Health and Medical News and Resources

General interest items edited by Janice Flahiff

Wellocracy aims to help trackers choose and use health apps and devices

From the 25 October 2012 blog post by Patrick J. Skerrett, Executive Editor, Harvard Health

Screen Shot 2013-10-26 at 8.27.09 AM

Screen Shot 2013-10-26 at 8.30.10 AMScreen Shot 2013-10-26 at 8.31.14 AM

There’s something satisfying about getting immediate feedback about exercise, sleep, and other activities. That’s why more and more people are joining the “quantified-self” movement. It involves formal tracking of health and habits, usually using apps and devices that feed data to them—from heart rate, activity, and sleep monitors to Bluetooth connected scales. I haven’t yet become a full-fledged member, partly because having so many apps and connected devices on the market makes it hard to decide which ones are worth trying.

I’m hoping that Wellocracy will help. This website, launched by the Harvard-affiliatedCenter for Connected Health, aims to give people like me impartial information about fitness trackers, mobile health apps, and other self-help technologies.

Wellocracy lists dozens of sleep trackers, wearable activity trackers, mobile running apps, and mobile pedometer apps, each with a mini-review and a “what we wish it had” listing. The site lets you compare apps and devices in each of the four categories. The compare feature isn’t yet as helpful as those from Consumer Health Reports, but that may be coming.

The site also provides a guide for beginners like me, and offers tips for adding activity “bursts” throughout the day.

“There are millions of people struggling to eat well, exercise, manage a chronic disease or decrease other health risks. Wellocracy will help them select and use digital health tools, understand their individual motivations, and make incremental lifestyle changes that can easily be incorporated into busy schedules,” said Wellocracy founder, Dr. Joseph C. Kvedar, an associate professor at Harvard Medical School.

One theme the site promotes is “stickiness.” That means finding motivational strategies, apps, and devices that help you stay on track to achieve your goals. You can calculate your “stickiness factor” on the website.

Maybe the information on Wellocracy is enough to nudge me from contemplation to action.

Related Resources

 

 

These may be helpful when selecting health apps

 

  • Set realistic expectations
  • Avoid apps that promise too much
  • Research the developers
  • Choose apps that use techniques you’ve heard of
  • See what other users say
  • Test apps before committing
  •  iMedical apps has mobile medical app reviews and commentary by medical professionals. Most apps are about  apps geared toward professionals and are not free.

         The iMedical app forum now includes a medical librarian corner, with some patient/consumer apps

 

 
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October 26, 2013 Posted by | Health Education (General Public) | , , , , | Leave a comment

Oral Probiotics: An Introduction

From the article at the US National Center for Complementary and Alternative Medicine (NCCAM)

Introduction

Probiotics are live microorganisms (e.g., bacteria) that are either the same as or similar to microorganisms found naturally in the human body and may be beneficial to health. Also referred to as “good bacteria” or “helpful bacteria,” probiotics are available to consumers in oral products such as dietary supplements and yogurts, as well as other products such as suppositories and creams. The U.S. Food and Drug Administration (FDA) has not approved any health claims for probiotics. This fact sheet provides a general overview of probiotics, with an emphasis on oral products, and suggests sources for additional information.

 

Key Points

  • Although some probiotic formulations have shown promise in research, strong scientific evidence to support specific uses of probiotics for most conditions is lacking.
  • Studies suggest that probiotics usually have few side effects. However, the data on safety, particularly long-term safety, are limited, and the risk of serious side effects may be greater in people who have underlying health conditions.
  • If you are considering a probiotic dietary supplement, consult your health care provider first. Do not replace scientifically proven treatments with unproven products or practices.
  • Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

 

Probiotics, Prebiotics, and Synbiotics

Probiotics are not the same as prebiotics—nondigestible substances that stimulate the growth and/or activity of potentially beneficial microorganisms. The term “synbiotics” refers to products that combine probiotics and prebiotics.

About Probiotics

The concept behind probiotics was introduced in the early 20th century, when Nobel laureate Elie Metchnikoff, known as the “father of probiotics,” proposed in The Prolongation of Life: Optimistic Studiesthat ingesting microorganisms could have substantial health benefits for humans. Microorganisms are invisible to the naked eye and exist virtually everywhere. Scientists continued to investigate the concept, and the term “probiotics”—meaning “for life”—eventually came into use.

Picturing the human body as a “host” for bacteria and other microorganisms is helpful in understanding probiotics. The body, especially the lower gastrointestinal tract (the gut), contains a complex and diverse community of bacteria. (In the body of a healthy adult, cells of microorganisms are estimated to outnumber human cells by a factor of ten to one.) Although we tend to think of bacteria as harmful “germs,” many bacteria actually help the body function properly. Most probiotics are bacteria similar to the beneficial bacteria found naturally in the human gut.

Various mechanisms may account for the effects of probiotics on human health. Possible mechanisms include altering the intestinal “microecology” (e.g., reducing harmful organisms in the intestine), producing antimicrobial compounds (substances that destroy or suppress the growth of microorganisms), and stimulating the body’s immune response.

