Archive for February, 2008

Americans Split Over Socialized Medicine

February 14th, 2008 by Melanie Matthews

During the course of the presidential nomination campaign, some candidates’ healthcare plans have been described as “socialized medicine.” Historically, the phrase socialized medicine has been used to attack health reform proposals in the U.S. However, a new poll by the Harvard Opinion Research Program at the Harvard School of Public Health (HSPH) and Harris Interactive finds that Americans are split on whether a socialized medical system would be better or worse than the current system.

Seventy percent of Republicans say that socialized medicine would be worse than our current system. The same percentage of Democrats (70 percent) say that a socialized medical system would be better than our current system. Independents are more evenly split with 43 percent saying socialized medicine would be better and 38 percent worse.

The uninsured do not view socialized medicine as negatively as those who have health insurance. Only 19 percent of the uninsured think that a socialized medicine system would be worse than our current system while 57 percent think it would be better. Those who currently have health insurance are divided on whether socialized medicine would be better (44 percent) or worse (41 percent).

Despite New Tumor-Causing Genes, Treatments Have Never Been Better

February 14th, 2008 by Melanie Matthews

According to the University of Cinncinnati, nearly 215,000 Americans will be diagnosed with a brain tumor in 2008. In this week’s Disease Management Update, while one study deals with a “Jekyll and Hyde”-type gene that could both fight a tumor or help the tumor advance in brain cancer glioblastoma cases, another study notes that new brain tumor treatments have never been better as the nation’s leading brain tumor centers have never been better.

Overweight Children Have Less Elbow Range of Motion

February 11th, 2008 by Melanie Matthews

Children who are overweight have less range of motion in their elbows than their normal-weight peers, which could make it tougher for them to exercise in order to lose weight, the findings of a research study suggest. The study correlated the elbow range of motion and body mass indices (BMIs) of 113 healthy children between the ages of 2 and 18. Seventy-two of the participants had weights in the normal range, with BMIs in the 15th to 85th percentile. Fifteen participants were at risk of being overweight, with BMIs from the 85th to 95th percentile, and 20 were overweight, with BMIs at or above the 95th percentile. Six were underweight, with BMIs below the 15th percentile. Researchers measured elbow range of motion using a standard orthopedic instrument called an extendable goniometer.

Overweight children may have difficulty participating in the same athletic endeavors as their normal-weight counterparts due to decreased joint motion. This could make it more difficult to lose weight and might further discourage overweight children from participation in sports.

When BMI is one standard deviation above normal, a child loses approximately two to three degrees of elbow movement. But the elbow of a child who is in the 99th percentile will flex between 12 to 15 degrees less than normal-weight peers. This loss of elbow movement may have significant effects on the overweight child’s ability to participate in athletics.

Coach Attributes Tied To Better Quit Rates in Smoking Cessation Program

February 11th, 2008 by Melanie Matthews

Measuring ChangeDoes a health coach who’s also an ex-smoker get better results from participants in a smoking cessation program? Not necessarily, says Darcy Hurlbert of Ceridian LifeWorks, but other coach attributes may make a difference. She describes some recent findings her company determined when evaluating health coach outcomes and ROI:

What attributes lead to a successful coach — a coach having successful outcomes? All of our coaches underwent a battery of assessments from SIGMA Assessment Systems that measure personality, aptitude and leadership. Eighteen of our coaches took these assessments and we looked at these results against an individual’s probability of quitting. We saw that a coach’s attributes do have an effect on quit rates…

We then looked at specific variables and found that there was not one coach attribute in particular that really made a difference. We found there is a group of three attributes that showed evidence of higher outcomes with a probability value of .05: verbal ability, self-reliance and individualism. We are going to do a coach-attributes analysis again, using our preliminary findings regarding these three core attributes. Socioeconomic analysis was not performed on the coaches, regarding their ages, education levels and salaries. We considered experience, education (whether they had a master’s degree), gender and whether they were former smokers.

Insomnia Patients Denied Sleep Treatment If They Have Mental Health Conditions

February 7th, 2008 by Melanie Matthews

Patients with insomnia who are diagnosed with accompanying mental health ailments often are not prescribed medication that will help them sleep — which could then make related anxiety or depression worse, new research suggests. Senior study author Rajesh Balkrishnan, the Merrell Dow professor of pharmacy at Ohio State University, and colleagues, collected data from the National Ambulatory Medical Care Survey, which tracks Americans’ annual outpatient medical visits. The researchers identified 5,487 physician visits by patients with insomnia between 1995 and 2004, which was calculated to represent about 161 million U.S. patients over that 10-year period.

