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Virtual Health Care: Your Questions Answered by a Telehealth Pioneer

If you follow the latest developments in health care, you may have noticed: telehealth has taken off. Our country is focused on making health care more accessible for Americans, and naturally, telehealth has emerged as a key innovation that can help to make this a reality. It’s an effective way to deliver evidence-based medicine – and it’s something that we as physicians can embrace right now.

Dr. Peter Antall

Dr. Peter Antall

As President and Medical Director of the world’s first telehealth practice, Online Care Group, I’m often asked a handful of common questions about telehealth. Here, I share the most common questions and my answers with Real World Health Care’s readers.

What is telehealth?

To me, telehealth is simple. Telehealth is a live video visit between a doctor and a patient from home or work. This differs from traditional telemedicine, which mainly connected hospital facilities to each other and relied on big, expensive hardware in clinical locations.

With telehealth, the patient can have a video visit with a doctor using every day consumer technologies that are becoming ubiquitous: a smartphone, tablet, or computer. There are other forms of telehealth on the market that use only phone or secure email; however, these visits do not allow for the same level of clinical patient evaluation. I have met with medical boards and associations across the country and found that live video is greatly preferred because it represents the closest interaction comparable to an in-person visit.

Do patients really want to talk to a doctor virtually?

For starters, let me just ask you when was the last time you shopped, banked, booked travel, made a dinner reservation, filed your taxes, or communicated with friends and family online. Chances are – if you’re like many Americans – you’ve done more than one of these things today, probably on your phone or tablet.

While the health care industry has done a great job of supplying information to patients online and has even started to offer patients the opportunity to book appointments online, information and scheduling stop short of what patients want and expect from health care: quality interactions with clinicians. To date, health care ‘transactions’ have only occurred at the intersection of a physical location and the supply of available clinicians. The industry can do better.

Over the last several years, a number of studies have shown that patients are rapidly warming to the concept of interacting with doctors online. Estimates suggest that half to three-quarters of Americans are interested in online consults, and I’d expect this number to grow as more patients have access to telehealth services and as more doctors offer such services to patients.

If you think about the patient experience today, it’s not surprising that most folks respond so positively to the value of telehealth. Consider the national average wait time to see a doctor of 18.5 days, not to mention the excessive wait time in certain urban and rural areas. And once you’re in the doctor’s office, that wait can be long, too, which you know if you’ve ever spent two or three hours in an urgent care clinic or emergency room waiting to be seen. Retail clinics are an option, but these are generally not staffed by a doctor and are often not available outside of normal business hours.

On the other hand, a patient can see a doctor in just a few minutes from their phone or tablet. For example, our wait times at the Online Care Group currently average less than 2.5 minutes, and there’s no appointment or travel required. So it’s not surprising that 97% of patients rate the service “very good” or “excellent”.

How do you examine a patient during a telehealth visit?

Examining a patient through video is different from in-person, though the fundamental rules of medicine still apply. The most important elements of any consultation – online or in-person – is taking a thorough history, asking plenty of questions, and doing a visual examination. Having a video connection with a patient is really important in helping to understand the patient’s overall demeanor and level of discomfort and stress, just as in the exam room. This gives me great insight into the patient’s physical and mental well-being. In terms of a physical exam, I’ve developed protocols to help our doctors guide patients through self-exams in order to provide empirical feedback that’s useful in making certain diagnoses.

One of our main tenets is that doctors must use their own clinical discretion when treating patients online. Our physicians diagnose and treat only when enough data can be ascertained in the video consultation to do so. If not, our physicians triage the patient and refer out for in-person care. That may mean seeing their doctor in-person, going to the emergency room, or ordering tests at a local health center.

What about security issues?

As with brick-and-mortar medicine, it is extremely important to protect patient health information. The information regarding a patient’s health should remain private between the physician and the patient and be stored securely, in compliance with the Health Insurance Portability and Accountability Act (HIPAA). American Well provides a secure space for patients to safely and confidentially consult with a doctor online. This is imperative for an effective and safe telehealth practice.

