment

[Repost] Most practice guideline recommendations based on less-than-ideal quality of evidence

Most practice guideline recommendations based on less-than-ideal quality of evidence.

From the 15 January 2014 Mayo Clinic NewsNetwork article by Shelly Plutowski (@rwp01)

ROCHESTER, Minn. — Jan. 15, 2014 — A study published in the January issue of Mayo Clinic Proceedings shows that most clinical practice guidelines for interventional procedures (e.g., bronchoscopy, angioplasty) are based on lower-quality medical evidence and fail to disclose authors’ conflicts of interest.

“Guidelines are meant to create a succinct roadmap for the diagnosis and treatment of medical conditions by analyzing and summarizing the increasingly abundant medical research,” write Joseph Feuerstein, M.D., and colleagues from Beth Israel Deaconess Medical Center. “Guidelines are used as a means to establish a standard of care … However, a guideline’s validity is rooted in its development process.”

Journalists: Sound bites with Dr. Talwalkar are available in the downloads.

In an accompanying editorial, Jayant Talwalkar, M.D., associate medical director of theValue Analysis Program in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, says that the study further illustrates that existing guidelines are highly variable with respect to evidence quality and transparency.

“Most of the current practice guidelines in circulation do not meet criteria that represent trustworthiness as defined by the Institute of Medicine,” Dr. Talwalkar says.

Dr. Talwalkar also points out that more attention needs to be paid to potential conflicts of interest among guideline authors and guideline development panels.

“There is a growing body of literature documenting the existence of one or more potential conflicts of interest reported for authors or members of guideline development panels,” he says. “As a result, the influence of external activities such as consulting or speaking fees, research grant funding and stock ownership has the potential to create significant bias and uncertainty for issued recommendations.”

Dr. Talwalkar notes that up to 80 percent of recommendations from most guidelines are supported by evidence from non-randomized studies or expert consensus opinion, making conflict of interest disclosure crucial.

Dr. Talwalkar says that, in the future, the guideline-writing process must evolve to include more concise and up-to-date recommendations as well as more transparency about the management of potential conflicts of interest.

Read the entire article here

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January 21, 2014 Posted by | health care, Medical and Health Research News | , | Leave a comment

Patients with learning disabilities become ‘invisible’ in hospitals, says study

Patients with learning disabilities become ‘invisible’ in hospitals, says study.

From the 17th January 2014 ScienceDaily article

Hospital patients with learning disabilities face longer waits and mismanaged treatment due to a failure to understand them by nursing staff, says a new report.

In one case, a patient who had problems making herself understood was accused of being drunk by hard pressed hospital staff.

It is estimated that one in 50 people in England have some form of learning disabilities such as Down’s syndrome.

Dr Irene Tuffrey-Wijne, senior research fellow in nursing at St George’s, University of London and Kingston University, said: “People with learning disabilities are largely invisible within the hospitals, which meant that their additional needs are not recognised or understood by staff.

“Our study found many examples of good practice, but also many examples where the safety of people with learning disabilities in hospitals was at risk.”

Dr Tuffrey-Wijne, a co-author of the study who works at the Faculty of Health, Social Care and Education, a partnership between the two universities, added: “The most common safety issues were delays and omissions of care and treatment.

“Some examples come down to basic nursing care like providing enough nutrition but other serious consequences were also seen in our study.

It found that the main barrier to better and safer care was a lack of effective flagging systems, leading to a failure to identify patients with learning disabilities in the first place.

 

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January 21, 2014 Posted by | health care | , , , , , | Leave a comment

[Reblog] Physicians discuss willingness to write prescriptions for health apps

From the 18th January 2014 at Scope (published by Stanford Medicine)

By   

health_appsThe mobile health market is rapidly growing, and it’s estimated that within five years 50 percent of mobile device users will have downloaded mobile health apps. While past surveys haveshown that patients are eager for doctors to recommend such apps, it remains unclear if physicians feel comfortable prescribing them.

Over on MedPage Today, writer Kristina Fiore explores the potential of physicians prescribing health apps, such as BlueStar, which is approved by the U.S. Food and Drug Administration and helps patients monitor diabetes. Several of the clinicians contacted for the story said they are open to the idea, assuming that patients are comfortable using the app and that data shows the app to be effective. From the article:

Sue Kirkman, MD, of the University of North Carolina at Chapel Hill, said a prescription app could be helpful, but its usefulness may be limited in that the patients “who want the app and are willing to enter data and respond to prompts may already be the more proactive ones.”

