ACP Internist

Friday, January 29, 2010

Patient-Driven Primary Care, A Cornerstone Of The Health & Wellness Movement?

This post by Alan Dappen, MD, originally appeared at Better Health.

Health and wellness go hand in hand; there is little question of this. I therefore ask why isn't primary care at the heart of the health and wellness movement? This, I feel, would make outstanding economic sense for all involved.

In an effort to survive these sour economic times, more and more companies are trying to stave off the escalating cost of healthcare by pushing for wellness. There is good reason for this. According to Buck Consultant's third annual global wellness survey which was cited on the Society of Human Resources Management web site those U.S. companies who measured financial outcomes of their wellness programs reported a 43% reduction in health care costs or about two to five percentage points per year.

At first 2% doesn't sound like that impressive a cost savings. Consider, however, the skyrocketing costs of healthcare and the fact that businesses often foot up to 80% of these costs, and 2% doesn't seem like such small peanuts anymore.

How would primary care and wellness programs partner to ensure the healthier wellbeing of people? Central to the concept are the delivery of services and affordability. First of all, all involved participants would have access to a primary care practitioner, round the clock, for any issue ranging run-of-the-mill primary care issues, to urgent care problems and to the management of ongoing chronic conditions, including smoking cessation, weight management, and the monitoring of diabetes.

A service like this costs our patients and corporate partners $25/month (or $300 per year) per employee, and guarantees our patients a face-to-face check and medical history and then 24/7 access to the a practitioner however the patient wants: by phone, e-mail, videoconferencing, same-day office visits and even house calls.

Imagine how much healthier corporate America would be if employers could guarantee their employees access to a doctor without the employees ever having to leave the office or waiting hours in a waiting room packed with sick people? If, when someone called her doctor, the doctor picked up the phone and talked to her directly, often times solving her problem within 10 minutes after the phone call started? Since we establish a patient-doctor relationship with a face-to-face visit first, our patients can be treated by telemedicine, and done so quickly that our malpractice insurance rates have actually gone down.

A benefit like this could easily be paid for by a company in numerous ways: by the employer either as an add-on benefit or by funding it from a health savings account. Employees, too, can pay for the benefit from their health savings account, if they have one, or from a flexible savings account as services are rendered.

If $300 per year per employee could save 5% of a company's health care costs, plus saving employees and the company hours of lost productivity and hassle--not to mention employee loyalty--isn't it worth it?

I now come full circle: Shouldn't convenient access to a primary practitioner be a core component of any health and wellness program? Wouldn't this save businesses--and all of us--millions of dollars, not to mention help to ensure our health and wellness?

This post originally appeared on Better Health , a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.

Labels: exercise, smoking cessation, telemedicine, weight loss

QD: News Every Day--states balancing doctor shortages, smoking funding and H1N1

ACP Internist's daily digest of news and events continues with a look at the shortage of primary care physicians and how it plays out in the state of New York, as well as how Congress might fund more incentives for medical students. But, the states aren't funding smoking cessation efforts like they should. (They're having enough problems trying to keep up with H1N1 vaccinations.)

Primary care shortage
The Health Care Association of New York State released its 2009 Physician Advocacy Survey, "The Doctor Can't See You Now," that says the state's doctor shortage is likely to worsen. The study shows that recruitment barely offsets retirements, and a severe lack of physicians in internal medicine and hospitalist care, as well as specialties such as obstetrics/gynecology, general surgery and psychiatry. Survey respondents reported a lack of 1,300 physicians, with 35% of that total comprised of a need for primary care/internal medicine and 7% a lack of hospitalists.

The survey found that:
--45% of hospitals lack ED coverage for certain specialists, forcing patients to travel to other hospitals, some time distant ones, to receive care;
--24% had to reduce or eliminate specialty services because of an inability to recruit physicians;
--66% indicated that they have to pay for on-call services; and
--75% employ locum tenens physicians.

The report not only calls for better funding of physician education from the state and the nation, but an expansion of telemedicine and an increased role for nurse practitioners and physician assistants.

