Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] Germs. The pseudoscience of quality improvement

hmmm…position justifications? power plays?

C-Dif

From the 7 December 2014 post by Karen Siebel, MD at the HealthCare Blog

No one wants a hospital-acquired infection—a wound infection, a central line infection, or any other kind.  But today, the level of concern in American hospitals about infection rates has reached a new peak—better termed paranoia than legitimate concern.

The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies.  As far as I can tell, these new rules are made up by people who are under pressure to create the appearance that action is being taken.

Here’s an example.  An edict just came down in one big-city hospital that all scrub tops must be tucked into scrub pants. The “Association of periOperative Registered Nurses” (AORN) apparently thinks that this is more hygienic because stray skin cells may be less likely to escape, though there is no data proving that surgical infection rates will decrease as a result.  Surgeons, anesthesiologists, and OR nurses are confused, amused, and annoyed in varying degrees.  Some are paying attention to the new rule, and many others are ignoring it.  One OR supervisor stopped an experienced nurse and told to tuck in her scrub top while she was running to get supplies for an emergency aortic repair, raising (in my mind at least) a question of misplaced priorities.

The Joint Commission, of course, loves nothing more than to make up new rules, based sometimes on real data and other times on data about as substantial as fairy dust.

A year or two ago, another new rule surfaced, mandating that physicians’ personal items such as briefcases must be placed in containers or plastic trash bags if they are brought into the operating room.  Apparently someone thinks trash bags are cleaner.

Now one anesthesiology department chairman has taken this concept a step further, decreeing that no personal items at all are to be brought into the operating room–except for cell phones and iPods.  That’s right, iPods, not iPads.  This policy (of course) probably won’t be applied uniformly to high-ranking surgeons or to people like the pacemaker technicians who routinely bring entire suitcases of equipment into the OR with them.

What’s particularly irrational about this rule is that cell phones likely are more contaminated with bacteria than briefcases or purses, even if they’re wiped off frequently.

 

Instead of creating more and more rules governing the care of all patients, perhaps we need to focus on the subsets of patients and case types that we already know are at higher risk, and examine what additional steps we need to take on their behalf.

 

 

 

December 9, 2014 Posted by | health care | , , , , , , , | Leave a comment

[Press release] Distrust of police is top reason Latinos don’t call 911 for cardiac arrest

Distrust of police is top reason Latinos don’t call 911 for cardiac arrest.

From the 4 December 2014 EurkAlert

WASHINGTON – Fear of police, language barriers, lack of knowledge of cardiac arrest symptoms and financial concerns prevent Latinos – particularly those of lower socioeconomic status – from seeking emergency medical help and performing cardiopulmonary resuscitation (CPR), according to a study published online yesterday in Annals of Emergency Medicine (“Barriers to Calling 911 and Learning and Performing Cardiopulmonary Resuscitation (CPR) for Residents of Primarily Latino, High-Risk Neighborhoods in Denver, Colorado”).

English: CPR training

English: CPR training (Photo credit: Wikipedia)

“Residents of low-income, minority neighborhoods have two strikes against them: the incidence of out-of-hospital cardiac arrest is much higher than average and rates of bystander CPR are below average,” said lead study author Comilla Sasson, MD, PhD, FACEP of the American Heart Association and the University of Colorado School of Medicine in Aurora, Colo. “We need to do a better job of overcoming the significant barriers to timely medical care for Latinos suffering cardiac arrest. Culturally sensitive public education about cardiac arrest and CPR is a key first step.”

Researchers conducted focus groups and interviews with residents of primarily lower-income Latino neighborhoods in Denver to determine why they underutilize 9-1-1 emergency services and how to increase knowledge and performance of CPR on people suffering cardiac arrest. General distrust of law enforcement, of which 9-1-1 services are bundled, was cited as a top reason for not calling 9-1-1 by most participants.

Many subjects also believed – incorrectly – that they would not be able to ride an ambulance to the hospital without first paying for it, as that is the practice in Mexico where many participants came from. Subjects also expressed a lack of understanding about the symptoms of cardiac arrest and how CPR can save a life. Strong reticence about touching a stranger for fear that it might be misconstrued was a unique cultural barrier to performing CPR. Language barriers – either with 9-1-1 dispatchers or first responders – also inhibited subjects from getting involved with someone experiencing cardiac arrest.

In the interest of educating more people on how to perform CPR, participants widely supported policy changes that would make CPR either a high school graduation requirement or a pre-requisite for receiving a driver’s license.

“Future research will need to be conducted to better understand how targeted, culturally-sensitive public education campaigns may improve the provision of bystander CPR and cardiac arrest survival rates in high-risk neighborhoods,” said Dr. Sasson.

###

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit http://www.acep.org.

December 5, 2014 Posted by | health care, Medical and Health Research News | , , , , , , | Leave a comment

[Report] Surveying Health Care Quality & Value

Surveying Health Care Quality & Value

From the 24 November 2014 Robert Woods Foundation report

Recent years have brought numerous efforts to educate and engage Americans in what “quality” health care is, how to find it and how they can get better value for their dollars. To better understand the latest trends, the Robert Wood Johnson Foundation funded the AP-NORC Center for Public Affairs Research at the University of Chicago to conduct three surveys through the summer and fall of 2014.

The surveys each individually examined how consumers and employers, as purchasers, perceive health care quality and how they use quality information and performance data on health plans and providers. Learn more about the research and access links to the full reports with accompanying materials.

 

 A medical assistant checks a patient's blood pressure and pulse.

Consumer Awareness of Provider Quality and Value

A number of initiatives in recent years have aimed at engaging consumers in making informed health care decisions, including empowering patients and their caregivers with data on provider quality, performance, cost and value. The first in the series of surveys looks at the inroads these efforts have made.

Thirty-seven percent of respondents don’t believe that higher health care costs correlate with better quality care—but 48 percent think they do. The poll also found that more than two-thirds say finding a doctor or hospital that offers the highest quality at the lowest possible cost is important to them. The survey also showed getting Americans to find quality information and use it in their health care decisions remains a challenge, with only 11 percent of Americans reporting they have done so.

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See the full survey results

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Cost- and Coverage-Based Decision-Making

As more provisions of the Affordable Care Act (ACA) are implemented over the next decade, the government projects that approximately 12 million additional people younger than 65 will enter the private insurance market. The second in the series of surveys looks at consumer opinions on health care costs and coverage, and how it impacts their decision-making.

It shows that nearly a fifth of insured Americans report skipping a trip to the doctor when they’re sick or injured to save money, and only 36 percent are confident they can pay for a major, unexpected medical expense. Those enrolled in health plans with high deductibles are greatly impacted by the out-of-pocket cost of health care—they are concerned with the uncertainty of major expenses, skip necessary medical treatment, and experience real financial burden when obtaining health care.

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See the full survey results

Billboard Illustration for SHADAC ESI Report April 2013

Employers Use of Quality Information in Purchasing

As a group, employers represent the largest purchaser of care in the United States. Given this, it is critical that they demand good value for the money they spend, ensuring that the plans offered to employees be high quality. The third and final report in the series of surveys looks at the opinions of private sector employers, including small-, medium- and large-sized businesses.

It shows that American firms are hesitant to say they would pay more for higher quality care, and when it comes to measuring quality, 90 percent don’t know or don’t use independent quality information when deciding on what plans to offer employees. And while many employers are indeed providing wellness programs to benefit their employees’ health, relatively few are actively promoting those programs or offering incentives for participation.

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

[Press Release] Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided

Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided

From the US Health and Human Services press release

Hospital-acquired conditions decline by 17 percent over a three-year period

A report released by the Department of Health and Human Services today shows an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013.  This progress toward a safer health care system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events. The efforts were due in part to provisions of the Affordable Care Act such as Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative.  Preliminary estimates show that in total, hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013.  This translates to a 17 percent decline in hospital-acquired conditions over the three-year period.

“Today’s results are welcome news for patients and their families,” said HHS Secretary Sylvia M. Burwell. “These data represent significant progress in improving the quality of care that patients receive while spending our health care dollars more wisely.  HHS will work with partners across the country to continue to build on this progress.”

Today’s data represent demonstrable progress over a three-year period to improve patient safety in the hospital setting, with the most significant gains occurring in 2012 and 2013. According to preliminary estimates, in 2013 alone, almost 35,000 fewer patients died in hospitals, and approximately 800,000 fewer incidents of harm occurred, saving approximately $8 billion.