Kirkman added that she hopes potential insurer reimbursement for apps opens the door wider to support of reimbursement for self-management tools such as contact with diabetes educators.

“Right now, pretty much only face-to-face visits are covered, not the ongoing contacts by phone, fax, email, etc., that are really needed to help someone sustain behavior changes and self-manage their diabetes optimally,” she said.

Previously: Text message reminders shown effective in boosting flu shot rates among pregnant womenTexts may help people with diabetes manage care, Why physicians should consider patients’ privacy before recommending health, fitness apps and Designing a mobile app to help patients and doctors identify personalized food triggers
Photo by Intel Free Press

Will Docs Write Rx for Apps?[Medpage Today]

Doctors can now write scripts for the first prescription-only app — but the question remains whether they’ll pick up a prescription pad to write for mobile technology.

The app, BlueStar, is a tracker for patients with diabetes. It analyzes logged blood glucose data and offers advice based on trends it detects — such as telling patients to adjust their diets based on sugar levels after meals. Clinicians also receive a report on their patients’ progress.

Parent company WellDoc just won $20 million in venture financing for the app, and the company has a track record of success with online disease management tools and applications. WellDoc’s argument is that better blood sugar control will lead to better patients outcomes, and, thus, less spending on healthcare in the long run.
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January 21, 2014 Posted by | Consumer Health, health care | , , , , , , , | Leave a comment

[Reblog] How Medicaid affects adult health — Study: Health insurance helps lower-income Americans avoid depression, diabetes, major financial shocks | Full Text Reports…

How Medicaid affects adult health — Study: Health insurance helps lower-income Americans avoid depression, diabetes, major financial shocks | Full Text Reports….

 

From the 10 January 2014 Full Text Report

 

January 10, 2014

How Medicaid affects adult health — Study: Health insurance helps lower-income Americans avoid depression, diabetes, major financial shocks
Source: New England Journal of Medicine (via MIT)

Enrollment in Medicaid helps lower-income Americans overcome depression, get proper treatment for diabetes, and avoid catastrophic medical bills, but does not appear to reduce the prevalence of diabetes, high blood pressure and high cholesterol, according to a new study with a unique approach to analyzing one of America’s major health-insurance programs.

The study, a randomized evaluation comparing health outcomes among more than 12,000 people in Oregon, employs the same research approach as a clinical trial, but applies it in a way that provides a window into the health outcomes of poor Americans who have been given the opportunity to get health insurance.

“What we found was that Medicaid significantly increased the probability of being diagnosed with diabetes, and being on diabetes medication,” says Amy Finkelstein, the Ford Professor of Economics at MIT and, along with Katherine Baicker of Harvard University’s School of Public Health, the principal investigator for the study. “We find decreases in rates of depression, and we continue to find reduced financial hardship. However, we were unable to detect a decline in the incidence of diabetes, high blood pressure, or high cholesterol.”

 

 

 

 

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January 20, 2014 Posted by | health care | , , | Leave a comment

Dental Care Coverage and Use: Modeling Limitations and Opportunities | Full Text Reports…

Dental Care Coverage and Use: Modeling Limitations and Opportunities | Full Text Reports….

Source: American Journal of Public Health

Objectives.
We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage.

Methods.
We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use.

Results.
Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth.

Conclusions.
Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use.

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January 20, 2014 Posted by | health care | , , , , , | Leave a comment

[Reblog] Fight for access to Medicare payments to physicians nearly over

From the 15 January 2014 article at Covering Health-Monitoring the Pulse of Health Care Journalism

Charles Ornstein

Charles Ornstein is a senior reporter with ProPublica in New York. The Pulitzer Prize-winning writer is a member of the Association of Health Care Journalists’ board of directors and past president.

(Editor’s note: This is a revision of the original post, which is available on Ornstein’s Tumblr site.)

The Centers for Medicare and Medicaid Services (CMS) said yesterday that it will soon begin releasing data on payments to individual physicians in the Medicare program.

Why is this such a big deal?