  • Thirty-eight percent of patients with insomnia were diagnosed with at least one other condition, and at least four of every 10 of those accompanying conditions related to mental health. The most common additional condition was anxiety (15.6 percent), followed by episodic mood disorders (14.9 percent), high blood pressure (10.1 percent), depression (7 percent) and diabetes (3.5 percent).
  • Patients visiting psychiatrists had two times higher odds of receiving medication for insomnia than patients visiting family practice or internal medicine physicians. The study showed that 33 percent of patients with insomnia saw family practice or internal medicine physicians, 30 percent visited psychiatrists and 9 percent went to neurologists.

Reducing Non-emergent ED Use

February 7th, 2008 by Melanie Matthews

Non-emergent emergency department (ED) usage can be a huge roadblock in proper disease management. It can drastically increase the cost of disease management and can seriously interfere with caring for truly needy patients in a timely and appropriate manner. Without the benefit of medical homes, many people head to the ED for everything from headaches and backaches to gastritis and lumbago.

This week’s Disease Management Update looks at two studies involving ED usage. While one study focuses on a dangerous increase in ED wait times, another notes a drastic increase in visits related to staph infections.

Minority Children Experience Multiple Disparities in Healthcare

February 6th, 2008 by Melanie Matthews

There is a lack of equity in healthcare for minority children in America, according to data gathered in a nationwide survey and analyzed by a UT Southwestern Medical Center researcher. The UT Southwestern analysis, available online and published as an abstract in the February issue of the journal Pediatrics, suggests certain disparities are particularly pronounced for specific racial and ethnic groups. Awareness of these disparities may be useful for clinicians, health systems and policymakers to address the needs of diverse populations.

  • Children in minority groups, such as Latino, African-American, Asian/Pacific Islander, Native American or multiracial, were significantly less likely than whites to have visited a physician or been given a medical prescription in the past year.
  • Latino and Native American children were more likely to be uninsured than African-American, multiracial, white and Asian/Pacific Islander children.

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February 5th, 2008 by Melanie Matthews

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Creating a Physician Practice Culture That Supports the Medical Home Model

February 5th, 2008 by Melanie Matthews

Dr. Lonnie Fuller
Fostering a practice environment in which staff are trusted to carry out standing orders and empowered to tell a physician when an error has been made can smooth the transition to the advanced medical home model, said Dr. Lonnie Fuller during our recent webinar on Building an Advanced Medical Home to Improve Chronic Care Outcomes. Dr. Fuller, medical director for the Pennsylvania Medicaid ACCESS Plus PCCM-DM Program, shared some of his thoughts:

In many cases, the physician is the boss. When I went into private practice, when I went into the hospital, sometimes the nurses stood up, and I thought, “What is this? I can’t believe they’re standing up just because I walked down the hall,” but the doctor was the expert, the doctor was right, no one could tell the doctor when they were wrong. So, when I made a mistake and the nurse saw, they might whisper to each other, but they didn’t say it to me. They weren’t comfortable pointing out things that I missed.

So part of this is, is your staff comfortable pointing out mistakes and problems? Can they tell the physician if the physician is wrong? “Doctor, that’s the wrong medication.” “But doctor, they really didn’t have the mammogram – can we order the mammogram?” Will the physicians let the staff determine how to do their job? As medical director, if I sat in an office and wrote out a policy and a protocol for how the medical assistants would draw blood, I would fail to do one that worked. They would try to follow it, knowing that it didn’t work. They would just get mad at me.

So we have to let people determine how best to do their job. Will physicians let the staff follow standing orders? Will we trust them to do the work? If we have measurement in place we can be sure they’re doing the work and follow up on it, but will we trust them as physicians?

HealthPresence Offers Virtual Face Time with the Doctor

February 4th, 2008 by Melanie Matthews

With our eldest away at college, we visit her virtually via our webcam and an online telephone service. Herky-jerky video quality aside, it reassures us greatly to see and hear her “live.” So I can certainly understand the positive reaction of physicians and patients in Scotland to Cisco’s new HealthPresence technology. This week, we report on the worldwide launch of this tool, which creates a virtual face-to-face experience for patients and providers.

Cisco HealthPresence is a technical platform that interfaces with medical diagnostic equipment, such as stethoscopes and otoscopes, as well as a vital signs monitor that can measure blood pressure, temperature, pulse rate and pulse oximetry to capture the physiological condition of the patient. An attendant is available to operate the medical devices on behalf of the remotely located caregiver as well as to maintain the technology in good operating condition.

This innovation has implications for many client and member encounters, including health and wellness coaching. Which technologies are enhancing your health coaching efforts, and what effect does coaching have on your population’s outcomes and healthcare expenses? Take our e-survey on health and wellness coaching and receive a complimentary e-summary of the results.