Hospital-acquired conditions include adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers, and surgical site infections, among others.  HHS’ Agency for Healthcare Research and Quality (AHRQ) analyzed the incidence of a number of avoidable hospital-acquired conditions compared to 2010 rates and used as a baseline estimate of deaths and excess health care costs that were developed when the Partnership for Patients was launched. The results update the data showing improvement for 2012 that were released in May.

“Never before have we been able to bring so many hospitals, clinicians and experts together to share in a common goal – improving patient care,” said Rich Umbdenstock, president and CEO of the American Hospital Association. “We have built an ‘infrastructure of improvement’ that will aid hospitals and the health care field for years to come and has spurred the results you see today. We applaud HHS for having the vision to support these efforts and look forward to our continued partnership to keep patients safe and healthy.”

Additional Information

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

Online Health Care Data Sources | Brookings Institution

Online Health Care Data Sources | Brookings Institution.

 

From the Web site

This is a preliminary scan of publicly available online health care datasets, transparency websites and tools, gathered from expert recommendations and intensive review. Though this list is not exhaustive, we have attempted to include the most relevant sources for the purposes of this study. Each health data source is assigned an icon representing (1) who the source is useful to i.e. consumers or researchers; (2) what information the source includes i.e. data pertaining to quality of care or cost of care; and (3) who the source provides information on i.e. providers or payers.

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

[News item] Parents skipping needed care for children, pediatricians say | Association of Health Care Journalists

Parents skipping needed care for children, pediatricians say | Association of Health Care Journalists.

Joseph Burns

 

Photo: Alex Prolmos via Flickr

High-deductible health plans (HDHPs) discourage families from seeking primary care for their children, according to the American Association of Pediatricians. The problem is so severe that the federal government should consider limiting HDHPs to adults only, the AAP said in a policy statement published in Pediatrics.

“HDHPs discourage use of nonpreventive primary care and thus are at odds with most recommendations for improving the organization of health care, which focus on strengthening primary care,” the association said in its statement. Under the Affordable Care Act, preventive services are covered in full without charge.

This is the second time in as many months that a report has shown consumers skipping needed care because of the cost. Last month, we reported that out-of-pocket health care costs force one out of every eight privately insured Americans to skip necessary medical treatment, according to the survey from the AP-NORC Center, “Privately Insured in America: Opinions on Health Care Costs and Coverage.” The Robert Wood Johnson Foundation funded the survey. In a report earlier this month, “Too High a Price: Out-of-Pocket Health Care Costs in the United States,” the Commonwealth Fund expressed similar concerns.

In an article about the policy statement, Alyson Sulaski Wyckoff, associate editor of Pediatrics, quoted Budd Shenkin, M.D., the lead author of the AAP’s policy statement on HDHPs, saying parents are so concerned about the cost of care that they don’t bring in their children when they should. “They’re reluctant to come in, they seek more telephone care, they’re reluctant to complete referrals, and they’re reluctant to come back for appointments to follow up on an illness,” he said.

For children with chronic conditions, foregoing care can exacerbate illnesses, said Thomas F. Long, M.D., chair of the association’s Committee on Child Health Financing. “If it’s going to cost them out-of-pocket money, they may say, ‘Well, it’s just a cold, I don’t need to see the doctor.’ And ‘just a cold, turns into ‘just pneumonia,’” he added.

The problem of delaying necessary care is one Paul Levy addressed in his blog, Not Running a Hospital, about HDHPs. “Beyond the sad impact on individual families in any given year, I fear that the economic backlash of these policies will be a deferment of needed health care treatments and a resulting future bulge of cost increases. We’re playing Whac-A-Mole here,” he wrote.

For the Commonwealth Fund, researchers found that among privately insured consumers across all income groups, low- and moderate-income adults were most likely to skip the health care they need because of high out-of-pocket costs.

It’s no surprise that adults with the lowest incomes were most likely to skip needed care, the fund reported. Among consumers earning less than $22,890 annually, 46 percent cited at least one example of skipping needed health care because of copayments or coinsurance: 28 percent did not fill a prescription; 28 percent skipped a medical test or follow-up treatment; 30 percent had a medical problem but did not see a doctor; and 24 percent did not see a specialist when needed.

When deductibles are high relative to income, consumers tend to skip care as well, and low- and moderate-income adults had the most trouble, the report showed. Consumers whose deductibles represent 5 percent or more of their income cited at least one example of skipping needed health care because of their deductible: 29 percent skipped a medical test or follow-up treatment; 27 percent had a medical problem but did not go to the doctor; 23 percent skipped a preventive care test; and 22 percent did not see a specialist despite their physician’s advice.

For an article in Modern Healthcare, Bob Herman covered this topic well. He cited the case of a woman in Indiana who was searching for a health plan on HealthCare.gov. A single, 40-year-old nonsmoker, this woman could choose from 29 plans and 24 of them were considered HDHPs, he wrote.

Under IRS rules, (PDF) an HDHP in 2015 is defined as one that has an annual deductible of at least $1,300 for an individual and $2,600 for a family coverage and annual out-of-pocket costs that do not exceed $6,450 for individual or $12,900 for a family.

The Commonwealth Fund report showed that 13 percent of consumers with private health insurance had plans with a deductibles equivalent to 5 percent or more of their income; that figure includes 25 percent of adults with low incomes and about 20 percent of adults with moderate incomes ($11,490 to $45,960 a year for a single person).

November 28, 2014 Posted by | Consumer Health, health care | , , , , | Leave a comment

[Press release]Paper electronics could make health care more accessible

aPaper electronics could make health care more accessible.

From the 19 November 2014 EurekAlert

Flexible electronic sensors based on paper — an inexpensive material — have the potential to some day cut the price of a wide range of medical tools, from helpful robots to diagnostic tests. Scientists have now developed a fast, low-cost way of making these sensors by directly printing conductive ink on paper. They published their advance in the journal ACS Applied Materials & Interfaces.

Anming Hu and colleagues point out that because paper is available worldwide at low cost, it makes an excellent surface for lightweight, foldable electronics that could be made and used nearly anywhere. Scientists have already fabricated paper-based point-of-care diagnostic tests and portable DNA detectors. But these require complicated and expensive manufacturing techniques. Silver nanowire ink, which is highly conductive and stable, offers a more practical solution. Hu’s team wanted to develop a way to print it directly on paper to make a sensor that could respond to touch or specific molecules, such as glucose.

The researchers developed a system for printing a pattern of silver ink on paper within a few minutes and then hardening it with the light of a camera flash. The resulting device responded to touch even when curved, folded and unfolded 15 times, and rolled and unrolled 5,000 times. The team concluded their durable, lightweight sensor could serve as the basis for many useful applications.

November 25, 2014 Posted by | health care, Uncategorized | , , | Leave a comment

High-Cost Generic Drugs — Implications for Patients and Policymakers — NEJM

High-Cost Generic Drugs — Implications for Patients and Policymakers — NEJM.

Excerpt

It is well known that new brand-name drugs are often expensive, but U.S. health care is also witnessing a lesser-known but growing and seemingly paradoxical phenomenon: certain older drugs, many of which are generic and not protected by patents or market exclusivity, are now also extremely expensive. Take the case of albendazole, a broad-spectrum antiparasitic medication. Albendazole was first marketed by a corporate predecessor to GlaxoSmithKline (GSK) outside the United States in 1982 and was approved by the Food and Drug Administration (FDA) in 1996. Its patents have long since expired, but no manufacturer ever sought FDA approval for a generic version. One reason may be that the primary indications for the drug — intestinal parasites, neurocysticercosis, and hydatid disease — occur relatively rarely in the United States and usually only in disadvantaged populations such as immigrants and refugees. In late 2010, the listed average wholesale price (AWP) for albendazole was $5.92 per typical daily dose in the United States and less than $1 per typical daily dose overseas.

….

 

Meanwhile, there is little that individual consumers can do. Some drug companies, such as Amedra, offer assistance programs for indigent patients, but these programs often have complicated enrollment processes, and they do not offer an effective general safety net.5 Some patients instead seek to acquire these drugs in other countries, since many of them are widely and inexpensively available outside the United States, but such foreign sources may be of variable quality. Until regulatory and market solutions are implemented to reduce prices for these older drugs, patients requiring such drugs and the physicians treating them will continue to be faced with difficult choices.

November 25, 2014 Posted by | health care | , , | Leave a comment

[Reblog] Rewarding Patient Recovery | HealthWorks Collective

Rewarding Patient Recovery | HealthWorks Collective.