Probiotics commonly used in the United States include Lactobacillus and Bifidobacterium. There are many specific types of bacteria within each of these two broad groups, and health benefits associated with one type may not hold true for others.

 

Government Regulation of Probiotics

Government regulation of probiotics is complex. Depending on a probiotic product’s intended use, the FDA might regulate it as a dietary supplement, a food ingredient, or a drug. Many probiotic products are sold as dietary supplements, which do not require FDA approval prior to marketing. Dietary supplement labels may make claims about how the product affects the structure or function of the body without prior FDA approval, but they cannot make health claims (claims that the product reduces the risk of a disease) without the FDA’s consent. (For more information about dietary supplements, seeUsing Dietary Supplements Wisely.) A product that is marketed as a drug must meet more stringent requirements. It must be proven safe and effective for its intended use through clinical studies (tests in people) and be approved by the FDA before it can be marketed.

Use of Probiotics in the United States

In the United States, probiotics are available as dietary supplements (including capsules, tablets, and powders) and in dairy foods (such as yogurts with live active cultures). According to the 2007 National Health Interview Survey, which included a comprehensive survey on the use of complementary health approaches by Americans, “prebiotics/probiotics” ranked fifth among natural products used for children, but were not among the top-ranking products for adults. Although probiotic products are more popular in Europe and Japan than in the United States, the U.S. consumer market for probiotics is growing rapidly.

Although the FDA has not approved any health claims for probiotics, they are used for a variety of gastrointestinal conditions such as infectious diarrhea, diarrhea associated with using antibiotics, irritable bowel syndrome, and inflammatory bowel disease (e.g., ulcerative colitis and Crohn’s disease). Probiotics are also being used for preventing tooth decay and for preventing or treating other oral health problems such as gingivitis and periodontitis. Some—but not all—probiotic formulations have been widely studied and show considerable promise. However, the rapid growth in marketing and consumer interest and use has outpaced scientific research on the safety and efficacy of probiotics for specific health applications.

 

What the Science Says

The potential of probiotics to benefit human health in many different ways has stimulated great interest and activity among researchers. For example, the National Center for Complementary and Alternative Medicine (NCCAM) is part of the National Institutes of Health (NIH) Probiotic and Prebiotic Working Group, a trans-NIH effort to identify gaps and challenges in prebiotic/probiotic research.

Probiotic research is moving forward on two fronts: basic science (laboratory studies) and clinical trials to evaluate the safety and efficacy of probiotics for various medical conditions. Many early clinical trials of probiotics have had methodological limitations, and definitive clinical evidence to support using specific probiotic strains for specific health purposes is generally lacking. Nevertheless, there is preliminary evidence for several uses of probiotics, and more studies are under way. In particular, a recent review of the scientific evidence on the effectiveness of probiotics in acute infectious diarrhea concluded that there was evidence that probiotics may shorten the duration of diarrhea and reduce stool frequency but that more research was needed to establish exactly which probiotics should be used for which groups of people.

In 2008, the journal Clinical Infectious Diseases published a special issue on probiotics, which included an overview of clinical applications. Based on a review of selected studies, the authors classified several applications according to the strength of evidence supporting the efficacy of probiotics in prevention and/or treatment. For example, the authors concluded that strong evidence exists for acute diarrhea and antibiotic-associated diarrhea, and substantial evidence exists for atopic eczema (a skin condition most commonly seen in infants). Promising applications include childhood respiratory infections, tooth decay, nasal pathogens (bacteria harbored in the nose), gastroenteritis relapses caused by Clostridium difficilebacteria after antibiotic therapy, and inflammatory bowel disease. The authors also discussed various potential future applications.

Studies also indicate that probiotics may reduce side effects associated with treatment for Helicobacter pylori infection, the cause of most stomach ulcers. A systematic review suggests that there is strong evidence that probiotics may reduce the risk of necrotizing enterocolitis, a severe intestinal condition of premature newborns. Other potential future applications include use in reducing cholesterol levels, treating obesity, and managing irritable bowel syndrome.

 

Safety and Side Effects

It appears that most people do not experience side effects from probiotics or have only mild gastrointestinal side effects such as gas. But there have been some case reports of serious adverse effects, and research on safety is ongoing. A 2008 review of probiotics safety noted that Lactobacillus rhamnosus GG has been widely studied in clinical trials for a variety of conditions and generally found to be safe. Nevertheless, a recent review of Lactobacillus and Bifidobacterium noted that the long-term, cumulative effects of probiotics use, especially in children, are unknown, and also pointed to evidence that probiotics should not be used in critically ill patients. Similarly, a 2011 Agency for Healthcare Research and Quality assessment of the safety of probiotics, partly funded by NCCAM, concluded that the current evidence does not suggest a widespread risk of negative side effects associated with probiotics. However, the data on safety, particularly long-term safety, are limited, and the risk of serious side effects may be greater in people who have underlying health conditions.

Concerns have also been raised about the quality of probiotic products. Some products have been found to contain smaller numbers of live microorganisms than expected. In addition, some products have been found to contain bacterial strains other than those listed as ingredients.