What does telehealth have to offer me as a doctor?

Telehealth is not only convenient for patients; it offers doctors flexibility at work, reliable pay, and access to new patients. And not only individual and group practices, but even large medical practices and hospitals, are starting to use telehealth to attract and retain patients and to expand their reach.

By incorporating telehealth, hospitals under accountable care organization (ACO) contracts, or otherwise caring for patients under capitation, reap the financial benefits of having healthier patients. Private offices can offer open access and after-hours care or designate that a subset of visits, like medication follow-up, be managed through telehealth. Practices can also bring in other specialties virtually into their office, like certified diabetes educators, dieticians, or behavioral health specialists.

Can I make money with telehealth?

There is high demand from patients for urgent-care-like telehealth services. Today, physicians across the country – including those in our national telehealth practice – make a very good living practicing medicine online, providing care anywhere from 10-40 hours per week.

Another option is for doctors to offer telehealth to their existing patients. In many states, doctors are already being reimbursed for services delivered to their own patients by including GT modifiers in their billing (this modifier is used to indicate telehealth services via interactive audio and video telecommunication systems). Currently 20 states mandate private payer reimbursement for telehealth services and 45 states reimburse for some telehealth services. As our doctors move from fee-for-service to capitated payment models under the Affordable Care Act, they are absorbing the risk (“rewarded for performance,” as some might say). Telehealth is one way to improve efficacy and efficiency of patient care. Telehealth lets doctors increase the number of touch points for patients, which potentially can improve outcomes as well.

Is telehealth the future of healthcare?

Telehealth isn’t really a new form of healthcare; it is the same healthcare that Americans are using every day, delivered in a faster, less expensive, more convenient way. Although not everything can be treated via telehealth, it’s a great option for many types of acute care, chronic care, behavioral health, and wellness services. Patients, doctors, hospital systems, employers, insurers, regulators, and legislators are all rapidly changing the way they view health care in order to incorporate telehealth. In the coming months, the proof that telehealth is here to stay will become even more evident. It’s time to embrace the now of health care.

Have you ever used telehealth? Would you? Share your thoughts and experiences in the comments section.

If you have any questions or to learn more about where and how I practice telehealth, email me at peter.antall@americanwell.com.

Dr. Antall is the Medical Director of Online Care Group, a physician-owned primary care group that offers its clinical services online using American Well’s technology. American Well’s web and mobile telehealth platform connects patients and clinicians for live, clinically meaningful visits through video, supplemented by secure text chat and phone. For more information, visit AmericanWell.com

Categories: Access to Care

Four benefits of electronic health records

Leaders from industry, academia, and health care discuss the rollout of this technology at The Atlantic’s sixth annual Health Care Forum

Today The Atlantic Health Care Forum brought together leading policymakers and industry experts in medicine, public health, and nutrition to have conversations about the state of the nation’s health care system. The event was sponsored by Siemens, Surescripts, WellPoint, GSK and PhRMA. Real World Health Care attended to share insights from the panel “Health Care Tomorrow: Examining the Tools and Technologies that Will Revolutionize the Future Health Care System.”

Jamie Elizabeth Rosen

Jamie Elizabeth Rosen

Much of the discussion centered around electronic health records, which are increasingly being rolled out in huge hospital systems after the federal government incentivized their adoption to the tune of billions of dollars five years ago. Four themes emerged from the panel, which included top executives from Johns Hopkins Medicine, athenahealth, PhRMA, and Carolinas HealthCare System.

 

1. Enhancing collaboration.

Electronic health records facilitate a team-based approach to hospital care, as well as allowing for better coordination between hospital systems. “What we’re going to see is it’s going to drive team-based clinical care because everyone in the system will have access to the same medical records,” said Dr. Paul Rothman, Dean of the Medical Faculty and Vice President for Medicine at The Johns Hopkins University and Chief Executive Officer at Johns Hopkins Medicine. “You’re going to see an [increased] level of collaboration not only between delivery systems, but also between the patient and the health care provider.”