From the 6 November 2014 item at HealthWorks Collective

What if we paid for patient recovery rather than just patient services?

What if we paid to treat patients rather than just conditions?

What if we paid to personalize care rather just population health quality measures?

While these questions may sound academic, there is a groundswell of innovative healthcare providers working on the answers.  To realign the healthcare system to overall patient recovery and well-being, it will take physicians and other healthcare providers transforming the entire system. The good news is that this is quietly happening from within, with physicians, healthcare systems and health plans working together.

They include the over 500 Accountable Care Organizations6,500 providers considering bundled payment pilots and providers signing risk sharing agreements with health plans.  Physicians, healthcare systems and insurance plans are sharing data, sharing financial risk and focusing on improving overall patient outcomes and cost.

With little debate or fanfare outside the healthcare industry, Medicare quietly saved $372 million with their versions of the ACO. While some critics predict that ACOs will follow Health Maintenance Organizations (HMOs) demise in the 1990s, ACOs are different.  Patients are assigned to ACOs and remain free to go to any provider.  ACOs can’t limit care or require patients to see providers in their network.  The ACO’s were still able deliver great results even with these two major challenges which they call “churn” (ACO assigned patient turnover) and “leakage” (patients going outside the provider network).

Bundled Payments are just getting started with up to 6,500 providers deciding soon whether to go live Jan 1, 2015 with Medicare’s Bundled Payment for Care Improvement (BPCI) pilot. Provider/Health Plan risk sharing arrangements are expanding rapidly, indicating they are delivering.  This surge began when the Affordable Care Act (ACA) started requiring health plans to write rebate checks if they paid out less than 85% of their premiums in medical claims. This encouraged Health Plans to partner and reward providers for improvements in patient outcomes and cost. Health Plans leaders believe that the “blurring of the lines” between providers and health plans is just getting started.

Patient Recovery vs. Patient Services

 

 

November 25, 2014 Posted by | health care | , , , , , | Leave a comment

[Reblog] “Health care consumers in the dark” – no kidding

“Health care consumers in the dark” – no kidding.

From the 24 November 2014
That headline appeared in the Minneapolis Star Tribune print edition yesterday. The focus of the article was how difficult it is to obtain medical cost data despite a state law and other efforts to increase transparency.item at HealthNewsReview.org

The same newspaper had a brief column the previous day about open enrollment season for workplace medical benefits, but that column’s final line seemed to conflict with the point of the longer story mentioned above.  The shorter column quoted the executive director of the MN Community Measurement group saying that the group’s rankings – “rating doctors on whether they provide optimal care to patients with diabetes, depression and other conditions….can help consumers make informed choices.”  The exec said consumers can now ask, “Is there much difference in quality, given the difference you might be asked to pay in price?”

Well, the “Health care consumers in the dark” story drove home the point that consumers can’t get the price answers.

Meantime, it was great to see a JAMA Internal Medicine article about a great piece of journalism on this same topic.  The article, by Lisa Aliferis of KQED radio in San Francisco, was entitled, “Variation in Prices for Common Medical Tests and Procedures.” It gives details about the PriceCheck project of KQED, KPPC, and the excellent ClearHealthCosts.com effort run by Jeanne Pinder.  Aliferis concludes the article:

“The window is cracked open on health cost transparency. We have been here before—with car sales, with airline tickets. Now, technology in combination with transparency can do the same for health care.

And yes, we have been asked whether people should “shop” for medical treatment in the same way they shop for a new car. If there were a correlation between cost and quality, this might be a reasonable question. Instead, in American health care, money is spent on unnecessary or unproven treatments much too often, and there’s widespread variation in price. People are waking up to these facts.

The money conversation makes the practice of medicine very complicated: the “gotcha” bill and the medication that is not covered challenge the physician-patient relationship. It is time to take off the blindfold and embrace transparency in pricing for medical care and services.”

 

November 25, 2014 Posted by | health care | , | Leave a comment

[Reblog] From a physician: A plea to big medical corporations

Next time my physician urges a screening, I’ll wonder if it is because of his concern for my health (most likely- knowing my physician) or his corporation’s interest in profit…
As this article outlines is that physicians in corporations are often

English: A doctor examines a female patient.

English: A doctor examines a female patient. (Photo credit: Wikipedia)

in Catch-22 positions.

From a November 2014 post at KevinMD

thought more highly of business folks until I started working for them.  I thought CEOs and boards of directors of companies had a vision, whether to maximize shareholder profit, or to produce a stellar product or provide a singular service, etc.  Once the vision was elucidated, everyone worked together like a team to make it happen.

Then I became employed by a large corporation as a family physician to provide medical care.  And it’s been one eye opening experience after another ever since.  To me, it’s quite simple.  The vision of a medical practice should be to provide good medical care while being cost conscious, and maintaining strong patient satisfaction.  That’s how all the money gets generated, right?  The patient pays his/her premium, part of which gets funneled to our large corporation, who is then tasked to provide care for that patient.  How is care provided to that patient?  By having a doctor see, talk to, examine and treat that said patient.

OK.  So we all know that it’s not quite that simple.  Enter primary care 2014, the world of risk adjustment factor (RAF) scores (which entail the corporation getting paid more for sicker patients), electronic health records (EHR), and quality metric incentive payments (the corporation gets more money from insurance companies by meeting certain goals in screening, like colonoscopies, mammograms, etc.).  Now health care has become more complicated.  But it’s still all based on that interaction we physicians have with our patients.  We can’t meet quality metric goals if we don’t see the patients, we can’t determine if they are sicker and therefore require more funds to care for if we don’t see them, and we can’t use EHR if we don’t see the patient.  There’s just a bunch of road blocks and distractions added in….

November 9, 2014 Posted by | health care | , , , | Leave a comment

[Report] A one-year assessment of the ACA | Association of Health Care Journalists

A one-year assessment of the ACA | Association of Health Care Journalists.

From the 31 October 2014 report

The New York Times recently pulled their reportorial and graphics know-how together to do a one-year assessment of the ACA.  It concludes: “After a year fully in place, the Affordable Care Act has largely succeeded in delivering on President Obama’s main promises, an analysis by a team of reporters and data researchers shows. But it has also fallen short in some ways and given rise to a powerful conservative backlash.”

Image by HealthCare.gov.

The package consists of seven sections that run the gamut, with some key numbers and charts.  Overall it’s a positive but not uncritical look. The cost section is particularly nuanced, noting the challenges of narrow networks and high deductibles.

Most of these topics we’ve considered on this blog over the last few years. But the series provides a nice, compact overview and handy reference going into the second year.

Here are the seven sections covered, and the nutshell conclusion the Times provided for each.

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

[Repost] Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

Screen Shot 2014-11-03 at 6.29.04 AM

Excerpt from the commentary by M. Christopher Roebuck, PhD, MBA

SUMMARY
This brief commentary extends earlier work on the value of adherence to derive medical cost offset estimates from prescription drug utilization. Among seniors with chronic vascular disease, 1% increases in condition-specific medication use were associated with significant (P<0.001) reductions in gross nonpharmacy medical costs in the amounts of 0.63% fordyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and1.17% for hypertension.
J Manag Care Pharm.
2014;20(10):994-95
Excerpts:
With about half of patients not taking their medications as directed, avoidable adverse health events and use of medical services are estimated to add up to $290 billion in U.S.health care expenditures annually. Improvements in clinical and economic outcomes from medication adherence have been demonstrated across a variety of conditions and patientcohorts. As an example, in 2011 my colleagues and I (Roebuck et al.) determined that adherence to medication for chronic vascular disease was associated with fewer inpatient hospital days and emergency department visits and lower overal health care costs. Specifically, annual net savings in healtcare expenditures for an adherent (compared to nonadherent) elderly beneficiary were estimated to be $7,893 for congestive
heart failure, $5,824 for hypertension, $5,170 for diabetes, and $1,847 for dyslipidemia—or approximately 9% to 28% of total
health care costs. This research employed a rigorous observational study design that addressed a key concern and limitation
ofprior analyses—the potentialendogeneity (confounding) of adherence. More plainly, results reported in earlier publications mayhave been biased if patients who took medications as directed also engaged in other unmeasured healthy behaviors

(i.e., the “healthy adherer effect”)
..
Figure 1 presents the new findings and includes the CBO estimate for reference. Specifically, 1% increases in condition-specific prescription drug utilization were significantly (P<0.001) associated with reductions in seniors’ gross nonpharmacy medical costs in the amounts of 0.63% for dyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and 1.17% for hypertension. These results demonstrate that medical cost offsets from prescription drug utilization likely vary bychronic condition and that impacts for therapeutic classes used to treat these 4 conditions—which represent 40% of Medicare Part D utilization—may be between 3 and 6 times greater than the CBO’s assumption. In dollar terms, these relative impacts are not trivial. For example, 53% of Medicare (fee-for-service) beneficiaries have the comorbidity combination of hyperten sion plus high cholesterol—with average annual medical costs of $13,825. The current findings suggest that a 5% increase in the use of antihypertensive medication by patients with those conditions may prompt reductions in medical (Parts A and B) costs of more than $800 annually per beneficiary.
….
The present analysis examined retirees with employer-sponsored insurance in addition to Medicare. To the extent that these individuals differed from the broader Medicare population, the generalizability of study findings may be limited.