 

Saccharomyces boulardi (large cells) found along with bacteria in fermented fruit juice. Image width W: 18.3 micrometers.Saccharomyces boulardi (large cells) found along with bacteria in fermented fruit juice.
Photo Credit: SciMAT / Photo Researchers, Inc

If You Are Considering Probiotics

  • Our understanding of probiotics is a work in progress. Although probiotic products are marketed for many different uses, scientific evidence supporting specific uses is still limited, and the FDA has not approved any health claims for probiotics. Before using probiotics, learn as much as you can by talking to your health care provider and researching reliable sources of information.
  • Probiotic products may contain different types of probiotic bacteria and have different effects in the human body. The effects also may vary from person to person.
  • Do not replace scientifically proven treatments with unproven products and practices. Do not use a complementary health product, such as probiotics, as a reason to postpone seeing your health care provider about any health problem.
  • If you are pregnant or nursing a child, or if you considering giving a child a dietary supplement, such as probiotics, it is especially important to consult your (or your child’s) health care provider.
  • Anyone with a serious underlying health problem should be monitored closely for potential negative side effects while taking probiotics.
  • Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips on talking with your health care providers about complementary health approaches, seeNCCAM’s Time to Talk campaign.

 

Scanning electron micrograph (SEM) of Bifidobacterium bifidum. (Microscope magnification: 16,000x, image width: 8.0 micrometers.)Scanning electron micrograph (SEM) of Bifidobacterium bifidum.
Photo Credit: SciMAT/Photo Researchers, Inc

NCCAM-Funded Research on Probiotics

Recent NCCAM-supported research on probiotics has included clinical studies1 focused on:

  • Diarrhea in infants
  • Irritable bowel syndrome and minimal hepatic encephalopathy (a complication of liver disease)
  • An antibiotic-resistant type of bacteria
  • Yogurt beverages as a way of giving high doses of probiotics to young children.

NCCAM also supports laboratory studies that explore possible mechanisms of action for probiotics, providing a foundation for clinical research. For example, recent studies have found evidence that a strain of Lactobacillus reuteri might slow the growth of certain tumors, and that Lactobacillus acidophilusmight enhance the effects of a vaccine against rotavirus infection—the most common cause of infectious diarrhea in infants and children worldwide.

NCCAM’s clinical research program has designated probiotics as a high-priority topic for upcoming projects. Studies will focus on probiotics for addressing gastrointestinal disorders in infants and children, including necrotizing enterocolitis, colic, and irritable bowel syndrome; treating and preventing antibiotic-induced diarrhea; and enhancing the effects of flu vaccine.

1. NCCAM-supported clinical research includes studies conducted under FDA-approved investigational new drug applications. Before these studies can proceed to medically vulnerable populations, researchers carry out rigorous trials to determine safety in healthy adults or people with mild medical conditions.

Color enhanced scanning electron micrograph (SEM) of the bacteria Lactobacillus acidophilus. A spirochete bacteria can also be seen at center.Color enhanced scanning electron micrograph (SEM) of the bacteria Lactobacillus acidophilus. A spirochete bacteria can also be seen at center.
Photo Credit: SciMAT/Photo Researchers, Inc

Key References

Top

For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on NCCAM and complementary health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.:
1-888-644-6226
TTY (for deaf and hard-of-hearing callers):
1-866-464-3615
Web site:

PubMed®

A service of the National Library of Medicine (NLM), PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals.

Acknowledgments

NCCAM thanks the following people for their technical expertise and review of the content update of this publication: Patricia Hibberd, M.D., Ph.D., Massachusetts General Hospital for Children; Marguerite Klein, M.S., NIH Office of Dietary Supplements; and Linda Duffy, Ph.D., and John (Jack) Killen, Jr., M.D., NCCAM.

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCAM.

* Note: PDF files require a viewer such as the free Adobe Reader.

NCCAM Pub No.:
D345
Date Created:
January 2007
Last Updated:
December 2012
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October 26, 2013 Posted by | Nutrition | , | Leave a comment

A Scientist Debunks The ‘Magic’ Of Vitamins And Supplements : Shots – Health News : NPR

 

Screen Shot 2013-10-26 at 8.14.15 AMA Scientist Debunks The ‘Magic’ Of Vitamins And Supplements : Shots – Health News : NPR.

From the 23 July 2013 NPR item

A pediatrician who spent years defending childhood vaccines against the likes of actress/activist Jenny McCarthy has launched an assault on megavitamins and dietary supplements.

“If you take large quantities of vitamin A, vtamin E, beta carotene [or] selenium you increase your risk of cancer, risk of heart disease, and you could shorten your life,” says Dr. Paul Offit, a researcher at The Children’s Hospital of Philadelphia.

Many large studies in recent years have shown that vitamins and dietary supplements rarely help and often hurt, Offit says. Yet a huge number of people still believe that these products will improve their health. So, Offit says, he decided to challenge the false beliefs of “the church of vitamins and supplements.”

Offit made the remarks during an appearance in Washington, D.C., Monday to promote his latest book: Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine.

Offit, an infectious disease specialist and the co-inventor of a rotavirus vaccine, is best known for publicly challenging groups that claim there is a link between childhood vaccines and autism. That effort often pitted him against actress Jenny McCarthy, who became a spokeswoman for anti-vaccine groups.