Because it overturns a longstanding agency policy that for more than three decades had barred the release of this very information. And, it follows advocacy for greater transparency by numerous news organizations, including the Association of Health Care Journalists.

CMS-9-3-13-1AHCJ’s board of directors last September sent a letter of comment to CMS asserting the public’s interest in release of this information. “As long as patient confidentiality is protected, we see no reason why taxpayers should not know how individual physicians are spending public dollars,” said the letter, signed by AHCJ executive director Len Bruzzese.

As this fight has played out, CMS released data to ProPublica on which drugs physicians prescribe in Medicare’s drug program, known as Part D. You can now look up your doctor’s prescribing patterns online.

 

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January 19, 2014 Posted by | health care | , , , | Leave a comment

STATISTICAL BRIEF #424: The Long-Term Uninsured in America, 2008-2011 (Selected Intervals): Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65

Screen Shot 2014-01-12 at 6.41.00 AM

STATISTICAL BRIEF #424: The Long-Term Uninsured in America, 2008-2011 (Selected Intervals): Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65.

    From the Web page of the Medical Expenditure Panel Survey

November 2013
Jeffrey A. Rhoades, PhD and Steven B. Cohen, PhD

Highlights

  • Approximately 20.4 million people, 7.6 percent of the population under age 65, were uninsured for the four-year period from 2008 through 2011. The percentage of long-term uninsured exceeded 10 percent for some younger adult age groups.
  • Adults ages 18 to 24 and 25 to 29 were the most likely to be uninsured for at least one month (48.0 and 46.9 percent, respectively) during 2010-2011. Children under age 18 were the least likely to be uninsured for the full four-year period from 2008-2011 (2.3 percent).
  • Individuals reported to be in excellent or very good health status were the least likely to be uninsured for at least one month during 2010 to 2011 (26.6 and 31.1 percent, respectively).
  • Hispanics were most likely to be uninsured for at least one month during 2010 to 2011 (47.8 percent) and for 2008-2011 (17.4 percent).
  • Hispanics were disproportionately represented among the long-term uninsured. While they represented 18.2 percent of the population under age 65, they comprised 41.5 percent of the long-term uninsured for 2008-2011.
  • Individuals who were poor, near poor, and low income were represented disproportionately among the long-term uninsured. While poor individuals represented 16.8 percent of the population under age 65, they represented 29.9 percent of those uninsured for 2008-2011.

 

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January 12, 2014 Posted by | health care | , , , | Leave a comment

[Reposting] A medical-testing lesson from Minnesota: Less can be more

 

The state’s approach to cutting unneeded medical scans could be a model for federal Medicare savings.

Screen Shot 2014-01-07 at 3.15.32 PM

 

From the 6 January 2013 article at Star Tribune – Health

 

A novel strategy that has saved Minnesota millions of dollars in unnecessary medical-imaging scans — and probably prevented dozens of patient deaths — might soon go national.

Leaders from Minnesota’s medical and insurance communities met Monday morning to celebrate the project — which has leveled off the skyrocketing growth of MRI and CT scans for back pain, headaches and other problems — and to promote legislation by Rep. Erik Paulsen that would bring it to bear on the federal government’s vast Medicare program.

Minnesota’s “decision support” strategy, enacted in 2006, created a single set of standards for doctors to follow in deciding when patients need the costly scans. It also created a green-yellow-red coding system to show patients when scans were recommended and when they weren’t. The use of such scans, which had been growing at a 7 percent annual clip, grew just 1 percent from 2007 to 2012.

….officials in other states often view Minnesota as “quite peculiar” because of its small, cooperative community of insurers and physician groups, and don’t believe its innovations can be repeated elsewhere, said Dr. Pat Courneya, medical director of HealthPartners, the Bloomington-based health plan.

Getting this type of approach to succeed in Medicare, on the other hand, would cause it to spread to other states, he said.

More than 80 percent of imaging scans in Minnesota are now ordered only after doctors seek out decision-support guidance to make sure they are recommended based on their patients’ conditions and medical histories.

Courneya said the initial guidelines were based on the clinical expertise and recommendations of Minnesota doctors. They have since been revised as studies refine when imaging scans should be used. Research, for example, has identified the types of patients who are suitable for scans to screen for breast or lung cancers.

 

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January 7, 2014 Posted by | health care | , , , , , | Leave a comment

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