This item comes as no surprise to those of us who primarily treat the elderly.
According to researchers, nearly 100,000 hospitalizations every year are linked to adverse drug events such as allergic reactions and unintentional overdoses. Nearly half, or 48.1 percent, of those hospitalized were adults 80 years old or older.
Those agents? Insulin, older generation anti-diabetic drugs (oral), aspirin, and warfarin. It is quite true — and as equally disturbing — that these medications are not only responsible for discrete adverse drug reactions in their own right, but their pharmacological behaviors are responsible for a substantial number of interactions whose iterative clinical manifestations are truly logarithmic in scope. | LINK | Abstract LINK
We’ve all seen the numbers, forever etched in the tableaus of talking points on each side of the healthcare debate in this country; and they continue to be staggering. The total of uninsured in the United States is now approaching 60M,[1] as of mid-2010. Throughout the 2000s healthcare policy watchers have seen a healthy and smooth trajectory upward of almost 20M since the late 1990s and the boomtimes of for-profit managed care. Within the scope of reform, the numbers are bad enough; but in a presidential administration beset with certain gridlock (between legislative and executive branches) come January, the newly released figures from the CDC do not bode well for ideas of reform on either side of the ideological aisle.
That’s because the data do not lie. For the first time, there is a significant jump in the number of uninsured who live well north of the poverty line, according to the CDC. Half of the uninsured are comprised of those who live above the poverty level, and the personal incomes of one in three adults under 65 rest comfortably in the middle income range — defined by the feds as being between $44,000 and $65,000/year for a family of four.
Also, much has been said about only the healthy going without some form of healthcare coverage. According to the CDC, however, more than 40 percent of those uninsured at some point during 2010 had at least one chronic disease. When one factors in the definition of “chronic disease” as disorders such as diabetes and asthma, alongside the prevalence rates of such disorders, it is not difficult to envision a deepening healthcare delivery crisis post-reform. With the new Congress taking a hardline on healthcare financing and the definition of reform certain to change, these numbers cannot be ignored. In fact, they demand reconsideration of the costs of covering the uninsured. | LINK
Year in and year out, it seems as though we’re greeted with the same news from health organizations: that the worldwide data on HIV/AIDS infection rates and treatments could not be more disparate. We keep hearing about the fact that, although awareness is at an all-time high, outreach to the world’s most affected populations continues to struggle. Two thousand nine/2010 are no different. This year, only a third of treatable persons worldwide are actually being treated.[1] That’s in spite of the fact that world leaders have pledged no narrow that gap, time and time again.
What about on these shores? Two days ago, the U.S. recognized National Gay Men’s Awareness Day. There is no doubt that a major increase in awareness in this country since the late 1980s has brought forth some of the world’s greatest pharmacological achievements in the fight against this dreaded infection. But, there is no escaping the fact that the celebration of 9/27 itself because of these achievements — was eclipsed by one startling statistic: that nearly half of all gay men do not know that they are infected with HIV. The nature of the infection, although constantly changing and being researched, is clearly well known. Perhaps education — or lack of it — about HIV as a sexually transmitted infection needs a re-examination itself. Perhaps, there is still a stigma attached to the relay of that information to the most appropriate points of contact: from the provider to the patient. Or, maybe, its the overconcern of the lifetime cost of care for someone infected with HIV.
All of these reasons (and probably many more too numerous to mention) are valid ones to consider as we pass yet another milestone in the history of HIV/AIDS, and the strategy to make this infection entirely preventable becomes more important than ever. | LINK
It can identify tuberculosis in 2 hours. That’s a far cry from a current modality which takes at least 2 days to even screen for. The latest advance in the war against TB — thought to have been largely won in the latter quarter of the 20th century — can now be characterized by a rapid assay said to be more than 97 percent accurate and is even able to diagnose drug-resistant TB. Current testing involves the use of a microscope and is prone to investigator error and poorly obtained samples — something that can result in a missed diagnosis at alarmingly high rates. In endemic areas of the globe, that inconsistency is, of course, problematic.
As a result, TB is able to be identified in one single office visit. TB is a chronic bacterial infection spread through the air and usually infects the lungs, although other organs of the body can be involved. Most people who are infected with tuberculosis bacterium (Mycobacterium tuberculosis) don’t have symptoms, but some will develop the disease. Around 2 billion people — one-third of the world’s population — are thought to be infected with M. tb. The World Health Organization estimates that 8 million people develop active TB each year and nearly 2 million die. The test will be up for FDA approval and is already available in Europe. | LINK
The huge drive to immunize the masses against threat of H1N1 in the 2009/10 influenza season (which the WHO has officially declared concluded) has created more than a watershed moment in 21st century public health response to a potential biological catastrophe, it has also touched off a political debate that’s just getting started. And it all has to do with authoritarian mandate of the vaccine for healthcare workers.
Contrary to popular thought, many healthcare workers do not receive the vaccine; in fact, approximately 40 percent of said workers actively refused [PDF link] the vaccine last year — during infection’s peak. This notion does not sit well with a couple of policy organizations — one academic and one medical. Both groups say mandatory influenza vaccine should be a condition of employment. The groups stress increased availability of the vaccine, a steadier supply of healthy workers to administer care in times of a crisis, and an overall decrease in the incidence of influenza-related deaths in already compromised inpatients with other medical problems.
