Rate of Hospital stays for Angina, Congestive Heart Failure and Diabetes for Older Adults Decreasing

• Among older adults, the rate of hospital stays for angina without procedure fell by almost half (from 13.4 to 7.6 discharges per 10,000 population) and the rate of stay for congestive heart failure fell by about one quarter (from 222.4 to 190.5 discharges per 10,000 population).
• The rate of hospital stays for diabetes decreased by 8 percent among older adults between 2003 and 2007 (from 54.5 to 49.9 discharges per 10,000 population). In contrast, the rate of these stays among younger adults increased from 18.2 discharges to 19.4 discharges per 10,000 population.

Source:  Potentially Preventable Hospitalization Rates Declined for Older Adults, 2003–2007. AHRQ’s Healthcare Cost and Utilization Project, Statistical Brief #83, December 2009. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb83.pdf

Medication nonadherence is more common among blacks, study finds
A study of 100 black and 100 white patients ages 60 and older found black patients used fewer medications and were more likely to be noncompliant, as well as more likely to have inadequate health literacy skills and more trouble affording their drugs, compared with white patients. However, researchers said that mediation problems, particularly nonadherence, were prevalent in both groups. Yahoo!/HealthDay News

Editor’s note: More than a decade after the IOM’s landmark report, “To Err is Human”, we continue to experience significant medical errors.

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Data show kidney patients get wrong blood thinners
Data from 829 U.S. hospitals showed 22.3% of kidney dialysis patients prescribed a blood thinner after undergoing percutaneous coronary intervention got one that was not recommended for them. Researchers said the mistakes resulted in almost twice the number of major bleeding events for these patients and significantly more deaths. ABC News/Reuters (12/8)

Researchers found that doctors are better able to control patients’ high blood pressure when they work closely with pharmacists because medications are intensified and used more effectively. The doctor-pharmacist team approach already is being used in several areas and may also help control other chronic diseases such as diabetes, high cholesterol and asthma. HealthDay News

Obesity threatens gains made in fighting heart disease
Gains made in fighting heart disease over the last several decades may be at risk because of increasing obesity rates, especially in children, researchers reported. Studies found that adults’ blood pressure and blood sugar levels are continuing to rise, in part due to rising average body mass index numbers, and that many people who are overweight or obese think their weight is normal. U.S. News & World Report/HealthDay News

NEW YORK (Reuters Health) – People who smoke or who have high blood pressure or diabetes in middle age are more likely to develop dementia, a new study has found.

The good news is that people who take steps to curb these risk factors in their 50s and 60s might have a better shot at avoiding Alzheimer’s disease and other forms of dementia in their 70s and 80s.

“People need to know that quitting smoking or controlling high blood pressure or diabetes is going to be beneficial not only for reducing the risk of heart attack, cancer, or stroke now, but also for reducing the risk of dementia later,” the study’s lead author, Dr. Alvaro Alonso, assistant professor of epidemiology at the University of Minnesota School of Public Health in Minneapolis, told Reuters Health in a telephone interview.

The study, published in the latest issue of the Journal of Neurology, Neurosurgery & Psychiatry, also showed that the link between the three risk factors and subsequent dementia holds true for African-Americans as well as for whites. Overall, African-Americans were 2.5 times more likely than whites to be hospitalized for dementia.

http://www.reuters.com/article/healthNews/idUSTRE5AI3WO20091119

Angioplasty no better than drugs to open kidney arteries
Angioplasty to open clogged kidney arteries is no more effective than medication alone and comes with a higher risk of complications, British researchers said. The study found similar rates of heart and kidney problems and death between the two groups after three years, but 20% of patients undergoing angioplasty suffered complications within the first month, including kidney failure, amputation and death. The Tribune (San Luis Obispo, Calif.)/The Associated Press (11/11)

In offspring of Alzheimer’s patients: hypertension, inflammation common

High fructose intake increases blood pressure, study finds
Researchers found in a study of 4,528 adults that consuming more than 74 grams of fructose, or about 2.5 sugary soft drinks, a day increases the risk of hypertension, even among those with no previous history of hypertension. More research is needed to determine if lowering fructose intake could help lower blood pressure, the researchers said. HealthDay News (10/30)