November 3, 2014 Posted by | health care | , , , , , , , | Leave a comment

[News item] Millions in unused medical supplies in U.S. operating rooms each year — ScienceDaily

Millions in unused medical supplies in U.S. operating rooms each year — ScienceDaily.

Date:
October 27, 2014
Source:
Johns Hopkins Medicine
Summary:
Surgeons urge the salvage of syringes, sutures, gauze, towels to improve care in developing countries. A new report highlights not only an opportunity for U.S. hospitals to help relieve the global burden of surgically treatable diseases, but also a means of reducing the cost and environmental impact of medical waste disposal at home, authors say.
Excerpt:

Johns Hopkins research team reports that major hospitals across the U.S. collectively throw away at least $15 million a year in unused operating room surgical supplies that could be salvaged and used to ease critical shortages, improve surgical care and boost public health in developing countries.

A report on the research, published online Oct. 16 in the World Journal of Surgery, highlights not only an opportunity for U.S. hospitals to help relieve the global burden of surgically treatable diseases, but also a means of reducing the cost and environmental impact of medical waste disposal at home.

The fact of surgical supply waste is nothing new, the researchers note, but say their investigation may be one of the first systematic attempts to measure the national extent of the problem, the potential cost savings and the impact on patients’ lives. While several organizations run donation programs for leftover operating room materials, such efforts would be far more successful if they were made standard protocol across all major surgical centers, the authors say.

“Perfectly good, entirely sterile and, above all, much-needed surgical supplies are routinely discarded in American operating rooms,”

The researchers tracked outcomes among 33 Ecuadorian patients whose surgeries were made possible as a result of the donations. Their analysis showed that donated surgical supplies prevented, on average, eight years of disability per patient.

In the study, materials topping the 19-item surgical supplies list included gauze, disposable syringes, sutures and surgical towels. However, the investigators say, it is important to tailor shipping to the specific needs of each hospital. Matching of donor leftovers to recipient need, they say, will prevent unnecessary shipping costs and avoid creating medical waste locally. In addition, the receiving hospital must have a demonstrated capability and the equipment to clean and sterilize the shipped materials before use in the operating room.

November 3, 2014 Posted by | health care | , , | Leave a comment

[Repost] Neglect of culture in medicine is ‘single biggest barrier’ to achieving better health | Daily Science News

Neglect of culture in medicine is ‘single biggest barrier’ to achieving better health | Daily Science News.

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From the 28 October post

The systematic neglect of culture is the single biggest barrier to advancing the highest attainable standard of health worldwide, say the authors of a major new report on culture and health, led by Professor David Napier, a leading medical anthropologist from University College London (UCL), UK, and published in The Lancet.

Bringing together experts from many different fields, including anthropologists, social scientists, and medics, the Commission is the first ever detailed appraisal of the role of culture in health. The authors argue that cultures of all kinds – not only people’s religious or ethnic identity, but also professional and political cultures – have been sidelined and misunderstood by both medical professionals and society as a whole.

Until now, culture has largely been conceived of as an impediment to health, rather than a central determining feature of it. However, the Commission makes a powerful case to the contrary, showing that culture not only determines health – for example, through its influence on behaviours such as smoking and unhealthy eating – but also defines it through different cultural groups’ understandings of what it means to be well.

Culture is often blamed for clinical malpractice,…

November 3, 2014 Posted by | health care, Uncategorized | , | Leave a comment

[News article] Emergency aid for overdoses — ScienceDaily

Emergency aid for overdoses — ScienceDaily.

From the 17 October 2014 news article

Every minute counts in the event of an overdose. ETH professor Jean-Christophe Leroux and his team have developed an agent to filter out toxins from the body more quickly and efficiently. It can also be used for dialysis in patients suffering from hepatic failure.

To date, antidotes exist for only a very few drugs. When treating overdoses, doctors are often limited to supportive therapy such as induced vomiting. Treatment is especially difficult if there is a combination of drugs involved. So what can be done if a child is playing and accidentally swallows his grandmother’s pills? ETH professor Jean-Christophe Leroux from the Institute of Pharmaceutical Sciences at ETH Zurich wanted to find an answer to this question. “The task was to develop an agent that could eliminate many different toxic substances from the body as quickly as possible,” he says.

Leroux and his team knew that lipid emulsions can bind to drugs when injected into the blood stream. The researchers pursued this approach in their own studies, developing an agent based on liposomes, which are tiny bubbles with a lipid membrane as an outer layer. Instead of an intravenous injection, the agent is used as a dialysis fluid for so-called peritoneal dialysis. This method of dialysis is less common than haemodialysis, which is mainly used as a long-term form of treatment of kidney failure.

October 19, 2014 Posted by | health care, Medical and Health Research News | , , , , , , , | Leave a comment

[News article]NerdWallet Health Study: Medical Debt Crisis Worsening Despite Policy Advances – Health

NerdWallet Health Study: Medical Debt Crisis Worsening Despite Policy Advances – Health.

From the 8 October 2014 article

Despite recent advances in health care policy, American households continue to struggle with medical debt, and it’s only getting worse. Americans are putting more of their take-home pay toward medical costs than ever before.

  • NerdWallet Health has found that Americans pay three times more in third-party collections of medical debt each year than they pay for bank and credit card debt combined. In 2014, roughly one in five American adults will be contacted by a debt collection agency about medical bills, but they may be overpaying – NerdWallet found rampant hospital billing errors resulting in overcharges of up to 26%.
  • NerdWallet found 63% of American adults indicate they have received medical bills that cost more than they expected. At the same time, 73% of consumers agree they could make better health decisions if they knew the cost of medical care before receiving it.
  • Between 2010 and 2013, American households lost $2,300 in median income, but their health care expenses increased by $1,814.[1] Out-of-pocket spending is expected to accelerate to a 5.5% annual growth rate by 2023 – double the growth of real GDP.

In a follow-up to last year’s study that found medical debt is the largest cause of personal bankruptcy, NerdWallet Health investigated the mounting financial obstacles facing the American patient.

Download a printer-friendly version of the study here.

October 17, 2014 Posted by | health care | , , , , , | Leave a comment

Psychiatrist appointments hard to get, even for insured, study shows — ScienceDaily

Psychiatrist appointments hard to get, even for insured, study shows — ScienceDaily.

Obtaining access to private outpatient psychiatric care in the Boston, Chicago and Houston metropolitan areas is difficult, even for those with private insurance or those willing to pay out of pocket. Researchers, who posed on the phone as patients seeking appointments with individual psychiatrists, encountered numerous obstacles, including unreturned calls, and met with success only 26 percent of the time.

October 17, 2014 Posted by | health care, Psychiatry, Psychology | , , , | Leave a comment

[News article] Corruption of health care delivery system? — ScienceDaily

Corruption of health care delivery system? — ScienceDaily.

From the 14 October 2014 article

he foundation of evidence-based research has eroded and the trend must be reversed so patients and clinicians can make wise shared decisions about their health, say Dartmouth researchers in the journal Circulation: Cardiovascular Quality and Outcomes.

Drs. Glyn Elwyn and Elliott Fisher of The Dartmouth Institute for Health Policy & Clinical Practice are authors of the report in which they highlight five major problems set against a backdrop of “obvious corruption.” There is a dearth of transparent research and a low quality of evidence synthesis. The difficulty of obtaining research funding for comparative effectiveness studies is directly related to the prominence of industry-supported trials: “finance dictates the activity.”

The pharmaceutical industry has influenced medical research in its favor by selective reporting, targeted educational efforts, and incentivizing prescriber behavior that influences how medicine is practiced, the researchers say. The pharmaceutical industry has also spent billions of dollars in direct-to-consumer advertising and has created new disease labels, so-called disease-mongering, and by promoting the use of drugs to address spurious predictions.