One big problem with dietary supplements is a 1994 law that exempts them from the tighter scrutiny the FDA applies to its regulation of medicines, Offit says. So the makers of a garlic supplement can say that it “supports cardiovascular health” even though a government study found that garlic supplements didn’t lower cholesterol. Meanwhile, Offit says, patients clearly benefit from a range of FDA-approved statin drugs that actually do what garlic supplements claim to do.

Dietary supplements are often advertised as “natural,” Offit says, even though that term can be misleading. For example, almonds are a natural source of vitamin E. But you would have to eat 17 pounds of almonds to get the amount of vitamin E in a single capsule sold by one supplement maker, Offit says. “So how is this a natural thing to do?”

Offit says doctors are partly to blame for the growing popularity of high-dose vitamins and other dietary supplements. Rather than pushing back against patients who want to take them, he says, doctors have acted like waiters at a restaurant, simply asking, “What would you like?”

Many hospitals also include unproved dietary supplements in their list of medicines available to patients, Offit says. But he says his own institution, The Children’s Hospital of Philadelphia, plans to remove nearly all supplements from its list later this month.

Offit says his attack on dietary supplements has generated a steady stream of hate mail. But he says it’s not as harsh as the hate mail he used to get from people who believe vaccines cause autism. “This is more, I’m ‘a liar and a shill for the pharmaceutical industry,’ ” he says, “not, ‘You’re going to hell.’ ”

Offit has some strong defenders, though, including former President Jimmy Carter and Carter’s wife, Rosalynn. They sat in the front row at Offit’s appearance in D.C. And during a question and answer session, the former president rose to tell Offit: “You’ve been a hero around our house for a long time.”

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October 26, 2013 Posted by | Consumer Health, Nutrition | , , | Leave a comment

Drug discount cards: Tips and tricks to watch out for

English: ancillary personal at work in a drugstore

English: ancillary personal at work in a drugstore (Photo credit: Wikipedia)

At our local Area Office on Aging I am a trained counselor through the Ohio Department of Insurance. In the past few months clients have been asking about drug discount cards.  Many marketing materials are very misleading .
Have hopefully been giving folks enough ways to look at the materials critically so they can decide. Going to refer folks to this. Already have added it to my Health/Medical News & Resources Web site. 

 

Drug discount cards: Tips and tricks to watch out for.

From the KevinMD.com post  by  | MEDS | SEPTEMBER 17, 2013

The finances behind drug discount cards

The amount you pay when using a drug discount card is the sum of four components. This is true for all drug discount cards.

1. The negotiated discounted price. The PBM does its best to negotiate the best discount from the pharmacies. Some PBMs do a better job of this than others. The size of the PBM, its market share, and how much business it will direct to the pharmacy are all important factors in the overall final discount.

2. Pharmacy transaction fee. Each time a card is used the pharmacy earns a small amount to help cover their costs.

3. PBM transaction fee. The amount the PBM earns to cover their costs of setting and running the pharmacy network, processing claims, etc.

4. Marketer fee. This is how much the marketer earns for promoting and distributing the card.

Who pays all these fees? You do!

Why pharmacies accept drug discount cards

You may wonder why pharmacies accept drug discount cards. After all, wouldn’t they make more by not accepting the cards and charging customers the non-discount price? There are five reasons pharmacies accept the cards.

1. Earning a profit even at the discounted price. They wouldn’t offer such a large discount that they lose money on the transaction.

2. Selling prescriptions they wouldn’t sell otherwise. For example, a customer may not be able to afford a prescription with a non-discounted price of $100 but may be able to afford it at the discounted price. The pharmacy gets the sale, but earns a lower profit.

3. Building customer loyalty. The drugstore business is very competitive. If a pharmacy gives you a good discount with a drug discount card you are more likely to continue to patronize that store than others.

4. Increased non-pharmaceutical purchases. There’s a reason why most pharmacies are at the back of the drugstore. This arrangement forces you to walk down aisles, increasing the chances you will make additional purchases.

5. Peer pressure. If all the pharmacies in town but one accept drug discount cards, that one will lose business.

How marketers make money

There are two main ways card marketers make money from drug discount cards and items you should watch out for.

1. Transaction fees. Each time a marketer’s card is used the marketer earns a transaction fee designed to cover expenses and make a profit. The size of the fee varies quite a bit. Generally speaking, non-profit companies and marketers that don’t have expensive marketing programs have lower transaction fees. Lower fees mean more savings for card users. Remember, card users pay the fees.

2. Selling of information. Some card marketers gather personal information on people who use their card. They can do this if you have to register to obtain a card. They can also receive personal information each time you use the card. For example, a company selling diabetic supplies would pay for a list of names and addresses of people who buy insulin.

Buyer beware

Here are some tips when selecting a drug discount card.

1. Never pay for a card. There are many good cards that are free. There is no reason to pay for a card since it’s unlikely it would offer a discount any better than a free one.

2. Never register for a card. This is one way marketers get info that they sell. The only reason to give your name and address is if the card is being mailed to you.