However, Ed Park, Executive Vice President and Chief Operating Officer, athenahealth, warned that the decades-old technologies that many hospital systems are using are limited in their capabilities. “The current crop of [electronic health records] are documentation tools instead of care management tools,” he said, adding that they are primarily for use by insurers and lawyers. “What I fear is health systems beginning to buy their way into their own prisons that are built of their own IT…as opposed to dealing in an open environment,” he said.

 

2. Enabling patient-centered care.

Electronic health records enable patients to reap greater benefits from telehealth. “Having your information on your iPhone: that’s not far away,” Dr. Rothman said. “[Patients are] going to do EKG’s at home. They’re going to be measuring their blood sugar at home. The patient will have control of the data.”

Electronic records also hold the promise of helping to solve age-old problems in the U.S. health care system, including keeping contact with patients to encourage them to take prescribed treatment regimens. “There is almost $350 billion a year in inefficiency because of lack of compliance and adherence with medications,” said John Castellani, President and Chief Executive Officer, PhRMA. “If you could just get an improvement in whether patients take the medicines that are prescribed, you could capture this great savings.”

“You have kids who have kidney transplants, and you can give them reminders on Facebook that they have to take their medications,” Dr. Rothman added.

 

3. Targeting therapies for increased success.

Electronic medical records can help health care providers ensure that they prescribe the treatments most likely to work for their patients.

“What I think is the promise of electronic medical records is our ability to find subsets of diseases through the broad diseases we treat,” Dr. Rothman said. “Asthma isn’t one disease. Obesity isn’t one disease. Diabetes isn’t one disease. We are going to be able to find subsets of diseases and target therapies [that work]. That’s when you’re going to see efficiency and return on investment.”

 

4. Harnessing the power of big data.

Our health care system has already begun to see the benefits of ‘big data’ with examples such as the discovery of drug side effects and interactions through mining consumer web search data. “We have to use the technologies to bring down the cost of the drug discovery process,” Castellani said.

“Just taking care of the patient, we capture data,” said Dr. Roger Ray, Executive Vice President and Chief Medical Officer, Carolinas HealthCare System. “That allows us to know when a patient…may be at risk for hospital readmission. Having the ability to mine [data]…makes a difference for patients.

“We all, each of us, remember with longing a simpler time when we could scribble and walk off and our job was done,” he added. “What we know now is that’s not very good for the patient. We had no standardization allowing us to help patients avoid lots of different bad outcomes they could have.”

 

Have electronic medical records impacted your health or that of your patients? Share your thoughts in the comments section.

Five Ways to Manage the Costs of Your Medicine

While a main precept of the Affordable Care Act is to expand access to health care, in some cases that improved access means more patients are being treated with medications that come with a cost. As a pharmacist, I have to be an insurance sleuth, use common sense, and teach my patients the old-fashioned methods of negotiation.

Joel Zive

Joel Zive

I work in solid organ transplant, HIV, and Hepatitis C medicine. I have patients on regimes ranging from 4 to over 20 medications. For my patients, obtaining consistent, reasonably-priced medications – both over-the-counter and prescription – is vital.

1. Make sure all the medications are at one pharmacy.  It’s important to keep a clinical eye on things for drug interactions. As a bonus, the pharmacist and the patient know what costs need to be examined.

2. Seek out insurance prior authorization.  Some insurance companies require prior authorization to cover certain drugs. Your pharmacist can help you seek prior authorization for medications that require it using software that creates forms specific to each insurance company. Ask if your pharmacist can fill out the form as much as possible before sending it to your doctor.

3. Contact the drug company.  Many pharmaceutical companies offer patient assistance programs or co-pay assistance cards to help eligible patients obtain free medicines, particularly for biologics and expensive drugs. These programs are especially helpful for patients who have insurance gaps and need the medications quickly. Depending on the assistance from a case manager or care coordinator, I have received authorization for medications right away or within 72 hours.

