News & Commentary

Briefly Noted February 2018

Even though enrollment in consumer-directed health plans (CDHPs) increased nearly sevenfold over the last 10 years, the plans did not “reduce spending on low-value health care services that offer unclear or no clinical benefit and represent a significant source of waste,” according to a study published in the American Journal of Managed Care. Switching to a CDHP was associated with a $231.60 reduction in annual outpatient spending, and the researchers noted that there was a small reduction in low-value imaging, although not relative to overall spending on imaging. CDHPs may encourage patients to curb spending indiscriminately rather than on low-value services, said researchers, and they may need to be redesigned with more targeted incentives if the goal is to steer spending and utilization away from low-value medical services.

Diabetes and hypertension patients who received support services from a pharmacist embedded in a medical home were more likely to achieve their disease management goals and in less time than patients who didn’t receive services from an embedded pharmacist, according to a study of Intermountain Healthcare patients.

Even as wellness programs become more popular among employers, companies have trouble getting employees to participate, according to a survey by LifeWorks, a wellness vendor. Workers aren’t aware of programs and if they are, they don’t necessarily know how to take advantage of them or have the time to do so.

Heart failure doesn’t always kill quickly. Thanks to new medications and procedures, people who were once told to “get their affairs in order,” can now live for years, even decades, the New York Times reports. “Yet there are no widely accepted guidelines for dealing with these patients as they near death”.

Hospice care is often less than ideal, according to an in-depth investigation by Kaiser Health News. Reporters for the news service found that families or caregivers had filed 3,200 complaints with state officials in the past five years and that government inspectors who investigated those complaints found shortcomings at 759 hospice organizations, including missed visits and other services that were not delivered as promised.

Everybody knows that exercise is good for you, and there’s evidence that people with mild cognitive impairment should exercise at least twice a week to boost their memory and thinking, according to updated guidelines issued by the American Academy of Neurology. The updated guidelines were published in Neurology. Ronald Petersen, the lead author of the guideline and the director of the Alzheimer’s Disease Research Center at the Mayo Clinic, said in a statement: “Regular physical exercise has long been shown to have heart health benefits, and now we can say exercise also may help improve memory for people with mild cognitive impairment. What’s good for your heart can be good for your brain”.

Fentanyl has nearly become a household word the last few years because of the role it plays in the nation’s opioid epidemic. Now some states are considering using the drug to execute prisoners on death row, the Washington Post reports. Nevada and Nebraska officials want to legalize fentanyl-assisted executions. Opponents warn that the untested use of fentanyl could lead to botched executions, the newspaper reports.

Five-year survival rates for colon cancer are inching in an encouraging direction, according to a study published in Cancer, but rates for blacks continue to be about 10 percentage points lower. Between 2001 and 2003, the five-year net survival rate for whites was 64.5% while for blacks it was 54.7%. Between 2004 and 2009, the five-year survival rate for whites was 65.4% while for blacks it was 56.6%. The authors say their findings argue for improved screening and early treatment in the black community.

Training primary care physicians to identify oral health problems helps prepare them for working in integrated health care delivery systems, according to a study in the Journal of the American Board of Family Medicine. Researchers looked at data collected from five health centers that have integrated oral care and primary care. “Physicians who have received oral health–related training are more likely to provide not only more comprehensive emergency care but also more appropriate and thorough counseling to their patients experiencing dental problems or to patients who may not have a regular source of dental care,” the study states.

A wellness program at Tops Friendly Markets has gotten some notice in the business world, Drug Store News reports. The program, available to more than 15,000 employees, offers walking and weight-loss support for employees and their spouses. Tops, which is headquartered in Williamsville, N.Y., near Buffalo, has about 180 retail locations in New York, northern Pennsylvania, western Vermont, and north central Massachusetts.

Overtreatment continues to be a problem. An analysis of the records of more than 4,000 breast cancer patients by eviCore healthcare showed that less than half (48%) got the three-week course of radiation that research has shown is just as effective as longer courses that may be more expensive and inconvenient. The South Carolina medical benefits management company conducted the study for Kaiser Health News.

Alzheimer’s disease patients who use benzodiazepines and other related drugs have a 41% higher risk for death than patients who do not use those medications, according to a study in the International Journal of Geriatric Psychiatry. The mortality rate for patients using the drugs was 13.4 per 100 person-years, compared with 8.5 per 100 person-years in nonusers. The authors say the results support guidelines for nonpharmacological approaches to Alzheimer’s as a first-line option.

PTSD is commonly associated with soldiers and armed conflicts, but there are many causes and not just soldiers are affected, reports NPR’s Weekend Edition. Often a person experiencing PTSD symptoms, such as getting highly emotional in inappropriate settings, doesn’t know he or she is suffering from PTSD. Talking with a primary care physician might be the first step to getting help.

EHRs are causing “alert fatigue.” They send so many prescribing alerts that health care providers often override them, according to a study published in the Journal of the American Medical Informatics Association. The researchers looked at medication-related alerts over a three-year period at a 793-bed tertiary care hospital. “Almost three quarters of alerts were overridden, and 40% of the overrides were not appropriate,” the study states.

The Federal Trade Commission may turn out to be a stick in the spokes of hospital mergers. For instance, in the case of Sanford Health’s acquisition of Mid Dakota Clinic in North Dakota, the agency challenged the deal, claiming that the merged entity would control 75% or more of primary care and other health services in the Bismarck–Mandan metropolitan area.

Two reports slammed the care offered to veterans, highlighting problems that have been dogging the VA health system for years. Those who want to see the system reformed are trumpeting the findings. One report focuses on how veterans struggling with mental health problems aren’t getting the services they need or are waiting too long to get them. The other examines wait times and how those wait times slow the process for veterans who want to take advantage of care offered in the private sector.

People who’ve experience sexual abuse in childhood have the greatest risk of developing type 2 diabetes compared to those who weren’t abused, according to a study in the Journal of Diabetes and Its Complications. People who experienced verbal or physical abuse also were more likely to develop type 2 diabetes. The findings are based on an evaluation of the 2011 Behavioral Risk Factor Surveillance System survey of 48,526 adults. The data also show that people whose parents suffered from mental illness had a 19% higher risk for diabetes.


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