3. Read the privacy policy. Make sure the marketer has a privacy policy that you agree with. Even then, there’ no guarantee they will follow it.

4. Helpline. All reputable marketers have a toll-free helpline. Give the line a call and see how responsive they are. Do they have real people answering your questions or just a recording? If you leave a message do they call you back?

5. Shop around. Try different cards to see which offers you the best discount. Ask your pharmacist which has the best prices.

6. Consider who is making money. All things being equal, using a card offered by a non-profit is best. Any money they make is going to further their cause while the money earned by a for-profit is just going into someone’s pocket.

Richard J. Sagall, is president and co-founder, NeedyMeds.

This post originally appeared on the Costs of Care Blog.Costs of Care is a 501c3 nonprofit that is transforming American healthcare delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

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October 26, 2013 Posted by | health care | , | Leave a comment

Corporate wellness programs fail both companies and patients

desk treadmill rendezblue-1

desk treadmill rendezblue-1 (Photo credit: healthiermi)

 

Corporate wellness programs fail both companies and patients.

 

From the 9 September 2013 article by Kevin Pho at KevinMD.com

 

This column was published in USA Today on September 9, 2013.

More patients are coming to my primary care clinic with forms from their employer, asking me to measure their blood pressure, or check their sugar and cholesterol levels. Companies requesting medical data drive employee wellness programs, a booming $6 billion business, with approximately half of large employers offering such plans.

Coaching and financial incentives are often offered to help employees meet certain health metrics, such as losing weight, lowering cholesterol or quitting smoking. The results of these tests are often tied to the cost of health insurance, with less healthy workers paying more. Under the Affordable Care Act, up to 30% of an employee’s premium in 2014 can be influenced by these programs, an average of$1,620 annually per worker.

 

Wellness programs are designed to lower costs for employers and keep workers healthy, but do they accomplish either goal?

True health cost savings?

Wellness plans are often promoted as saving $3 or more for every dollar invested. But a recent RAND Corporation analysis found that fewer than half of companies took the time to calculate whether these programs saved them money. If they did, the numbers might have startled them. That same study also concluded that wellness programs did not significantly reduce employer health costs.

Why? Health screenings generally promote more doctor visits, prescription medications or further tests. While this might benefit workers’ health, it doesn’t necessarily save money.

If there are no measurable savings, employers pass on the cost of these programs, as much as $500,000 per year, to workers by raising their insurance premiums.

Whether wellness programs improve health is also dubious. This year, the California Health Benefits Review Program, which advises the state’s legislature, found that employees’ blood pressure, blood sugar or cholesterol did not improve by participating in a corporate wellness plan. Weight loss was minimal, with the RAND researchers finding that workers lost about 1 pound annually for three years.

Furthermore, there was no improvement in the rate of hospitalizations and emergency room visits.

Some short-term benefits

While there was a short-term gain in the rate of smokers quitting, it came with a qualification. Fewer than half of employees participate in wellness programs, which are mostly voluntary. Those who participate are often the most motivated, making it hard to tell whether their smoking cessation was due to the wellness program or the employees’ motivation.

Wellness programs also require tests more frequently. For instance, many require blood sugar and cholesterol screens every year in healthy adults, far in excess of recommended guidelines, which call for checking these levels once every three and five years, respectively. Such over-testing doesn’t necessarily make patients any healthier and contributes to the $210 billion our health system spends annually in unnecessary care.

Because I want my patients to save money on their insurance premiums, I dutifully fill out their wellness forms and order the requested screening tests that might not be needed. But it’s doubtful I’m saving these companies money or making my patients healthier by doing so.

Kevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.

 

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October 26, 2013 Posted by | health care | , , , , , | Leave a comment

[Reblog] Infographic: Top Trends in Telemedicine (at mHealthWatch)

Infographic: Top Trends in Telemedicine | mHealthWatch.

October 03, 2013 — By 

Infographic: Top Trends in Telemedicine telemedicine mHealth infographics CDW According to recently compiled data fromCDW, telemedicine continues to advance at an impressive pace.

From monitoring chronic health conditions to providing teleconsultations to patients, the opportunities are vast when it comes to positive telemedicine applications.

So what are the top trends in telemedicine today? Check out this informative visual snapshot of this remarkably healthy young industry and its impressive growth.

 

Infographic: Top Trends in Telemedicine telemedicine mHealth infographics CDW

This post was written by:

 – who has written 448 posts on mHealthWatch.

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October 26, 2013 Posted by | health care | , , , | Leave a comment

Study: The Health Care Experiences and Expectations of Low-Income Californians – NPQ – Nonprofit Quarterly

Study: The Health Care Experiences and Expectations of Low-Income Californians – NPQ – Nonprofit Quarterly.

From the 24 October 2013 article BY ANNE EIGEMAN at NonProfit Quarterly

As the most recent update in an ongoing research project that began in 2011, this week, the Blue Shield Foundation of California released a report on the healthcare experiences and expectations of low-income Californians. Two central goals guided the project: 1) to help healthcare facilities—particularly California’s community health centers—successfully navigate the changes brought about by the ACA, and 2) to help community health centers identify the most effective ways of encouraging patients and providers alike to embrace primary care redesign and move closer toward the goal of patient empowerment. As key findings, the study points to the “wide range of positive outcomes” that come from successful communication between patients and providers and the “broad gap” that currently exists between the information patients possess and the information they want.