Low vitamin D tied to heart, stroke deaths: American Journal of Epidemiology

• Health plans in New England (CT, ME, MA, NH, RI, VT) were 16.3% more likely to treat diabetic patients according to accepted guidelines compared with health plans in South Central states (AL, KY, MS, TN, AR, LA, OK, TX); 
• Health plans in Mid-Atlantic states were 14.1% more likely to adhere to guidelines for treating patients with cardiovascular disease compared with plans in South Central states.
• New England health plans were 19.2% more likely to ensure that all patients received all appropriate cancer screenings compared with health plans in South Central states.
• Health plans in Pacific states (AK, CA, HI, OR, WA) were 20.8% more likely to appropriately treat and follow up with patients with mental health and substance abuse issues compared with health plans in West North Central states (IA, NE, KS, ND, MN, SD, MO) 

Source: “U.S. HEALTH CARE QUALITY: STUCK IN NEUTRAL SLOWDOWN HAS IMPLICATIONS FOR REFORM,” National Committee for Quality Assurance (NCQA), October 23, 2009, http://www.ncqa.org/tabid/1077/Default.aspx 

I got this video from “Creative Chronic Babes” and found it appropriate for just about anyone. Elizabeth Gilbert is funny, soothing and inspiring. Although you may not end up ROFL, it’s still a must see if you enjoy a great speaker and want to feel inspired. Sit back and enjoy.

Editor’s note: While we want to believe that patient’s do the right things and it is the system that is failing them, we need to be congnizant that individual choices and individual responsibility drives much of health care’s costs.

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Treatment compliance a problem in uncontrolled asthma
A study of people with asthma that was difficult to control found many didn’t comply with prescription drug therapy recommended by their physician. Researchers said of 182 patients in the study, 35% had filled no more than half of their prescriptions for inhaled steroids. Yahoo!/Reuters

http://asthmanewstoday.blogspot.com/2009/10/stubborn-asthma-new-research-on-why.html

Diabetes state by state rankings for 2009

http://www.pophealthmetrics.com/content/pdf/1478-7954-7-16.pdf

Diabetes prevalence and diagnosis in US states: analysis of health surveys

Abstract (Provisional)

Background

Current US surveillance data provide estimates of diabetes using laboratory tests at the national level as well as self-reported data at the state level. Selfreported diabetes prevalence may be biased because respondents may not be aware of their risk status. Our objective was to estimate the prevalence of diagnosed and undiagnosed diabetes by state.

Methods

We estimated undiagnosed diabetes prevalence as a function of a set of health system and sociodemographic variables using a logistic regression in the National Health and Nutrition Examination Survey (2003-2006). We applied this relationship to identical variables from the Behavioral Risk Factor Surveillance System (2003-2007) to estimate state-level prevalence of undiagnosed diabetes by age group and sex. We assumed that those who report being diagnosed with diabetes in both surveys are truly diabetic.

Results

The prevalence of diabetes in the U.S. was 13.7% among men and 11.7% among women [greater than or equal to] 30 years. Age-standardized diabetes prevalence was highest in Mississippi, West Virginia, Louisiana, Texas, South Carolina, Alabama, and Georgia (15.8 to 16.6% for men and 12.4 to 14.8% for women). Vermont, Minnesota, Montana, and Colorado had the lowest prevalence (11.0 to 12.2% for men and 7.3 to 8.4% for women). Men in all states had higher diabetes prevalence than women. The absolute prevalence of undiagnosed diabetes, as a percent of total population, was highest in New Mexico, Texas, Florida, and California (3.5 to 3.7 percentage points) and lowest in Montana, Oklahoma, Oregon, Alaska, Vermont, Utah, Washington, and Hawaii (2.1 to 3 percentage points). Among those with no established diabetes diagnosis, being obese, being Hispanic, not having insurance and being [greater than or equal to] 60 years old were significantly associated with a higher risk of having undiagnosed diabetes.

Conclusions

Diabetes prevalence is highest in the Southern and Appalachian states and lowest in the Midwest and the Northeast. Better diabetes diagnosis is needed in a number of states.