4. Search for a co-pay assistance program that covers your condition.  If your drug company does not offer a patient assistance program or you are not eligible based on your income and insurance coverage, it is possible that a charitable patient assistance program through a non-profit organization such as the HealthWell Foundation may be able to help you.

5. Seek discounts for over-the-counter medications.  Over-the-counter medications can put a strain on the wallet. In many cases, purchasing over-the-counter medications is more expensive than prescription medications covered by insurance. Other items like vitamins, natural supplements, and enteral formulas (also known as ‘milks’) require the patient to do a little negotiating. If you tell the pharmacy or vitamin store you will be taking these items indefinitely, they may be inclined to discount. Also, be on the lookout for buy one get one deals (BOGOs). Finally, enteral formulas can be quite expensive, so if you get prescribed a specially formulated one, ask if you can take a more basic formulation instead. Remember to let your prescriber and pharmacist know which over-the-counter medications and supplements you are using.

In conclusion, while the path to affordable medications is not always easy, there are individuals, programs, and strategies that can help you meet your health care goals.

How do you manage your medications? Share your tips in the comments section.

Categories: General

Our Top 4 Most ‘Liked’ Health Care Stories

This week is Real World Health Care’s one-year anniversary. Over the past year, we showcased solutions that are proven to lower costs, increase access, and provide more patient-centered care. In celebration of this milestone, we are sharing the favorite posts as measured by Facebook ‘likes’ from our readers, who have visited the blog over 10,000 times.

 

#4 – Keeping Boston Strong: How Disaster Training at Osteopathic Medical School Helped Save Lives

In May, former RWHC editor Paul DeMiglio told the story of Dr. Danielle Deines’ emergency response to the Boston Marathon bombing. Dr. Deines’ education at the Edward Via College of Osteopathic Medicine – Virginia Campus (VCOM) required her to participate in a two-day, mandatory training curriculum on Bioterrorism and Disaster Response Program, which immersed her in real-life disaster training, field exercises and specialized courses.

(Photo courtesy of VCOM)

(Photo courtesy of VCOM)

The day of the bombing, after crossing the finish line, Dr. Deines found herself triaging runners in medical tents to make room for the victims. “The back corner became the most severe triage area, nearest the entrance where the ambulances were arriving,” she said. “I saw victims with traumatic amputations of the lower extremities, legs that had partially severed or had shrapnel embedded, and clothing and shoes literally blown off of victims’ bodies.”

Read the post: http://www.realworldhealthcare.org/2013/05/keeping-boston-strong-how-disaster-training-at-osteopathic-medical-school-helped-save-lives/

 

#3 – Making Life Easier for Patients and Loved Ones: Meet MyHealthTeams

In April, Eric Peacock, Co-founder and CEO of MyHealthTeams, contributed a guest blog about the need for social networks for communities of people living with chronic conditions. These networks allow patients to “share recommendations of local providers, openly discuss daily triumphs and issues, share tips and advice, and gain access to local services,” he wrote.

“Sharing with people who are in your shoes offers a sense of community that can’t be found elsewhere – these are people who know the language of your condition; they understand the daily frustrations and the small triumphs that can mean so much,” he added.

Read the post: http://www.realworldhealthcare.org/2013/04/making-life-easier-for-patients-and-loved-ones-meet-myhealthteams/

 

#2 – When the Health Care Blogger Becomes the Cancer Patient

In August, even as she was still undergoing daily radiation treatments, contributor Linda Barlow shared her personal story of being diagnosed with cancer and the slew of medical bills she faced even though she had insurance.

Linda Barlow

Linda Barlow

“While these out of pocket costs are certainly hard to swallow – I can think of a hundred other things I’d rather spend my money on – for my family, they are doable,” she wrote. “We won’t have to skip a mortgage payment or a utility bill. We won’t have to dip into a child’s college tuition fund. We certainly won’t have to worry about having enough money for food. But I know – from my work on this blog and with its main sponsor, the HealthWell Foundation – that many families living with cancer aren’t so lucky.”