Another problem with such studies is publication bias, where results of trials that fail to demonstrate an effect remain unpublished, but trials where the results are demonstrated are quickly published and promoted.

English: Example of promotional "freebies...

English: Example of promotional “freebies” given to physicians by pharmaceutical companies (Photo credit: Wikipedia)

 

The authors offer possible solutions:

October 17, 2014 Posted by | health care | , , , , , , , , , , | Leave a comment

[Press release] Discussing alternative medicine choices for better health outcomes

 

English: A graph of age-adjusted percent of ad...

English: A graph of age-adjusted percent of adults who have used complementary and alternative medicine in 2002 in the United States according to the National Center for Complementary and Alternative Medicine. (Photo credit: Wikipedia)

From the 3 October 2014 press release at EurkAlert

Discussing alternative medicine choices for better health outcomes

In the field of medicine there has often been a divide between those who focus on modern medicine and those who prefer alternative practices. But pediatrician Sunita Vohra is a firm believer there should be room for both.

A new study from Vohra, a professor in the Faculty of Medicine & Dentistry’s Department of Pediatrics at the University of Alberta, and a pediatric physician for Clinical Pharmacology with Alberta Health Services, is giving insight into the use of alternative medicines by pediatric cardiac patients and how effective they are seen to be. “We wanted to know if the use of alternative therapies helped or not, and we wanted to know if it hurt them or not,” she says.

The study, published in the journal CMAJ Open, examined the use of alternative therapies such as multivitamins, minerals, chiropractic care and Aboriginal healing in 176 patients at the Stollery Children’s Hospital in Edmonton, Alberta, and the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, Ontario.

It found 64 per cent of patients at the Stollery Children’s Hospital reported using complementary and alternative medicine products and practices, compared with just 36 per cent at CHEO. Of those patients, Vohra says most had no regrets about their choices.

English: Classification of complementary and a...

English: Classification of complementary and alternative therapies Italiano: Classificazione di terapie complementari e alternative (Photo credit: Wikipedia)

“The vast majority felt that they had been helped by the complementary therapy that they took and it was extremely unusual for them to report that they felt an adverse event had occurred because of it.”

The study also found one third of patients and their families did not discuss the use of alternative medicines with their physicians. Vohra believes it shows that patients may be reluctant to discuss their choices if they’re not sure how it will be received by health care providers.

That decision could have important health consequences, says Vohra, who also serves as director of the Complementary and Alternative Research and Education (CARE) program at the University of Alberta, and that patients’ discussing alternative therapies with health professionals is vital in order for them to make informed choices.

“There may be some therapies that help children feel better, but there may be others that, unbeknownst to the family, cause interaction between a specific natural health product and a prescription medicine. In that setting, instead of helping the child get better, harm may actually be happening.”

Vohra stresses the need for open communication and says children’s hospitals in Canada need to do a better job of providing information to patients looking at other avenues to health.

“That communication is essential because the health-care providers and the parents—together we are a team. And everyone’s hope is for that child’s better health.”

Other highlights from the study:

  • Multi-vitamins were the most common complementary and alternative medicine products with 71 percent of patients using them, followed by vitamin C (22 per cent), calcium (13 per cent) and cold remedies (11.8 per cent)
  • The most common practices include massage (37.5 per cent), faith healing (25 per cent), chiropractic (20 per cent), aromatherapy (15 per cent) and Aboriginal healing (7.5 per cent)
  • Almost half (44 per cent) of patients used complementary and alternative medicine products along with conventional treatments. The study’s research was supported by funding from the Sick Kids Foundation and Alberta Innovates Health Solutions.

October 15, 2014 Posted by | health care | , , , , , , , , | Leave a comment

[Reblog] Americans living longer; some pay more for outpatient services

English: image edited to hide card's owner nam...

English: image edited to hide card’s owner name. author: Arturo Portilla (Photo credit: Wikipedia)

From the 9 October 2014 post at Covering Health: Monitoring the pulse of health care journalism

First, the good news: A new National Center for Health Statistics data brief shows that Americans are living longer. Overall life expectancy rose by 0.1 percent from 2011 to 2012, to 78.8 years, and was highest for non-Hispanic whites and non-Hispanic blacks. Women can expect to live an average of 81.2 years, and men an average of 76.4 years, based on the new analysis.

Now the bad news – a new report released by the Office of the Inspector General in the Department of Health and Human Services found increased costs associated with critical access hospitals. Medicare beneficiaries paid nearly half of the costs for outpatient services at critical access hospitals – a higher percentage of the costs of coinsurance for services received at these facilities than they would have paid at hospitals using Outpatient Prospective Payment System rates.

Critical access hospitals (CAHs) ensure that rural Medicare beneficiaries have access to hospital services. Reimbursement is at 101 percent of their “reasonable costs,” rather than at the predetermined rates set by the Outpatient Prospective Payment System. Medicare beneficiaries who receive services at CAHs pay coinsurance amounts based on CAH charges; beneficiaries who receive services at acute care hospitals pay coinsurance amounts based on OPPS rates.

October 11, 2014 Posted by | health care | , , , | Leave a comment

[Reblog] Health costs, journalism and transparency: One site opening door to price data

From  the 19 August 2014 blog item BY JOANNE KENEN at Covering Health: Monitoring the Pulse of Healthcare Journalism

Here’s a resource for health care costs – and a creative journalistic model of crowdsourcing, data collection, mapping, reporting and blogging.

ClearHealthCosts.com was started by formerNew York Times reporter and editor Jeanne Pinder. She received start-up funding from foundations (Tow-Knight Center for Entrepreneurial Journalism at CUNY and others listed on the website) and ClearHealthCosts now has a team of reporters and data wranglers chipping away at some of the difficult questions that patients need answered: How much is this treatment going to cost me? Can I find a better price?

Screen Shot 2014-08-21 at 6.26.40 AM

It’s about shedding light on a health care cost and payment system that, to use Pinder’s word, is “opaque.” Some of what they are doing is specific to a half-dozen cities; other projects are building out nationally.

The data collected by ClearHealthCosts focuses on elective or at least nonemergency procedures such as imaging, dental work, vasectomy, walk-in clinics, screening (mammograms and colonoscopy) and blood tests. Much of the data is crowdsourced, and focused on New York area, including northern New Jersey and other suburbs; the San Francisco and Los Angeles areas; and Houston, Dallas-Fort Worth, Austin and San Antonio in Texas.
…….

 

Related resources

  • Hospital Compare  US government website managed by Medicare and Medicaid services. Links include, Quality payment, Medicare’s Hospital value-based purchasing programs, Hospital readmission reduction programs, voluntary reporting from American College of Surgeons, American College of Cardiology readmission measure etc.
    Allows one to compare the quality of care at over 4,000 Medicare-certified hospitals in the country
  • Joint Commission Quality Check The Joint Commission is an accredition/certification program based on performance standards. Quality Check® includes information on US health care organizations.

 

Related articles

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

[Press Release] MyChart use skyrocketing among cancer patients, UT Southwestern study finds

From the 9-Jul-2014 EurkAlert

 

 IMAGE: From left to right are: Drs. David Gerber and Simon J. Craddock Lee.

Click here for more information. 

DALLAS – July 9, 2014 – There has been a sharp increase in the number of cancer patients at UT Southwestern Medical Center using MyChart, the online, interactive service that allows patients to view laboratory and radiology results, communicate with their healthcare providers, schedule appointments, and renew prescriptions.

Over a six-year period, the number of patients actively using MyChart each year increased five-fold, while the number of total logins each year increased more than 10-fold, according to a study by Dr. David Gerber, Associate Professor of Internal Medicine, and Dr. Simon J. Craddock Lee, Assistant Professor of Clinical Sciences.

“This pattern suggests that not only are far more patients using this technology, but also that they are using it more intensively,” Dr. Gerber said.

These findings, published in the Journal of Oncology Practice, are noteworthy because no prior study has systematically examined the use of electronic patient portals by patients with cancer, even though use of this technology is surging nationwide, creating new terrain in clinical care and doctor-patient relationships.

……

In 2009, Congress allotted $27 billion to support the adoption of Electronic Medical Records. The Department of Health and Human Services began allocating the funding in 2011. UT Southwestern started offering these services years earlier.

…..

