Addiction Medicine: Closing the Gap between Science and Practice

From the 5 February 2013 article at Full Text Reports

Addiction Medicine: Closing the Gap between Science and Practice (report link)

Source: National Center on Addiction and Substance Abuse (Columbia University)

Forty million Americans ages 12 and older have addiction involving nicotine, alcohol or other drugs, a disease affecting more Americans than heart conditions, diabetes or cancer according to a five-year national study released today by The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia). Another 80 million people are risky substance users – using tobacco, alcohol and other drugs in ways that threaten health and safety.

The report, Addiction Medicine: Closing the Gap between Science and Practice, reveals that while about 7 in 10 people with diseases like hypertension, major depression and diabetes receive treatment, only about 1 in 10 people who need treatment for addiction involving alcohol or other drugs receive it. Of those who do receive treatment, most do not receive anything that approximates evidence-based care.

The CASA Columbia report finds that addiction treatment is largely disconnected from mainstream medical practice. While a wide range of evidence-based screening, intervention, treatment and disease management tools and practices exist, they rarely are employed. The report exposes the fact that most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction, and most of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of evidence-based services.

Related articles

• Well: Effective Addiction Treatment (well.blogs.nytimes.com)
• Young Adults Want to Recover from Addiction but Need Help to Make It Happen (addictionts.com)
• 8 reasons addiction carries a stigma (salon.com)
• Outpatient Rehab in Delray Beach, Florida Follows New Study that… (prweb.com)
• 15 Myths about Addiction (challengingaddiction.wordpress.com)

 

Behind the fetish of vitamin B12 shots

From the 3 February 2013 post at KevinMD.com

…

The treatment of B12 deficiency, as has been established from studies done in the 1960s, is ORAL B12. That’s right. Pills. Injections of B12 are not necessary—oral supplements work well, even in pernicious anemia. They’re cheap and they work. I suppose a very rare patient, say one who has surgically lost most of their gut, could require injections. But the vast majority of people with genuine B12 deficiency can get all of the B12 they need through eating foods or swallowing supplements. No needles needed.

So why this fetish with injections? From the patient’s point of view, shots feel more like something important is going on. Placebos need rituals—with acupuncture, for instance, the elaborate ritual creates an illusion of effectiveness. And from the doctor’s point of view, injections reinforce dependence on the physician, creating visits and cash flow.

So: people seem to think they feel better with injections, and the doctor makes a little cash, and everyone’s happy. So what’s the harm in that?

I think it’s wrong to knowingly dispense placebos, even harmless ones. We doctors like to criticize the chiropractors and homeopaths. We point fingers. They’re the quacks. We’d better take a close look at what we’re doing, first. Our placebos are sometimes far more dangerous than theirs.

More importantly, people should be able to expect more from physicians…

 

Read the entire article here

What is observation care? Clearing up common misperceptions

From the 4 February 2013 article at KevinMD.com

o treat observation care as simply a loophole that allows hospitals to avoid the Medicare penalties from readmissions — as Brad Wright, an assistant professor of health management and policy at the University of Iowa did earlier this month — is to take a short-sighted approach to a complex health issue.

 

Observation care in fact aims to address several of healthcare’s thorniest challenges head on. In the process, a well-run observation unit can not only help reduce hospital readmission rates, but it can reduce crowding and speed throughput in the ER, save patients an extended first hospital admission (let alone a re-admission), and perhaps most importantly, improve patient outcomes.

To see how, and to clear any misconceptions some like Wright could have about observation care, it might be helpful to do some Q&A.

…

 

Read the entire article here

Related articles

• Can Patient-Centered Care Reduce Hospital Readmissions? (healthblawg.typepad.com)
• The Relationship Between Discharging Patients From the Hospital Too Early and the Likelihood of a 30 Day Readmission: Treat, Street and Repeat. (diseasemanagementcareblog.blogspot.com)
• D. Brad Wright: Penalizing Hospitals for Re-admissions: Will It Work? (huffingtonpost.com)
• Positive nursing environments reduce readmissions (medicalstaffingnetwork.wordpress.com)