Read the post: http://www.realworldhealthcare.org/2013/08/when-the-health-care-blogger-becomes-the-cancer-patient/

 

#1 – What If You Want Politicians to Get Moving But You Can’t Move?

Neil Cavuto

Neil Cavuto

Last week, Neil Cavuto, Senior Vice President and Anchor, Fox News and Fox Business, contributed a moving guest post about his triumphs over multiple sclerosis (MS) for MS Awareness Week. His deeply personal blog inspired resounding praise in the comments section and 1,300 Facebook ‘likes’.

“If I can pass along any advice at all, it is…to simply never accept a prognosis as is,” he wrote. “Fight it. Challenge it. ‘Will’ yourself over it. Many doctors say it’s a naïve approach to the disease, but attitude counts a lot for me with MS, as it did for me two decades ago when I was battling advanced Hodgkin’s Disease. Then, as now, it was about one day at a time, and staying optimistic and positive all the time.”

Read the post: http://www.realworldhealthcare.org/2014/03/ms-awareness-week/

 

If you would like to suggest a topic, contribute a guest post, or learn more about short-term co-sponsorship opportunities, please contact us at dsheon@WHITECOATstrategies.com. As a blog currently sponsored solely by the HealthWell Foundation, an independent non-profit providing nationwide financial assistance to insured Americans with high out-of-pocket medication expenses, co-sponsorship helps us keep Real World Health Care alive and well as a resource for journalists, health care professionals, policymakers, and patients. Plus, co-sponsorship will increase your organization’s visibility among thought leaders in the health care sphere.

Do you have a favorite Real World Health Care post? Is there something you’d like to see more of? Post to the comments section or tweet at us at @RWHCblog.

Live Updates from 15th Annual Patient Assistance & Access Programs

Because this blog is all about increasing access, lowering costs, and improving patient outcomes, we think there’s no better place for us to share ideas that work than to report live from the 15th Annual Patient Assistance & Access Program, in Baltimore, March 5-7.  Check back often as we publish updates from sessions, and follow all of the developments by following #PAP2014.

UPDATE 9:45  Resources for navigators: www.nationaldisabilitynavigator.org; patient advocacy groups such as AIDS Institute are publishing helpful sites.  Also marketplace.comment@cms.hhs.gov is a place you can send questions. This is monitored 24/7 with staff – not interns – but people who really know how to help.  These are triaged and go up to leadership when there are problems or trends.

UPDATE 9:40 Lessons learned:

  1. Partner’s are critical to success of ACA implementation; reach out early, often because plan selection often isn’t a one step process.  Patients need to come back many times before ready to sign up.  Very real “huge” health literacy gaps.
  2. Things to come: we are in closing days of enrollment.  March Madness may be a great opportunity for outreach; then we’ll reach out to those most in need; final week will be “here we are.”  So theme weeks continue.   After window closes Mar 31, you’ll soon start seeing promotion of the new window.

UPDATE 9:25 25 states and DC have indicated they will expand Medicaid.  About 85% of Americans already have minimum essential coverage.

UPDATE: 9:15 Health care law saved $8.9 M in drug costs for Medicare, said Janet Miller, Division of Strategic Partners, Office of Communications, Centers for Medicare and Medicaid Services.  2014 changes: no discrimination due to pre-existing conditions, annual limits on insurance coverage eliminated, small business tax credit increased; more people are eligible for Medicaid in some states.

Essential benefits include at least 10 general categories such as emergency services, hospitalization, maternity and newborn care, prescription drugs, mental health and substance abuse, lab services, preventive and wellness  services and chronic disease management.

Categories: Access to Care

A Shot of Courage for Those Who Fear Needles

This is the first of a two-part series on what’s working to prevent and address needle fear.

Most people don’t enjoy shots.

But for those with needle phobia, the fear of shots can be so severe that they actively avoid medical procedures involving injections, and in extreme cases avoid medical care more generally.