“I was struck by the immediacy of the uptake and the volume of use,” Dr. Gerber said. “I suspected that the volume would be high. I did not think that it was going to be multi-fold higher than other patient populations.”

Use of MyChart was greater among cancer patients than among another other patient groups except for children with life threatening medical conditions, according to the study.

“We undertook this study because we suspected that the volume of electronic portal use might be greater among patients with cancer than in other populations,” Dr. Gerber said.

While the study did not directly compare use patterns with non-cancer groups, the average use in the current study was four to eight times greater than has been reported previously in primary care, pediatric, surgical subspecialty, and other populations.

Dr. Gerber explained that patient use of electronic portals to receive and convey information may have particular implications in cancer care. Laboratory and radiology results may be more likely to represent significant clinical findings, such as disease progression.

“I think we are still learning how patients understand and use the complex medical data, such as scan reports, that they increasingly receive first-hand electronically,” Dr. Gerber said.

Furthermore, symptoms reported by patients with cancer may be more likely to represent medical urgencies. Notably, the study found that 30 percent of medical advice requests from patients were sent after clinic hours.

 

July 11, 2014 Posted by | health care | , , , , , | Leave a comment

[News article] Pharmacists say collaboration bill will improve care | CJOnline.com

Pharmacists say collaboration bill will improve care | CJOnline.com.

From the 7 July 2014 article

Kansas pharmacists say a bill that went into effect this past week will improve patient care by allowing them to enter into agreements with physicians to do things like monitor and change medication levels without new orders.

Greg Burger, a pharmacist at Lawrence Memorial Hospital who helped push for the bill, said studies have shown reductions in cost and improvements in care when pharmacists have the authority to adjust medication levels, provide the right antibiotics for certain infections and adjust for drug allergies without waiting for a doctor’s say-so.

“There’s all kinds of things we do in hospitals now that we’re hoping to expand out to where pharmacists might be in clinics,” Burger said.

….

English: Well Street Late Night Pharmacy This ...

English: Well Street Late Night Pharmacy This pharmacy is tucked in behind 1594903 making it very handy for getting prescriptions filled after visiting the Doctor’s surgery. The flat-roofed building to the left and behind is a Co-operative pharmacists, one would have thought that the competition would be quite high, but they seem to manage alright. (Photo credit: Wikipedia)

July 9, 2014 Posted by | health care | , , , | Leave a comment

[Reblog]Technology and the doctor-patient relationship

Technology and the doctor-patient relationship.

From the 1 July 2014 KevinMD article

I often hear people talking about their doctors.  I overhear it restaurants, nail salons, while walking down the street. I hear what people think of their doctors, what their doctors said or what they didn’t say, why people were disappointed by or validated by their doctors.  I hear people analyzing, criticizing, and surmising about this relationship quite a bit, and I don’t blame them. The relationship you have with your doctor is a critical one, and yet it is fraught with misunderstanding, disappointment, and distrust. People didn’t used to doubt their doctors the way they do today, and I believe the essence of the doctor-patient  relationship has degraded in our culture.

 

In large part, I believe this is due to technology.

The Mayo Clinic recently announced they have partnered with Apple to create what they call the Health Kit.  Although the details are still unknown, the product is supposedly one that will allow patients to become more involved in their health care, from diagnosis to treatment delivery. This has always been the doctor’s job, but with the technology booming, it is no surprise that the next step would be computerized health care.

So is this a good thing, or a bad thing? I have mixed feelings, and I think the results will be mixed as well. Statistics show that positive relationships and supportive interactions with others are crucial parts of living a healthy life. Can a computer ever truly replace that je ne se quoi that occurs between a doctor and a patient?  In my own practice, I would like to believe that the interaction between my patients and myself is part of what leads to healing. I don’t believe a computer could do that as well as I can.

Here’s the problem, though.  Doctors are inundated with demands from insurance companies, paperwork, accountability measures, and check lists upon checklists required for medical records, billing, and measurable use. This situation worsened several years ago, with the mandatory implementation of Electronic Medical Records, and then even worse since the implementation of the Affordable Care Act.

These changes have also affected patients, many of whom have had to drop doctors they have had for many years because those doctors didn’t take the new insurance. The message, whether stated outright or not by advocates or detractors of the new systems, is that this doctor-patient relationship is not really all that important.

….

 

 

July 9, 2014 Posted by | health care | , , , , , , | Leave a comment

[News Article] Large New Study Confirms That Childhood Vaccines Are Perfectly Safe

Large New Study Confirms That Childhood Vaccines Are Perfectly Safe | ThinkProgress.

From the 1 July 2014 Think Progress article

BY TARA CULP-RESSLER

vaccine

CREDIT: SHUTTERSTOCK

The vaccines that children receive when they’re young are quite safe, and the vast majority of them don’t lead to serious side effects, according to asweeping new review of 67 recent scientific studies on childhood vaccinations. The analysis, published on Tuesday in the journal Pediatrics, also found no link between vaccines and autism — effectively debunking a common myth that dissuades some parents from inoculating their children.

The new report is specifically intended to ease parents’ concerns about vaccines, as persistent misconceptions about vaccination have recently spurred a rise in infectious diseases. In order to reassure people who may be worried that their kids’ shots aren’t safe, the federal governmentcommissioned the RAND Corporation to review everything that scientists know about the 11 vaccines recommended for children under the age of six.

Like any medical intervention, vaccines are not without their potential risks. In some rare cases, certain shots can increase kids’ risk of fevers, seizures, and gastrointestinal problems. But the RAND researchers found that those adverse reactions are incredibly unlikely.

……

 

July 8, 2014 Posted by | health care | , , , , , | 4 Comments

[News article] Proof Birth Control Access Is A Very, Very Big Deal To Women

Proof Birth Control Access Is A Very, Very Big Deal To Women.

Image of vaginal birth control device NuvaRing

Image of vaginal birth control device NuvaRing (Photo credit: Wikipedia)

From the 7 July 2014 Huffington Post article

On Monday, the Supreme Court ruled that corporations cannot be required to provide their employees with coverage for contraception, a decision that medical groups like the American College of Obstetricians and Gynecologists — this country’s leading group of professionals providing health care to women — have called “profoundly” disappointing.

“This decision inappropriately allows employers to interfere in women’s health care decisions,” the group said in a statement.

“Contraceptives are essential health care for women and should not be treated differently than other, equally important parts of comprehensive care for women, including well-woman visits, preconception care visits, cervical and breast cancer screenings and other needed health care services,” ACOG added.

Because that’s the thing about birth control. For many women across the United States, of all different religious, political and socioeconomic backgrounds, it’s an absolutely essential part of how they stay healthy. From pain management and menstrual cycle regulation to straight-up family planning, here are just some of the ways that birth control has been a very, very good thing in the lives of real women.

 

July 8, 2014 Posted by | health care | , | Leave a comment

[Magazine Article] Hospitals Are Mining Patients’ Credit Card Data to Predict Who Will Get Sick – Businessweek

Hospitals Are Mining Patients’ Credit Card Data to Predict Who Will Get Sick – Businessweek.

A patient having his blood pressure taken by a...

From the 3 July article

Imagine getting a call from your doctor if you let your gym membership lapse, make a habit of buying candy bars at the checkout counter, or begin shopping at plus-size clothing stores. For patients of Carolinas HealthCare System, which operates the largest group of medical centers in North and South Carolina, such a day could be sooner than they think. Carolinas HealthCare, which runs more than 900 care centers, including hospitals, nursing homes, doctors’ offices, and surgical centers, has begun plugging consumer data on 2 million people into algorithms designed to identify high-risk patients so that doctors can intervene before they get sick. The company purchases the data from brokers who cull public records, store loyalty program transactions, and credit card purchases.

Information on consumer spending can provide a more complete picture than the glimpse doctors get during an office visit or through lab results, says Michael Dulin, chief clinical officer for analytics and outcomes research at Carolinas HealthCare. The Charlotte-based hospital chain is placing its data into predictive models that give risk scores to patients. Within two years, Dulin plans to regularly distribute those scores to doctors and nurses who can then reach out to high-risk patients and suggest changes before they fall ill. “What we are looking to find are people before they end up in trouble,” says Dulin, who is a practicing physician.

…..

July 8, 2014 Posted by | health care | , , , | Leave a comment

[Article] BBC News – Do doctors understand test results?

BBC News – Do doctors understand test results?.

From the 6 July 2014 article

A confused doctor

Are doctors confused by statistics? A new book by one prominent statistician says they are – and that this makes it hard for patients to make informed decisions about treatment.