Citation

Goodarz Danaei, Ari B Friedman, Shefali Oza, Christopher JL Murray and Majid Ezzati

Population Health Metrics 2009, 7:16doi:10.1186/1478-7954-7-16

See the rankings and data

The other day, I was at my own physician’s office (I see a Family Medicine doctor too) and talked with the nurse about my own job as she was getting my flu shot ready.  She told me that the doctor had asked her to call a certain patient every day to remind her to take her blood pressure medication.  No, it wasn’t an elderly patient, or someone with mental illness or anything like that.  It was a young woman who was working full time, and busy, and simply not taking her medication for whatever reasons. 

I don’t know about that.  It seems much more productive to help people find the tools to solve their own problems.  Tools already exist- things like pill boxes, calendars, post-it notes, toothbrushes (as in, keeping the pill bottle next to it…assuming that you do indeed brush your teeth at least once a day).  The nurse went on to say that she called this woman every day until she herself went on maternity leave, and then hadn’t started up again; if she had encouraged the woman to solve her own problem, the leave would not have disrupted anything (and, well, I don’t imagine that the nurse called her at home on the weekends, either).  This sounds catty.  I don’t mean it to be.  I am figuring this out for myself.  People that I have been calling and talking with have told me how nice it is that I took the time to see how they are doing and several have told me that they hadn’t been taking their meds- and started to take them after I called them.  Interestingly,  a recent study shows that when patients perceive that a caregiver does, indeed, care about them, they get better faster. 

So I would have asked that patient, what’s something that you do every day at around the same time, something you never forget or skip in your routine?  How could you use that as a trigger to remember to do this other thing?  Or, could you set an alarm?  What else can you come up with?

What else can you come up with?

Based on the Stanford University model,  an innovative programme to help people manage their illnesses was set up in Tallaght, Dublin 24. It originated as a pilot in the hospital with support from the HSE in 2005. Veronica O’Doherty, Psychologist coordinates the overall programme with the support of  lay coordinator Veronica Lucas.

So what is it? It’s a 6 week programme for anyone in the area or attending the Hospital with a diagnosis of heart disease, diabetes, multiple sclerosis, mild depression, cancer survivors and any other long term condition.

Many people are trying to cope with more than one condition at the same time. As we live longer and medical treatment improves, we need to learn to cope with long term illnesses.  The Self Management Programme   provides this opportunity for many people.  It tackles the ups and downs of living with long term conditions by giving people a set of psychological tools they can use.

Most people say the first thing that happens to them when they get a diagnosis of having a chronic condition is loss of confidence in themselves, psychologically and physically. They no longer feel good about themselves and often get caught up in the illness itself.  In other words they often understandably define themselves as the person with heart disease or diabetes or ….The programme reminds people that they are a person first and that the chronic condition happens to people but does not define them.

It is not a substitute for your usual medical care but can help you deal better with managing your care.

80% of people can manage their care very well alongside proper medical treatment.

So how do I get onto this progamme?

You can contact us on 085  7043504 and we will return your call.

I will be updating this page from time to time with any news, research in the area and voluntary comments from people who have done the programme.

I’ve done some benchmarking in the past year.  Several months ago I had set up a tour of another big urban Family Medicine clinic in our city, one whose focus is to serve the underserved (as is ours), but that seems to be more innovative in doing so.  One of the things that amazed me about the place- besides the fact that all providers are bilingual in either Spanish or Hmong- is its commitment to offering facilitated peer groups.  They offer all kinds of groups for people with all kinds of chronic conditions.  Diabetic cooking classes.  Salsa dancing for weight loss.  Asthma management groups.  The only offering that was not well-received, they told me, was a group for women with depression.

Another “sister” clinic offers a smoking cessation group, prenatal programs, nutrition classes, weight loss, and a diabetic group.

We ourselves have had a group for diabetic patients for a couple years now, and recently piloted a prenatal group- the nurse that works with the prenatal group was happy with how it worked out.  “They call each other!” she told me today.  Certainly, it did look like the pregnant ladies were having a good time- and learning- in their meetings.  I can’t help but think that peer groups are the way to go: mutually supportive people coping with similar situations, able to share their own solutions to problems. 

I put together a proposal for a six-week stress-management group that we could offer in January and February, the darkest and coldest and most post-holiday time of year here; we’ll see if it is deemed feasible.  It could be fun.  I certainly hope so!