Tobacco-related diseases remain the number one preventable cause of death in America, killing more than 438,000 Americans each year. And according to the University of Florida, while millions of Americans resolve to quit each year, far too many fall off the wagon before January 2.
This week’s Disease Management Update takes a look at the myths behind smokeless tobacco and the results of the American Lung Association???s State of Tobacco Control 2007 report.
A modified version of a popular high-protein, low-carbohydrate diet can significantly cut the number of seizures in adults with epilepsy, a study led by Johns Hopkins researchers suggests. The Atkins-like diet, which has shown promise for seizure control in children, may offer a new lifeline for patients when drugs and other treatments fail or cause complications. Thirty adults with epilepsy, ages 18 to 53 years, who had tried at least two anticonvulsant drugs without success and had an average of 10 seizures per week, were placed on the modified Atkins diet.
- Half the patients had experienced a 50 percent reduction in the frequency of their seizures by the first clinic visit.
- Fourteen patients who stuck with the diet until the six-month mark chose to continue, even after the study ended ??? a testament to how effective the diet worked to treat their epilepsy.
During this week’s webinar examining the 2008 updates to CMS’ Physician Quality Reporting Initiative (PQRI), AAFP Medical Director of Quality Improvement Dr. Bruce Bagley said the lack of an EHR was no excuse for a practice’s non-participation. “A lot of practices are waiting to open the box on the EHR before doing any kind of quality work, which is a dangerous approach,” he said. “There’s so many things that we can do in terms of better processes and data collection tools and registries that are almost independent of the electronic medical record or can be done with or without it.” You can hear more from Dr. Bagley and co-presenters Lorraine Larrance and Sue Kincer of Pershing Yoakley & Associates in this week’s featured podcast.
Another initiative impacting the family practice and quality of care is the medical home model. A few days remain to take HIN’s survey on medical homes in 2008 and receive a complimentary copy of the results.
The New Jersey Academy of Family Physicians has made a video promoting the use of the medical home model. The video makes a case for physician payment reform to support the medical home model but also does a great job of showing the medical home’s potential for providing comprehensive, coordinated and patient-centered care.
This week’s Disease Management Update looks at skin cancer and reports what one hospital is doing to target the destruction of the melanoma-causing cells, as well as research revealing a new skin cancer virus.
When faced with even a modest health insurance co-payment for a mammogram, significantly fewer women receive these potentially life-saving breast cancer screenings, according to a new study by Brown University and Harvard Medical School researchers. The review included 366,475 women within 174 Medicare managed-care plans between the ages of 65 and 69 living in 38 states. The team compared the rates of biennial breast cancer screening within plans requiring co-payments with screening rates for plans with full coverage. They also analyzed data from plans that introduced co-payments over the three-year study period in order to study how mammography rates would change compared to rates in plans without co-payments.
- Biennial breast cancer screening rates were eight to 11 percent lower in cost-sharing plans ??? a difference that persisted even when adjusting for possible differences due to income, education, race and other factors.
- From 2002 to 2004, screening rates decreased by 6 percent in plans that introduced co-payments while screening rates increased by 3 percent in matched control plans that retained full coverage.
Researchers from Monash University in Melbourne have found that weight-loss surgery works much better than standard medical therapy as a treatment for Type 2 diabetes in obese people, the New York Times reports today. This is the first study to compare the two approaches.
- The study of 60 patients showed that 73 percent of those who had surgery had complete remissions of diabetes, meaning all signs of the disease went away. By contrast, the remission rate was only 13 percent in those given conventional treatment, which included intensive counseling on diet and exercise for weight loss, and, when needed, diabetes medicines like insulin, metformin and other drugs.
- In the study, the surgery worked better because patients who had it lost much more weight than the medically treated group did ??? 20.7 percent versus 1.7 percent of their body weight, on average. Type 2 diabetes is usually brought on by obesity, and patients can often lessen the severity of the disease, or even get rid of it entirely, by losing about 10 percent of their body weight. Though many people can lose that much weight, few can keep it off without surgery.
Cost and coverage for the surgery are factors, the article continued:
Medicare covers weight-loss surgery according to [National Institute of Health] rules, but many private insurers refuse to cover the surgery at all, said Dr. Philip Schauer, director of the bariatric and metabolic institute at the Cleveland Clinic. He said his center had to turn away three or four patients for every one accepted because insurers would not pay.
The United States places last among 19 countries when it comes to deaths that could have been prevented by access to timely and effective healthcare, according to new research supported by The Commonwealth Fund and published in the January/February issue of Health Affairs. Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine compare trends in deaths that could have been prevented by access to timely and effective healthcare. Specifically, they looked at deaths “amenable to healthcare before age 75 between 1997???98 and 2002???03.”
The study found that:
- If the U.S. had performed as well as the top three countries out of the 19 industrialized countries in the study, there would have been 101,000 fewer deaths in the U.S. per year by the end of the study period. The top performers were France, Japan and Australia.
- While other countries made strides and saw deaths “amenable to healthcare before age 75″ decline by an average of 16 percent, the U.S. experienced only a 4 percent decline.
- In 1997???98 the U.S. ranked 15th out of 19 countries on the “mortality amenable to healthcare” measure. However, by 2002???03 the U.S. fell to last place, with 109 deaths amenable to healthcare for every 100,000 people.
- Mortality rates per 100,000 people in the leading countries were: France (64), Japan (71), and Australia (71). The other countries included in the study were Austria, Canada, Denmark, Finland, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden and the United Kingdom.
Study authors state that the measure of deaths amenable to healthcare is a valuable indicator of health system performance because it is sensitive to improved care, including public health initiatives. It considers a range of conditions from which it is reasonable to expect death to be averted even after the condition develops. This includes causes such as appendicitis and hypertension, where the medical nature of the intervention is apparent; it also includes illnesses that can be detected early with effective screenings such as cervical or colon cancer, and tuberculosis which, while acquisition is largely driven by socio-economic conditions, is not fatal when treated in a timely manner.
Despite efforts to increase the use of information technology in healthcare by the federal and state governments, the potential to improve care through electronically stored and shared clinical information remains largely a promise, with nearly three-quarters of medical groups in California still relying on paper records, according to new studies published by the California HealthCare Foundation.
- California leads the nation in physicians using electronic health records (EHRs), with 37 percent of physicians reporting use of EHRs, compared with 28 percent nationally. In California, the larger the medical practice, the more likely it uses EHRs.
- The major barrier for EHR adoption by medical groups was cost (59 percent), followed by the difficulty and expense of implementation (42 percent), uncertainty about how to select the right product (31 percent), and resistance to changes in practice style (30 percent). Among long-term care facilities, the lack of integration with other systems was the most commonly cited barrier to Health Information Technology (HIT) adoption.
This week’s Disease Management Update focuses on cognitive problems in older patients. A new study links sleep apnea with cognitive impairment, while another suggests that older patients who undergo non-emergent surgeries are at greater risk for developing cognitive problems.