Jamie Elizabeth Rosen

Jamie Elizabeth Rosen

Needle phobia can arise from genetic and environmental factors, including experiencing pain during encounters with needles or seeing others uncomfortable or distressed by needles. Studies show that approximately two out of three children and one in four adults are afraid of needles, and 10 percent of adults have an outright needle phobia, characterized by avoidance behavior and physiological responses, such as increased heart rate or fainting.

The miracle of modern medicine has enabled us to protect ourselves from a range of dangerous or life-threatening diseases. In one recent study, seven to eight percent of adults and children reported avoiding potentially life-saving immunizations as a result of needle fear. Given the growth of vaccine-preventable outbreaks throughout the world (check out this interactive map), this is not only a concern for individual health but also for public health.

Preventing and Addressing Needle Fear

Fortunately, a growing cadre of empathetic health professionals is taking the prevention of needle pain, which can trigger needle fear, to the next level.

“In order to combat pain, vascular access professionals across the country are looking at creative ways to address patient pain and patients’ perception of pain,” said nursing leader and vascular access expert Lorelle Wuerz, MSN, BS, BA, RN, VA-BC. “Offering the patient options before you do any procedure is important.”

Wuerz said that she uses a variety of interventions to combat needle fear and pain in patients, including:

  • Ensuring patients know what to expect;
  • Deep breathing;
  • Guided imagery;
  • Distraction techniques;
  • Topical agents;
  • Warm compresses;
  • Involvement of child life professionals;
  • Pain control devices, such as Buzzy®;
  • Aromatherapy (“Anecdotally, this is something patients find soothing and calming during an uneasy time,” Wuerz said.).

Needle pain prevention extends beyond traditional health care settings. For instance, after discovering that 23 percent of Americans who skipped flu vaccination did so to avoid needles, Target Pharmacy began offering micro-needle flu vaccines. The needles are 90% smaller than those that have traditionally been used and reportedly result in less muscle ache and pain immediately following injection.

“Treating needle pain reduces pain and distress and improves satisfaction with medical care,” wrote pain researcher Anna Taddio in a chapter on needle procedures in the Oxford Textbook of Paediatric Pain. “Other potential benefits include a reduction in the development of needle fear and subsequent health care avoidance behaviour.” 

The 4 Ps of Needle Pain Management

In the Oxford Textbook chapter, Taddio outlined the four domains of interventions that can reduce needle pain for patients, known as the 4 Ps: procedural, pharmacological, psychological, and physical.

Procedural interventions involve bypassing needles altogether through the use of needle-free immunization or non-invasive sampling devices. Pharmacological interventions include local anesthetics, which have been shown to be effective and safe for reducing pain from common needle procedures, and sweet solutions for infants up to 12 months, which have been shown to reduce needle pain behaviors. Psychological interventions include coaching people to cope and providing distractions. Physical interventions – such as upright body positioning, tactile stimulation, and use of cooling agents or ice – can also reduce the perception of needle pain.

Empowering Ourselves

Many people will celebrate the day when shots are replaced with futuristic technology, such as a robotic pill or one of many other innovations currently in development.

In the meantime, what can patients do to help themselves? “A patient should never not speak up,” Wuerz said. “It’s okay to have all of the information before you make a choice.”

Stay tuned for Part II of the series, in which Dr. Amy Baxter, MD – pain researcher, CEO of MMJ Labs, and inventor of Buzzy® Drug Free Pain Relief – will outline how you can protect yourself and your family from needle pain. Dr. Baxter will appear on ABC’s Shark Tank Friday, February 28 at 9:00 pm EST.

How do you respond to needles? What works for you? Have you had a good experience with a health care professional? Post your experiences to the comments section.

The Hospital Fast Food Debate: How a Simple, Low-cost Idea can Improve What People in Hospitals Eat

Back in April 2012, nearly two dozen hospitals that host fast food restaurant chains received a letter from an advocacy group asking them to evict their fast food tenants and to “stop fostering a food environment that promotes harm, not health.” But as it turns out, many of these outlets offer options that are nutritious in addition to unhealthy options, and the same can be said about many hospital-owned cafeterias.  In fact, a review by the Physicians Committee for Responsible Medicine (PCRM) found that some hospitals with fast food vendors also had their own cafeterias with equally unhealthy options.