One Congressional amendment introduced Wednesday would provide incentives and training programs for medical students who want to practice in rural communities. The 2,074-page Senate bill will grow longer as these types of amendments are considered. Learn how to read a 2,074-page bill. (MinnPost.com, CNN)

Health care reform
Although the Congressional Budget Office hasn't scored the Senate's health care reform bill (that is, put a price tag on it) the impact on individuals is becoming clear. Officially, details haven't been announced but they've been leaked widely. People ages 55 to 64 could enroll in Medicare and will likely pay less for health care than now. But those in their 20s and 30s will face higher premiums, though for better coverage. (AP)

Smoking cessation
While states collected record amounts of revenue from the 1998 settlement with tobacco companies ($25.1 billion this year) they are spending less of it on programs to prevent kids from smoking and help smokers quit. Sates have cut funding for tobacco prevention programs by more than 15% in the past year, and only North Dakota meets the funding recommended by the Centers for Disease Control and Prevention.

H1N1 influenza
State health departments have cut back or redirected resources from other efforts, such as screening for other diseases, restaurant inspections and anti-obesity campaigns, to staff H1N1 vaccination efforts. (Wall Street Journal)

Labels: H1N1, health care reform, hospital medicine, primary care shortage, QD, smoking cessation

QD: News Every Day--flu's growing tally

ACP Internist's daily digest of news and events continues with the latest numbers on H1N1 infections, more respect for primary care and a boot-strap approach to health care reform in Kentucky.

H1N1 influenza
Swine flu has killed 4,000 people and sickened 22 million, according to new estimates released this week. More vaccine is on the way; the Food and Drug Administration approved GlaxoSmithKline's vaccines and the drugmaker expects to deliver 7.6 million doses by the end of the year. (Philadelphia Inquirer, AP/The Washington Post)

Evidence-based medicine
One path to less expensive health care is to look at the common tests and procedures that really don't work, or may have adverse effects in patient care. Meanwhile, drugs that were shown to reduce some forms of cancer go largely unused. (Forbes, New York Times)

Primary care shortage
Pauline Chen, MD, (a surgeon) writes that the first way to cure the primary care shortage is to improve its image problem. (New York Times)

In case you missed it ...
Rural Kentucky has high rates of some of the worst health in America. But it also has leading facilities and residents who took a boot-strap approach to health care reform. (Kaiser Health News)

Smoking rates are (slightly) rising again. (Philadelphia Inquirer)

Labels: evidence-based medicine, H1N1, primary care shortage, QD, rural medicine, smoking cessation

QD: News Every Day--health reform ready to reconcile

ACP Internist's daily digest of news and events continues with updates from the weekend's passage of health reform in the U.S. House, a global look at H1N1 influenza, and a look at a local hospitals attempt to make a profit by hiring an internist.

Health care reform
Health care passed in the U.S. House over the weekend, and now pressure is on to reconcile it all in the Senate and with the White House. (Kaiser Health News, New York Times, Los Angeles Times)

H1N1 influenza
It hasn't been just H1N1 influenza vaccines in short supply. Hand sanitizers are also evaporating in the face of increased demand. One manufacturer is running its plants around the clock with increased workers, and has asked customers not to stockpile. (CNN)

Globally, an Amazon tribe faces hundreds of infected members and possibly seven deaths from H1N1. Meanwhile, Saudi Arabia's health minister received the H1N1 vaccination on television to calm fears and encourage vaccination among those participating in the Hajj, the once-a-lifetime pilgrimage required of Muslims. (BBC, CNN International)

New Scientist examines H1N1's impact throughout history.

Smoking cessation
America's new "anti-smoking czar" lays out his goals as head of the FDA's new agency, the Center for Tobacco Products: reduce youth smoking rates, reduce tobacco-related disease, and inform the public about tobacco products' ingredients. (Courier-Journal, Louisville, Ky.)