The study found that only 28 percent of low-income Californians feel they have easily comprehensible health information for decisions about care. In addition, almost 40 percent rely on media sources to address concerns—“a potential problem” according to the study, because “trust in information is much higher when it comes from a medical professional than from other sources.”

A central theme is the value to patients that comes from a strong patient-provider relationship, which can lead to improvement in a patient’s overall sense of being well informed about his or her health, the level of satisfaction with the quality of care at a specific facility, and trust of the information provided by doctors. In light of upcoming structural changes to healthcare systems from the ACA, the study’s note that “alternative communication approaches also show great promise in helping to improve patients’ relationships with their providers.” is significant. Examples of these new approaches include team based care, decision aids, health coaches, and online or smartphone-accessible health sites, all of which were found to “enhance, rather than diminish, the critical connection between patients and their providers.”

The study devotes considerable attention to the effect of the digital divide on healthcare for specific groups of low-income Californians. “While four in ten low-income Californians overall lack Internet access, that soars to 67 percent of Spanish-speakers, 63 percent of non-citizens, 62 percent of Latinas and 59 percent of those in only fair or poor health,” the study reports. In addition, the fact that 59 percent of low-income residents over 50 lack Internet access and 41 percent lack a text-capable phone makes this “vulnerable population particularly hard to reach with technology-based information and communications.”

 

 

Read the entire article here

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October 26, 2013 Posted by | health care | , , , , , , | Leave a comment

Incentivizing Healthy Behaviors in Low-Income Patient Populations

Incentivizing Healthy Behaviors in Low-Income Patient Populations.

From the 24 October 2013 blog item at Leavitt Partners

What works and 8 lessons other health care organizations learn

Data suggests costs can be better contained if all people are practicing healthy life behaviors.[i] State and Federal leaders, charged with holding down costs without sacrificing access to or quality of care, agree with this principal—and as a health insurance payer with one of the longest histories of serving low-income individuals, state Medicaid programs have explored many approaches to incentivizing positive health-related behaviors in its patient populations.

On January 1 2014, about half of the states will expand their Medicaid programs to newly eligible individuals with income below 133% FPL. Insurance subsidies will also be provided to individuals with income between 100% and 400% FPL, increasing access to commercial insurance to those with low- to moderate-incomes. As health care organizations begin managing the health and wellbeing of these newly insured groups, many will be looking for ways to control long-term costs by incentivizing healthy changes in behaviors.

In order to better understand which approaches are the most effective, Leavitt Partners analyzed case studies and program outcomes to answer the following questions:

What are the most effective approaches to motivate low-income adults to make positive changes in their behavior (for themselves and children)?

What are the most effective approaches to motivate low-i

– See more at: http://leavittpartners.com/2013/10/incentivizing-healthy-behaviors-low-income-patient-populations/#sthash.DyBTYRJG.dpuf

 

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October 26, 2013 Posted by | health care | , , , , , | Leave a comment

Patients Not Included * [Inclusion of Patients at a Medical Conference]

From the 25 October 2013 blog item By LESLIE KERNISAN, MD at The HealthCare Blog

 few weeks ago, I went for the first time to Stanford’s Medicine X conference. It’s billed as a conference that brings a “broad, academic approach to understanding emerging technologies with the potential to improve health and advance the practice of medicine.”

Well, I went, I saw, and I even briefly presented (in aworkshop on using patient-generated data).

And I am now writing to tell you about the most important innovations that I learned about at Medicine X (MedX).

They were not the new digital health technologies, even though we heard about many interesting new tools, systems, and apps at the conference, and I do believe that leveraging technology will result in remarkable changes in healthcare.

Nor were they related to social media, ehealth, or telehealth, even though all of these are rapidly growing and evolving, and will surely play important roles in the healthcare landscape of the future.

No. The most remarkable innovations at MedX related to the conference itself, which was unlike any other academic conference I’ve been to. Specifically, the most important innovations were:

  • Patients present to tell their stories, both on stage and in more casual conversational settings such as meals.
  • Patient participation in brainstorming healthcare solutions and in presenting new technologies. MedX also has an ePatient Advisors group to help with the overall conference planning.

These innovations, along with frequent use of storytelling techniques, video, and music, packed a powerful punch. It all kept me feeling engaged and inspired during the event, and left me wishing that more academic conferences were like this.

These innovations point the way to much better academic conferences. Here’s why:

The  power of patient presence

I wasn’t surprised to see lots of patients at Medicine X, because I knew that the conference has an e-patient scholars program, and that many patients would be presenting. I also knew that the director of MedX, Dr. Larry Chu, is a member of theSociety of Participatory Medicine. (Disclosure: I’ve been a member of SPM since last December.)

I was, on the other hand, surprised by how powerful it was to have patients on stage telling their stories.

How could it make such a difference? I am, after all, a practicing physician who spends a lot of time thinking about the healthcare experience of older adults and their caregivers.