In 1992, shortly after Gerd Gigerenzer moved to Chicago, he took his six-year-old daughter to the dentist. She didn’t have toothache, but he thought it was about time she got acquainted with the routine of sitting in the big reclining chair and being prodded with pointy objects.

The clinic had other ideas. “The dentist wanted to X-ray her,” Gigerenzer recalls. “I told first the nurse, and then him, that she had no pains and I wanted him to do a clinical examination, not an X-ray.”

These words went down as well as a gulp of dental mouthwash. The dentist argued that he might miss something if he didn’t perform an X-ray, and Gigerenzer would be responsible.

But the advice of the US Food and Drug Administration is not to use X-rays to screen for problems before a regular examination. Gigerenzer asked him: “Could you please tell me what’s known about the potential harms of dental X-rays for children? For instance, thyroid and brain cancer? Or give me a reference so I can check the evidence?”

GigerenzerGerd Gigerenzer

The dentist stared at him blankly……

 

July 8, 2014 Posted by | health care | , , , , | 1 Comment

[Press release] Health, United States, 2013 includes special section on prescription drugs

From the 14 May 2014 press release

Most common prescription drugs among adults are those for cardiovascular disease and high cholesterol

Photo: Spilled bottle of pills.

About half of all Americans reported taking one or more prescription drugs in the past 30 days during 2007-2010, and 1 in 10 took five or more, according to Health, United States, 2013, the government’s annual, comprehensive report on the nation’s health.

This is the 37th annual report prepared for the Secretary of the Department of Health and Human Services by the Centers for Disease Control and Prevention’s National Center for Health Statistics.  The report includes a compilation of health data from state and federal health agencies and the private sector.

This year’s report includes a special section on prescription drugs.  Key findings include:

  • About half of all Americans in 2007-2010 reported taking one or more prescription drugs in the past 30 days.  Use increased with age; 1 in 4 children took one or more prescription drugs in the past 30 days compared to 9 in 10 adults aged 65 and over.
  • Cardiovascular agents (used to treat high blood pressure, heart disease or kidney disease) and cholesterol-lowering drugs were two of the most commonly used classes of prescription drugs among adults aged 18-64 years and 65 and over in 2007-2010.  Nearly 18 percent (17.7) of adults aged 18-64 took at least one cardiovascular agent in the past 30 days.
  • The use of cholesterol-lowering drugs among those aged 18-64 has increased more than six-fold since 1988-1994, due in part to the introduction and acceptance of statin drugs to lower cholesterol.
  • Other commonly used prescription drugs among adults aged 18-64 years were analgesics to relieve pain and antidepressants.
  • The prescribing of antibiotics during medical visits for cold symptoms declined 39 percent between 1995-1996 and 2009-2010.
  • Among adults aged 65 and over, 70.2 percent took at least one cardiovascular agent and 46.7 percent took a cholesterol-lowering drug in the past 30 days in 2007-2010.  The use of cholesterol-lowering drugs in this age group has increased more than seven-fold since 1988-1994.
  • Other commonly used prescription drugs among those aged 65 and older included analgesics, blood thinners and diabetes medications.
  • In 2012, adults aged 18-64 years who were uninsured for all or part of the past year were more than four times as likely to report not getting needed prescription drugs due to cost as adults who were insured for the whole year (22.4 percent compared to 5.0 percent).
  • The use of antidepressants among adults aged 18 and over increased more than four-fold, from 2.4 percent to 10.8 percent between 1988-1994 and 2007-2010.
  • Drug poisoning deaths involving opioid analgesics among those aged 15 and over more than tripled in the past decade, from 1.9 deaths per 100,000 population in 1999-2000 to 6.6 in 2009-2010.
  • The annual growth in spending on retail prescription drugs slowed from 14.7 percent in 2001 to 2.9 percent in 2011.

Health, United States, 2013 features 135 tables on key health measures through 2012 from a number of sources within the federal government and in the private sector.  The tables cover a range of topics, including birth rates and reproductive health, life expectancy and leading causes of death, health risk behaviors, health care utilization, and insurance coverage and health expenditures.
The full report is available at www.cdc.gov/nchs

 

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May 17, 2014 Posted by | health care, Health Statistics | , , | 1 Comment

[News article] Strategies that reduce early hospital readmissions

From the 13 May 2014 ScienceDaily article

30-day readmissions can be reduced by almost 20 percent when specific efforts are taken to prevent them, a review has found. Key among these are interventions to help patients deal with the work passed on to them at discharge. “Effective approaches often are multifaceted and proactively seek to understand the complete patient context, often including in-person visits to the patient’s home after discharge,” says the lead author.

To put this problem into context, studies estimate that 1 in 5 Medicare beneficiaries is readmitted within 30 days of a hospitalization, at a cost of more than $26 billion a year. “Patients are sent home from hospitals because we have addressed their acute issues,” says Dr. Leppin. “They go home with a list of tasks that include what they were doing prior to the hospitalization and new self-care tasks prescribed on discharge. Some patients cannot handle all these requests, and it is not uncommon for them to be readmitted soon after they get home. Sometimes these readmissions can be prevented.”

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

[Reblog] The illegal ways patients buy drugs

The illegal ways patients buy drugs.

From the 27 March 2014 KevinMD article by Pamela Wible, MD

Tom is diabetic, asthmatic, and broke. He’s back for a checkup.

“I take my metformin every morning with my grits,” he says, “but I don’t need no refill. I just got me some metformin XR.”

“How did you get extended release? They’re super expensive.”

Screen Shot 2014-05-13 at 5.16.10 AM

“Well, my neighbor runs a tattoo shop. We live behind her store. Her doc switched her up to insulin, so she gave me her old meds—a big sackful in the alley. That’s gonna last me another year.”

Prescriptions dispensed behind a tattoo parlor? Wow. I’m constantly impressed by my patients’ ingenuity. One gal this week told me she’s on her deceased grandfather’s antidepressants. Another gets his pharmaceuticals from the farm supply store. I’m just glad to know he doesn’t have fleas.

“Are you good on your inhalers?” I ask.

“Well, the cheapest inhaler is 52 bucks. So I basically can’t afford to breathe. On Craigslist, I found some for ten bucks. I contacted the guy, and he met me at the Walmart gas station in a black Jaguar. I went to the door. He asked if I was Tom. Then he said, ‘You know this is illegal.’”

…….

And from one of the comments

Considering the high prices that pharmaceutical companies are allowed to legally charge in the US, this kind of thriving illegal underground market does not surprise me at all. It may be wrong and potentially dangerous, but it’s also wrong for Big Pharma to price millions of Americans out of being able to buy the drugs they need legally. Think of that huge segment of the population as “what the market can’t bear.”

Read the entire article here

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

[News article] mHealth still untapped resource for docs

From the 18 April article at Healthcare IT news

mHealth still untapped resource for docs
People cite privacy concerns for lack of adoption

For the most part, providers are still wary over the mHealth movement. And this caution just might be preventing them from big care improvement opportunities, say the findings of a new study.

The study, commissioned by mobile professional services firm Mobiquity, finds some 70 percent of consumers use mobile apps every day to track physical activity and calorie intake, but only 40 percent share that information with their doctor.

[See also: mHealth market scales to new heights.]

Privacy concerns and the need for a doctor’s recommendation are the two factors hindering the use of mobile and fitness apps for mHealth reasons, say officials with the Boston-based Mobiquity, which produced “Get Mobile, Get Healthy: The Appification of Health and Fitness.”

That, officials said, means the healthcare community has to take a more active role in promoting these types of apps and uses.

“Our study shows there’s a huge opportunity for medical professionals, pharmaceutical companies and health organizations to use mobile to drive positive behavior change and, as a result, better patient outcomes,” said Scott Snyder, Mobiquity’s president and chief strategy officer, in a press release. “The gap will be closed by those who design mobile health solutions that are indispensable and laser-focused on users’ goals, and that carefully balance data collection with user control and privacy.”

[See also: FCC creates mHealth task force.]

The study, conducted between March 5 and 11, focused on 1,000 consumers who use or plan to use health and fitness mobile apps.