In case you missed it ...
Unicoi County Memorial Hospital in Tennessee was losing money. The hospital's auditor helpfully suggested, "We'd always like to see the hospital have an income." So board members hired an internist and a surgeon to join the staff. Read about their gamble to break even. (The Erwin Record)

Labels: H1N1, health care reform, hospital medicine, QD, smoking cessation

Saving health and money

Last month, I asked for some data on the cost-effectiveness of preventive care. The American Journal of Public Health has obliged. In a new study reported by HealthDay, researchers evaluated the cost and health benefits to be gained by preventing several chronic diseases. They found that preventing a patient's hypertension would save $13,702 in lifetime medical spending, while prevention of diabetes would save $34,483, and preventing obesity would save $7,168. Unfortunately, those cost arguments for tobacco cessation programs turn out to be wrong: quitting smoking would result in an increase of $15,959 in lifetime medical costs.

Since only the abstract of the study is free, I also didn't get to find out how one would successfully prevent all these conditions. The key to preventing obesity, especially, seems like a secret we would all like to know.

Labels: Diabetes, health care cost, hypertension, obesity, prevention, smoking cessation

Maybe it's not health care's fault.

The failure of the U.S. to match longevity statistics of other developed countries is well-known, but a column in today's New York Times offers a different explanation for the gap. To put it simply, it's lifestyle (particularly smoking) that sets us apart from these other countries, not the quality of our health care, according to researchers. "Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries," the Times reports.

The good news is that many Americans have quit smoking in the past decade or so, so we should be seeing continuing gains in health. The bad news is that we're working hard to make up the difference by getting fatter.

Labels: longevity, obesity, smoking cessation

Smokers finding air becoming rare in which to indulge

Outdoor smoking faces bans in big cities as the largest review to date concludes that public smoking bans reduce heart attacks by 26% annually, and the effects can be measured in as few as six months.

New York City’s health commissioner said a week ago that he wanted to ban smoking at parks and beaches. Mayor Michael R. Bloomberg released a response that he wanted "to see if smoking in parks has a negative impact on people’s health."

Yeah, it does, according to research in the Sept. 29 issue of the Journal of the American College of Cardiology. A systematic review and meta-analysis of 10 reports from 11 geographic locations in the North America and Europe compared heart attack rates before and after public smoking bans. The studies involved 24 million people and observations of the effect of the bans ranged from two months to three years.

Thirty-two states and cities have banned smoking in public places and workplaces. Recently entering into the fray is Rockville, Md., which voted the same night as New York's proposal to ban smoking within 40 feet of city parks and may push for a more comprehensive ban. A nationwide ban on public smoking could prevent as many as 154,000 heart attacks each year, the study concluded.

Steven Schroeder, MACP, director of the Smoking Cessation Leadership Center University of California, San Francisco, said, "Several years ago, the idea that secondhand smoke was harmful to the heart was a theory and one with some controversy attached, but this article moves us from the theoretical to fact and to practice. The reduction in heart attacks associated with public smoking bans is a big deal."

Labels: cardiology, smoking cessation

Finally, a practical use for Twittering

One of our constant questions at ACP Internist is: What is Twitter really useful for? Everyone has a feed but no one is really saying anything. Just as we'd given up on a practical purpose for it, (surgery aside) we found two bread-and-butter applications for internal medicine: smoking cessation and weight loss.

Qwitter helps users track how many cigarettes they smoke, keep a journal, view progress over time and share info with supporters.

Next, you can Tweet what you Eat, using Twitter to set up a diary, track consumption, enter calories and find our how many are in the food you eat.

Personally, I think Twittering would help reduce smoking or eating just because it's something else to do with your hands. If you try these, or let patients try them, let us know how you fare.

Labels: diet, smoking cessation, social networking, weight loss

Smoking without the stigma

A press release that crossed our desks recently plugged an electronic, smokeless cigarette made by a European company called SuperSmoker. It's billed as a revolutionary way to kick the habit without giving up the look and feel of actually smoking.

The device itself looks just like a cigarette, comes in similar packaging and is available in normal, light, zero and menthol. But the "smoke" is really odorless water vapor that dissolves harmlessly into the air, thus not aggravating friends, family and co-workers and allowing smokers to stay inside talking to their non-smoking friends during breaks. The unit is powered by a rechargable battery.