David Sheon

David Sheon

Meanwhile, some fast food companies, such as McDonalds, have worked hard to improve nutritious options. Others, such as Burger King, should be acknowledged for adding veggie burgers.

Perhaps the debate over having these chains located in hospitals is misplaced. Perhaps the more important factor in helping customers make healthy decisions is labeling nutritious food in an easy to understand manner.

Hospitals appear to be able to convince cafeteria customers to buy healthier food by adjusting item displays to have traffic light-style green, yellow and red labels based on their level of nutrition.

According to a recent report by HealthDay News:

“Our current results show that the significant changes in the purchase patterns … did not fade away as cafeteria patrons became used to them,” study lead author Dr. Anne Thorndike, of the division of general medicine at Massachusetts General Hospital in Boston, said in a hospital news release. “This is good evidence that these changes in healthy choices persist over time.”

As part of the study, labels — green, yellow or red — appeared on all foods in the main hospital cafeteria. Fruits, vegetables and lean sources of protein got green labels, while red ones appeared on junk food.

The cafeteria also underwent a redesign to display healthier food products in locations — such as at eye level — that were more likely to draw the attention of customers.

The study showed that the changes appeared to produce more purchases of healthy items and fewer of unhealthy items — especially beverages. Green-labeled items sold at a 12 percent higher rate compared to before the program, and sales of red-labeled items dropped by 20 percent during the two-year study. Sales of the unhealthiest beverages fell by 39 percent.

“These findings are the most important of our research thus far because they show a food-labeling and product-placement intervention can promote healthy choices that persist over the long term, with no evidence of ‘label fatigue,'” said Thorndike, an assistant professor of medicine at Harvard Medical School.

Perhaps we should worry less about whether food vendors in hospitals are fast food chains, and more about labelling nutritious choices and positioning them to encourage healthy eating. What do you think? Would clear labelling of healthy choices affect the way you eat at hospitals? Would this translate outside of the hospital setting?

Categories: General

It’s Not Over Yet: Addressing Part Two of the Door-to-Balloon Time Initiative’s Success

ReillyJohn

John P. Reilly, M.D., FSCAI

From the very first sign of a heart attack, the clock starts ticking in the race to save a patient’s heart muscle and even his or her life.

Thanks to technology and finely tuned systems of heart attack care that are now available in communities throughout the United States, we are getting faster all the time.

But sometimes we still lose the race.

During a heart attack, the heart is deprived of oxygen. The longer the heart goes with too little oxygen, the more muscle is lost, often irreversibly. This is what doctors mean when we say, “Time is muscle.” How quickly a patient receives treatment once heart attack symptoms appear often determines if he or she will make a full recovery, suffer heart muscle damage, or die.

Door to Balloon Signaled Success, or Did It?

This is why, a decade ago, healthcare professionals across the country set out to reduce the time it takes to treat heart attack patients once they arrive at the hospital. Since stopping a heart attack often involves balloon angioplasty to reopen the blocked artery, the effort was called the Door-to-Balloon (D2B) Initiative. This effort has prevented or limited heart damage for countless patients.

The D2B initiative involved making the healthcare system more efficient, more responsive and more effective, starting from the moment a heart attack patient comes to the attention of an emergency medical responder (EMR) answering a 9-1-1 call or presenting in the emergency department.  When D2B began, it often took more than two hours from the time a heart attack patient arrived at the hospital until he or she received life-saving treatment to reopen a blocked artery.

Now, 90 percent of patients who enter hospital doors receive treatment in less than 90 minutes and many are treated within 60, 30, even 15 minutes. [1]

D2B is one of healthcare’s greatest success stories. But, according to a new study [2], reducing D2B times has not been enough to significantly reduce mortality rates among heart attack patients.

What Happens Before the Hospital Door?