According to the study:

  • 34 percent of mobile health and fitness app users say they would use their apps more often if their doctor recommended it
  • 61 percent say privacy concerns are hindering their adoption of mobile apps. Other concerns include time investment (24 percent), uncertainty on how to start (9 percent) and not wanting to know about health issues (6 percent).
  • 73 percent said they are more healthy because they use a smartphone and apps to track health and fitness
  • 53 percent discovered, through an app, that they were eating more calories than they realized
  • 63 percent intend to continue or increase their mobile health tracking over the next five years
  • 55 percent plan to try wearable devices like pedometers, wristbands or smartwatches
  • Using a smartphone to track health and fitness is more important than using the phone for social networking (69 percent), shopping (68 percent), listening to music (60 percent) or even making/receiving phone calls (30 percent).

“We believe 2014 is the year that mobile health will make the leap from early adopters to mainstream,” Mobiquity officials said in their introduction to the survey. “The writing is on the wall: from early rumors about a native health-tracking app in the next version of Apple’s iPhone operating system to speculation that Apple will finally launch the much-anticipated iWatch, joining Google, Samsung and Pebble in the race to own the emerging wearables market.”

[See also: Realizing the mHealth promise.]

 

……..

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May 6, 2014 Posted by | health care | , , , , , | Leave a comment

[Reblog] The Problem of Pain: When Best Medical Advice Doesn’t Equal Patient Satisfaction

From the 4 April 2014 post by Karen Sibert, MD at The Health Care Blog


The problem of pain, from the viewpoint of British novelist and theologian C. S. Lewis, is how to reconcile the reality of suffering with belief in a just and benevolent God.

The American physician’s problem with pain is less cosmic and more concrete. For physicians today in nearly every specialty, the problem of pain is how to treat it responsibly, stay on the good side of the Drug Enforcement Administration (DEA), and still score high marks in patient satisfaction surveys.

If a physician recommends conservative treatment measures for pain–such as ibuprofen and physical therapy–the patient may be unhappy with the treatment plan. If the physician prescribes controlled drugs too readily, he or she may come under fire for irresponsible prescription practices that addict patients to powerful pain medications such as Vicodin and OxyContin.

….

 

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May 3, 2014 Posted by | health care | , , , , , , , | Leave a comment

[Reblog] Fatal Error (in Health Care)

 

The VA Palo Alto Health Care System in Palo Al...

The VA Palo Alto Health Care System in Palo Alto, California. (Photo credit: Wikipedia)

From the 4 April 2014 post by Rob Lamberts, MD at The Health Care Blog

The janitor approached my office manager with a very worried expression.  ”Uh, Brenda…” he said, hesitantly.

“Yes?” she replied, wondering what janitorial emergency was looming in her near future.

“Uh…well…I was cleaning Dr. Lamberts’ office yesterday and I noticed on his computer….”  He cleared his throat nervously, “Uh…his computer had something on it.”

“Something on his computer? You mean on top of the computer, or on the screen?” she asked, growing more curious.

“On the screen.  It said something about an ‘illegal operation.’  I was worried that he had done something illegal and thought you should know,” he finished rapidly, seeming grateful that this huge weight lifted.

Relieved, Brenda laughed out loud, reassuring him that this “illegal operation” was not the kind of thing that would warrant police intervention.

Unfortunately for me, these “illegal operation” errors weren’t without consequence.  It turned out that our system had something wrong at its core, eventually causing our entire computer network to crash, giving us no access to patient records for several days.

The reality of computer errors is that the deeper the error is — the closer it is to the core of the operating system — the wider the consequences when it causes trouble.  That’s when the “blue screen of death” or (on a mac) the “beach ball of death” show up on our screens.  That’s when the “illegal operation” progresses to a “fatal error.”

The Fatal Error in Health Care 

Yeah, this makes me nervous too.

We have such an error in our health care system.  It’s absolutely central to nearly all care that is given, at the very heart of the operating system.  It’s a problem that increased access to care won’t fix, that repealing the SGR, or forestalling ICD-10 won’t help.

It’s a problem with something that is starts at the very beginning of health care itself.

The health care system is not about health.

……

For any solution to have a real effect, this core problem must be addressed.  The basic incentive has to change from sickness to health.  Doctors need to be rewarded for preventing disease and treating it early. Rewards for unnecessary tests, procedures, and medications need to be minimized or eliminated.  This can only happen if it is financially beneficial to doctors for their patients to be healthy.

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May 3, 2014 Posted by | health care | , , | Leave a comment

2m elderly will have no adult child to provide care by 2030

Originally posted on Empathic Urbanite:

66259-425x283-Woman_and_son Wow. 2 million of us without carers! When I started this enterprise I knew that we were an ageing population and there’d be a lot of need for care in the future. But I hadn’t considered that there’d be so many childless people, which basically DOUBLES the number of people who will need paid care workers.

“By 2030, 230,000 people who need more than 20 hours of care a week will not have a relative to provide it, the think tank said.”

This is an IPPR report, so it’s solid evidence that our society, culture and especially government needs to start supporting care agencies and offering much better individual training and organisational opportunities if we are to meet this massive challenge. And don’t forget, when we talk about older people in the future, it’s not a report about some vague ‘other’, this time, we are talking about ourselves!

Three Sisters…

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

[News Article] The Steep cost of Life Saving Drugs

Originally posted on Medication Health News:

ID-10057221 With many new drugs being brought to market, there has been increased talk about the pricing of many agents. Today, drugs in question include Evzio, a new naloxone auto-injector and  Sovaldi, a new antiviral for hepatitis C. These agents could save many lives, but their potential high costs could be a barrier to many of the patients of need. How should we solve this dilemma?  Should the subsidies be provided to those in need of these therapies?  What are your thoughts?

For additional information, please see the news analysis in the New York Times.

Image courtesy of [ddpavumba]/FreeDigitalPhotos.Net

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

[Reblog of an Alzheimer item] The 36-Hour Day Podcast: Getting Help

Originally posted on Johns Hopkins University Press Blog:

Today is the fifth and final in a series of brief podcast excerpts from The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss. This bestselling title by Nancy L. Mace, M.A., and Peter V. Rabins, M.D., M.P.H., is in its fifth edition and is now available in an audio edition.

Podcast #5: Excerpt from Chapter 10: Getting Help

In this excerpt from Chapter 10, Dr. Rabins focuses on the need for caregivers to have outside help and have time away from the responsibilities of caregiving. He describes how to find good information on available services, how to seek and accept help from friends and neighbors,  and how to address problems you may encounter.

You can find this podcast and the rest of the series of podcasts here.

mace

These podcasts are excerpted from a Johns Hopkins University Press audio…

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May 2, 2014 Posted by | health care, Health Education (General Public) | , , , , | Leave a comment

[Reblog] ‘Inherently dangerous’ drugs routinely prescribed to seniors: Report

Originally posted on Metro News:

Thousands of seniors in Ontario nursing homes are on a powerful mix of antipsychotics and sedatives, according to a new provincial Health Ministry report that surfaced after a recent Torstar News Service investigation.

The report, commissioned by the ministry and co-authored by a leading doctor and scientist, sheds new light on the widespread use of powerful prescription drugs among the vulnerable elderly.

“These drugs are prescribed so commonly because they are perceived to be benign. That’s not true,” said Dr. David Juurlink, a drug safety expert who co-authored the report. “These drugs are inherently dangerous.”

Last week, Torstar revealed that some long-term-care homes, often struggling with staffing shortages, are routinely doling out antipsychotics to calm and “restrain” wandering, agitated and sometimes aggressive patients.

At close to 300 homes, Torstar found, more than a third of the residents are on the drugs, despite warnings that the medications can kill elderly patients…

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April 29, 2014 Posted by | Consumer Health, Consumer Safety, health care | , , , , | Leave a comment

[News Article] New AARP report looks at onus on spousal caregivers

From the 24 April 2014 article at Covering Health

A new report from the The United Hospital Fund and AARP Public Policy Institute finds that spouses who act as the primary family caregiver routinely perform complex medical and nursing tasks without adequate in-home support from health care professionals, especially when compared with non-spousal family caregivers.

Screen Shot 2014-04-29 at 4.34.05 AM

“Wedding vows include the promise to be there “in sickness and in health”, but we should not expect spouses to do things that can make nursing students tremble without offering them instructions and support. They should not have to do this important work at home alone. They need and deserve support from professionals, other family members, and the community,” Reinhard said.

It’s unclear why spouses receive less help, but Reinhard and co-authors Carol Levine and Sarah Samis of the United Hospital Fund theorize that choice, lack of awareness about resources, financial limitations, or fear of losing independence play a role. The report calls for additional research to help tailor interventions that support but do not supplant the primary bond between spouses.

 

Read the entire article here

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April 29, 2014 Posted by | health care | , , | Leave a comment

[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

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