But it did make a difference. I found myself feeling more empathetic, and focused on the patient and family perspective. And I felt more inspired to do better as a physician and as a healthcare problem-solver.

In short, having patients tell their stories helped me engage with the conference presentations in a more attentive and meaningful way.

…

Read the entire blog item here

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October 26, 2013 Posted by | health care | , , , , , , , | 1 Comment

[Reblog] Climate Change and Medical Risk

Bioethics-in-the-News-logo

From the 25 October 2013 post at The Center for Ethics and Humanities in the Life Sciences at Michigan State Universi

This post is a part of our Bioethics in the News series. For more information, click here.

By Sean A. Valles, Ph.D.

 After winning the 2007 Nobel Peace Prize, the UN’s Intergovernmental Panel on Climate Change has returned to the headlines. Heeding the growing body of climate evidence, they say, “it is extremely likely [95%-100% likely] that human influence has been the dominant cause of the observed warming since the mid-20th century” (IPCC Working Group I 2013, pp. SPM-2, SPM-12). Unfortunately, according to a March Gallup poll:

In contrast to majority acceptance of global warming as real, Gallup finds Americans less than alarmed. One-third worry “a great deal,” and 34% expect it to threaten their way of life. These could be the attitudes that matter most when it comes to Americans’ support for public policies designed to address the issue (Saad 2013).

That skepticism about climate change’s seriousness (and, to a lesser extent, about humans’ responsibility for it) is impeding democratic action in the US. The leadership provided by a skeptical vocal minority has turned the public dialogue into a dispute over uncertainties in how we predict future climate, whether it is accusing researchers of inadequate “objectivity” (LaFramboise 2013) or publicizing pieces of climate data that seem inadequately explained (Darwall 2013). I encourage my bioethics colleagues to help change the conversation, and re-frame the US climate change dialogue to focus on one crucial fact: even with lingering uncertainties, climate change poses health risks that we would be foolish to ignore.

A 2009 special report by TheLancet and University College London Institute for Global Health Commission declares, “climate change is the biggest global health threat of the 21st century” (Costello, et al. 2009, p. 1693). These are bold words, especially coming from TheLancet—one of the most prestigious medical journals. The report lists a number of health risks: more numerous heat waves will worsen respiratory and cardiovascular symptoms (Costello, et al. 2009, p. 1702), mosquitoes and mosquito-borne diseases will spread and flourish in newly warm areas (Costello, et al. 2009, p. 1702), and extreme weather events will become more common and stronger (impacting mental health, access to food, access to sanitation infrastructure, etc.) (Costello, et al. 2009, p. 1706). The list goes on, and policy groups such as the EPA have demonstrated that they take it quite seriously. A recent article in Bioethics by Cheryl Cox MacPherson explains that such risks make it clear “Climate Change Is a Bioethics Problem” (MacPherson 2013, p. 305).

Unfortunately, bioethicists’ involvement in the climate change dialogue—a crucialmedical dialogue—has been the exception rather than the norm. Bioethicists are already expert communicators, researchers, interdisciplinary collaborators, and public advocates in the management of multiple intersecting risks and ethical considerations. They apply this expertise to issues such as tissue donation, vaccination, and pharmaceutical testing. I recommend that they add climate change to their list of priorities. Economic constraints, individual liberty, public welfare, being mindful of social justice; these sorts of difficult climate change considerations are very much in bioethicists’ wheelhouse.

Mean surface temperature change for 1999–2008 ...

Mean surface temperature change for 1999–2008 relative to the average temperatures from 1940 to 1980 (Photo credit: Wikipedia)

Recent research on science communication indicates that pragmatically it would be a wise strategy to move health out of the background in the climate change dialogue. A recent study compared audience responses to three different presentations of climate change, “emphasizing either the risks to the environment, public health, or national security;” the researchers found that, “across audience segments, a public health focus was the most likely to elicit emotional reactions consistent with support for climate change mitigation and adaptation” (Myers, et al. 2012, p. 1105). Maibach et al. explains that the “dominant mental frame used by most members of the public to organize their conceptions about climate change is that of ‘climate change as an environmental problem’” (Maibach, et al. 2010, p. 2). We all hear plenty of talk about ‘saving the environment,’ but switching to a health frame would offer important benefits.

Re-defining climate change in public health terms should help people make connections to already familiar problems such as asthma, allergies, and infectious diseases experienced in their communities. The frame also presents the opportunity to involve additional trusted communication partners on the issue, notably public health experts and local community leaders (Maibach, et al. 2010, pp. 9-10).

Pictures of forlorn polar bears floating on melting blocks of ice have proved compelling for some people, but a health-centered approach looks more promising as a default strategy.