The other part of its appeal is nicotine, contained in replacable cartridges, although the company maintains that it doesn't produce tar and has no cancer-causing substances. The FDA has not approved electronic cigarettes but it has caught on in some places, according to this article in the New York Times.

Will electronic smoking be the answer for the many who've tried and failed to kick the habit? Maybe, but won't smokers still be left with nicotine addiction?

Labels: smoking cessation

Medical news of the obvious

Our focus this week is on smoking. A new study in BMJ finds that smoking is bad for you, even if you're rich! As reported by HealthDay, the authors conclude that "in essence, neither affluence nor being female offers a defense against the toxicity of tobacco." So much for the magical properties of our solid gold cigarette holder.

In other bad-but-perhaps-already-known news for women, a group of public health investigators have determined that tobacco companies are trying to make cigarettes appealing. To quote HealthDay again, cigarette ads "depict cigarette smoking as feminine and fashionable rather than the harmful and deadly addiction it really is."

And while we're on the subject, we've got to mention this study, even though its conclusions are far from obvious. A signficant proportion of surveyed smokers said that while the effects of smoking on their own health are not sufficient motivation to quit, they would stop smoking if they knew their pets were being harmed by the habit. Really, people? Really?

Labels: medical news of the obvious, smoking cessation

Nicotine dependence: It's worse than you think

It's the best of times and worst of times for ending tobacco dependence, according to David Sachs, ACP Member, of the Palo Alto Center for Pulmonary Disease Prevention.

The best, because there are more tools than ever to help patients quit.
The worst, because most physicians have no idea how to treat patients effectively.

In part, that's because doctors don't know that nearly 75% of people seeking tobacco-dependent treatment are categorized as "highly" dependent-- meaning standard, OTC therapies won't work on them, Dr. Sachs said during a Chest 2008 press conference about a new study he authored. In the study, he and his colleagues analyzed pretreatment dependence severity from 1989-2006 and found severity increased 12% during that time, with those classified as "highly dependent" increasing 32%.

Doctors should measure dependence in their patients trying to quit. For treatment, they may need to increase drug doses and duration of use, try different drug combinations, and put more stress on minimizing withdrawal symptoms.

Dr. Sachs didn't have a pat answer for why dependence has increased in the last 15 years, so moderator Mark Rosen, FACP, speculated: "Can we attribute any of this (increase in dependence) to the stress of having Bush in the White House for the last eight years?"

Labels: Chest conference, smoking cessation

ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.

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Send comments to ACP Internist staff at acpinternist@acponline.org.

Blog log

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

db's Medical Rants
Robert M. Centor, FACP, contributes short essays contemplating medicine and the health care system.

Everything Health
EverythingHealth is designed to address the rapid changes in science, medicine, health and healing in the 21st Century.

Getting Better with Dr. Val
Getting Better is the continuation of Dr. Val Jones' previous blog at Revolution Health. It is devoted to helping people understand health issues from a balanced, scientifically sound perspective.

HealthHombre
A roundup of health policy news drawn from a database of hundreds of Web sites.

Interact MD
Michael Benjamin, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

Kevin, MD
The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.

LSUHSC-S Medical Library Evidence Alert
Major guidelines, systematic reviews, meta-analyses and/or major reviews by national and international organizations.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by a doctor.

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ACP Internist

Friday, January 29, 2010

Patient-Driven Primary Care, A Cornerstone Of The Health & Wellness Movement?

Thursday, December 10, 2009

QD: News Every Day--states balancing doctor shortages, smoking funding and H1N1

Friday, November 13, 2009

QD: News Every Day--flu's growing tally

Monday, November 9, 2009

QD: News Every Day--health reform ready to reconcile

Thursday, September 24, 2009

Saving health and money

Tuesday, September 22, 2009

Maybe it's not health care's fault.

Monday, September 21, 2009

Smokers finding air becoming rare in which to indulge

Friday, March 13, 2009

Finally, a practical use for Twittering

Thursday, March 5, 2009

Smoking without the stigma

Monday, February 23, 2009

Medical news of the obvious

Tuesday, October 28, 2008

Nicotine dependence: It's worse than you think

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