Already, the state of New York is hard at work in developing regulatory actions for its public healthcare workers. | LINK
Just how effective are vaccines at keeping mass pandemics of infectious disease abated? Well, it may not be so easy to estimate.
[T]he number of annual flu-related deaths in the United States has ranged from a low of about 3,300 to a high of about 49,000. This is a revision of the static estimate of 36,000 annual deaths that has been reported consistently for years by the U.S. Centers for Disease Control and Prevention.
The CDC has revised its projections on the preventive care of the seasonal influenza vaccine, moving from statistical dead targets to ranges of mortality among influenza outbreak figures. Its projections cover most of the past 30 years (up to 2007, and not inclusive of last year’s H1N1 pandemic). | PDF LINK to latest issue of CDC’s Morbidity & Mortality Weekly
The questions and lingering concerns surrounding the overuse of antibiotics is an age-old and well-worn conundrum for physicians and patients. Even the latter group, well-informed as consumers of healthcare, can agree that most acute upper respiratory infections are most often the result of viral infestations which play themselves out in spite of antimicrobial treatment.
The decision to (over)use them in standard medical practice is often the point of debate, as physicians weigh factors such as patient satisfaction and lingering medical and health policy issues surrounding resistance.
Last year, this blog reported on these issues as background for a program in which some retail pharmacy chains were giving away for free antibiotics to patients with prescriptions from their physicians as a way of helping with affordability in the wake of the debate on reform. The CDC offered a statement promoting the responsibilities providers, pharmacists, and patients should consider in taking part in such a program.
Smaller chain pharmacies are trying to compete with the big boys, and in trying to earn store-brand loyalty among their (un- and underinsured) consumers, they are throwing free antiobiotics their way. Last week, the CDC sent out letters those several chain pharmacies that offer no-cost prescription antibiotics to low-income consumers urging them to promote responsible use of antibiotics.
While the program was essentially successful in its efforts to bridge the gap between affordable, accessible healthcare and patient responsibility, no one was really prepared for the massive policy decisions that would have to be made as the June ’09 H1N1 pandemic loomed — after its initial discovery just one month after this initial Doctor Pundit posting.
It’s often said that the beleaguered emergency department (ED) is the initial point of care for many patients. In this current broken healthcare delivery system, that means an umbrella which “covers” the uninsured as well as those who are underinsured. The total cost for these points of acute care notwithstanding, how is the best way to explain new numbers out of the CDC this week?
The CDC’s National Center for Health Statistics reported the numbers in its annual summary of U.S. data on disease conditions, health behaviors and use of medical services. The scan figures are based on visits to roughly 500 hospitals and 3,000 doctor’s offices and outpatient clinics.
According to this survey data, the CDC says that the use of imaging modalities in the ED has quadrupled since the mid-1990s. Besides being just another point of confirmation of the origin of skyrocketing healthcare costs in this country, the heavy emphasis placed on tech will not abate anytime soon. Issues pertaining to defensive medicine, integration of such tech into ingrained training of new physicians, and the cost of using such technology within the medical device market are all good reasons to try to begin attacking this startling — yet, unsurprising — statistic. | LINK
Although his press people say that an HHS secretary is not essential during this time of a major flu pandemic worldwide, while using less direct and more obfuscatory language in the process, a greater level of criticism is coming from both sides of the political aisle concerning the matter of the relative lack of political appointees to prominent healthcare posts in the Obama cabinet. This stands as an obvious direct contrast to an issue so central to his administration’s platform. A new op-ed in the NYT calls this juxtaposition a “deeply disquieting” leadership scenario for a president who thrives on strictly scripted control and management. So, how will the Obama administration be judged on his response to the 2009 swine flu crisis? Without stable CDC and HHS appointments, it will be an interesting case study in the bridge between his First 100 Days and the meat of his remaining (first) term. | LINK
President Obama has picked a new CDC head. The candidate is a 49 year-old, CDC veteran with wide public health experience. A pediatrician by training, he served in the CDC’s Epidemic Intelligence Service, tracking foodborne diseases, followed by several years working on infectious disease issues. He spearheaded a national campaign to prevent overuse of antibiotics, a practice which helps to spawn antibiotic resistant infectious agents.
Hopefully, Obama will use this vetting experience into choosing a more appropriate Surgeon General. | LINK
It’s the classic chicken-and-egg argument. What’s responsible for the recent rise in certain sexually transmitted infections (STI)? According to the CDC, the rate of new infections from the atypical pathogen Chlamydia set a new record with 1.1 million new cases in 2007. Together, with frequent comorbid agent, N. gonorrhea, the number of new infections topped 1.5 million in that time frame. Better testing techniques lead to accurate and timely reports to state health departments, without a doubt. But one has to wonder, are we doing enough to drive home the message of safe sexual methods to prevent these rates of STIs? | LINK
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
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DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