…

Read the entire blog item here

Related articles
  • Climate change is real, ignore the denialists (irishtimes.com)
  • Pacific nations ‘very disappointed’ by Tony Abbott’s climate scepticism (theguardian.com)
  • A new European report on climate extremes is out (realclimate.org)
  • International Journal of Global Warming — Special Issue on Loss and Damage from Climate Change (Full Text Reports)

    Source: International Journal of Global Warming
    From press release (EurekAlert!):

     

    An open access special issue of the International Journal of Global Warming brings together, for the first time, empirical evidence of loss and damage from the perspective of affected people in nine vulnerable countries. The articles in this special issue show how climatic stressors affect communities, what measures households take to prevent loss and damage, and what the consequences are when they are unable to adjust sufficiently. The guest-editors, Kees van der Geest and Koko Warner of the United Nations University Institute for Environment and Human Security (UNU-EHS) in Bonn, Germany, introduce the special issue with an overview of key findings from the nine research papers, all of which are available online free of charge.

    ‘Loss and damage’ refers to adverse effects of climate variability and climate change that occur despite mitigation and adaptation efforts. Warner and van der Geest discuss the loss and damage incurred by people at the local-level based on evidence from research teams working in nine vulnerable countries: Bangladesh, Bhutan, Burkina Faso, Ethiopia, The Gambia, Kenya, Micronesia, Mozambique and Nepal. The research papers pool data from 3269 household surveys and more than 200 focus groups and expert interviews.

    The research reveals four loss and damage pathways. Residual impacts of climate stressors occur when:

    • existing coping/adaptation to biophysical impact is not enough;
    • measures have costs (including non-economic) that cannot be regained;
    • despite short-term merits, measures have negative effects in the longer term; or
    • no measures are adopted – or possible – at all.

    The articles in this special issue provide evidence that loss and damage happens simultaneously with efforts by people to adjust to climatic stressors. The evidence illustrates loss and damage around barriers and limits to adaptation: growing food and livelihood insecurity, unreliable water supplies, deteriorating human welfare and increasing manifestation of erosive coping measures (e.g. eating less, distress sale of productive assets to buy food, reducing the years of schooling for children, etc.). These negative impacts touch upon people’s welfare and health, social cohesion, culture and identity – values that contribute to the functioning of society but which elude monetary valuation.

     

  • The Majority of Americans Recognize the Climate is Changing (sustainableutah.wordpress.com)

 

October 26, 2013 Posted by | environmental health | , | Leave a comment

United Health Care Terminations of Physicians in Medicare Advantage Plan

Screen Shot 2013-10-26 at 5.07.33 AMThis is worrisome. Granted UHC may not be doing anything illegal, but are their actions ethical?
Disclaimer…at the local Area Office on Aging I assist folks with Medicare Advantage Plan comparisons. A very satisfying volunteer position. Well worth the 20 hours or so of training through the State of Ohio Department of Insurance.

From the 25 October 2013 blog item at the Medical Society of New Jersey

In mid-October UHC began terminating physicians in their Medicare Advantage plan. We immediately reached out to UHC when it appeared that the terminations were not isolated, but rather part of a   broad initiative. This week, UHC responded to some of our questions. We are disappointed that there was no warning of this termination initiative which appears to be a significant redesign of the UHC Medicare Advantage network, nationwide, and that information is sparse. For example, UHC would not tell us how many physicians in New Jersey were terminated or whether any specialties were immune to the termination initiative. Yet, UHC assured us that the network had been “tested and retested” for network adequacy and that there would not be a specialty access issue.

Network Adequacy: Obviously, MSNJ has no way of evaluating the impact on the network without more information. Therefore, we are asking all physicians who received termination letters, to provide us with information so that we can better evaluate network adequacy concerns. CMS has agreed to help us with that assessment.

Lack of Transparency: In addition to our network adequacy concerns, we are troubled that patients may be enrolling or re-enrolling in the UHC Medicare Advantage plan now, because seniors are in the middle of open enrollment, believing that they will be able to continue to be treated by physicians who are currently in the plan. UHC agreed to consider our complaint on lack of transparency on the 2014 network, given that seniors are enrolling now based on the current network. It is important to note that patients may change their network selection. CMS will honor the last selection made by the patient by December 7 when open enrollment ends.

Continuity of Care: We expressed our concerns about continuity of care and a disruption of established physician-patient relationships.  We urged UHC to carve out an exception for patients who wish to continue to see their current physician. UHC agreed to consider this request. We believe that patients should have the right to choose their physicians and must know their network status to make those choices.

Discussions with CMS: With a reopening of the federal government, we have contacted CMS about our network adequacy and continuity of care concerns. Our Region 2 office has been facilitating communication with the Region 9 office which is responsible for the UHC Medicare Advantage network. CMS Region 9 is charged with ensuring network adequacy and transparency for Medicare beneficiaries in their selection of a Medicare product. CMS has offered to test areas for network adequacy. Pleaseprovide us with information so that we can identify geographical and specialty areas of concern.

What to do: Last week we urged physicians who wished to stay in the Medicare Advantage network to appeal and provided suggestions for those appeals. We will continue to update our advice to members as more information becomes available to us.  Visit our web site for a list of Do’s and Don’ts, Appeal Suggestions, a template letter to inform patients of your imperiled status in the UHC Medicare Advantage Network.

Save the date for MSNJ’s UHC Termination Update webinar on Tuesday, October 29 at 7:00PM. Details to follow on www.msnj.org.

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October 26, 2013 Posted by | health care | , , | Leave a comment

   

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