There are two sides to the time equation. Unfortunately, the part of the equation that has not improved enough is how long it takes patients to get to the hospital once heart attack symptoms start. Most patients wait two or more hours after heart attack symptoms appear to seek medical help. [3] Many patients are taking too long to call 9-1-1, placing themselves at risk of suffering irreversible heart damage or death.

We must do for Symptom-to-Door (S2D) Time what we have done so successfully for D2B. Revamping a system of care outside the hospital, however, is much different and perhaps more difficult than revamping a system of care within the hospital.

There have been myriad heart attack awareness programs, including online public education programs like SecondsCount.org, for which I am an editor, aimed at helping people understand the risks of heart attack, how to recognize the symptoms and why responding promptly is essential.

We have made progress. An increasing number of people know that chest pain, shortness of breath, nausea, fatigue, dizziness, and pain in the jaw, back or arm are often the first signs of heart attack. While I see more people who identified their symptoms early on, there are also many who remain unaware, are in denial or are just confused. Every day, I see patients who thought their symptoms “weren’t that bad” or explain them away as indigestion or a virus. I also see the toll that lost time takes in hearts damaged and lives lost.

Only 60 percent of patients contact emergency medical responders when experiencing symptoms. About 40 percent arrive at our hospitals on their own. [4] That’s dangerous, whether the patient is driving him- or herself. Or, even if a friend or relative is driving, it still represents a lost opportunity for treatment to begin in the ambulance, or to alert the doctors in the emergency room that a heart attack patient is on the way in.

Let’s Save More Hearts and Lives

To get started, here are a few thoughts on how we might reduce S2D:

  • We need a concerted national effort to reduce S2D time that establishes consistent messages rather than myriad programs offering incomplete or inconsistent information.
  • We must improve regional and statewide systems of care to coordinate heart attack care to ensure everyone gets the most expeditious care.
  • We need to better inform the people who are most at risk for heart attack or other heart issues about what symptoms to look for and what to do if they develop.
  • And, of course, we must continue our educational efforts, helping everyone to understand that if they are concerned they may be having a heart attack, then they should call 9-1-1 without delay and without concern about looking foolish if their symptoms turn out to be something other than a heart attack.  The alternative – sitting at home while having a heart attack, with heart muscle dying as the minutes tick by – would be far worse.

We’ve had remarkable success in reducing D2B times. But it’s not enough. To save hearts and lives, we must take on the other side of the heart attack challenge.

We’ve done it once. We can do it again.

1. Bates ER, Jacobs AK. Time to Treatment in Patients with STEMI. N Engl J Med 2013;369:889-892.
2. Menees DS, Peterson ED, Wang Y, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med 2013;369:901-9.
3.  Life After a Heart Attack. National Heart, Lung, and Blood Institute.
4.  http://nypress.com/forty-percent-do-not-call-911-survival-rates-show-every-minute-matters/, http://www.nejm.org/doi/full/10.1056/NEJMp1308772

Are You Ready to Help Stop Cervical Cancer?

National patient advocacy organizations and allies are urging American women to start the year off right by learning more about cervical cancer and prevention during Cervical Health Awareness Month this January.  Here’s what you need to know.

Paul DeMiglio

Paul DeMiglio

Although enormous strides have been made in the prevention of cervical cancer – which has gone from being the number-one cause of cancer death among American women in the 1950s to now ranking 14th for all cancers impacting U.S. women – much work remains in the fight to end this disease. Cervical cancer is still a major health concern, with approximately 12,000 women diagnosed each year in the United States and more than 4,000 women who die from the disease annually.

Cervical cancer is primarily caused by the human papillomavirus (HPV), the most common sexually transmitted virus in the U.S. impacting 79 million Americans. While HPV is most often the cause, other identified risk factors can include:

  • Smoking;
  • Having HIV or other conditions that weaken the immune system;
  • Prolonged (five or more years) use of birth control;
  • Three or more full-term pregnancies; and
  • Having several or more sexual partners.

While many of these factors don’t always lead to cervical cancer, it’s been shown that the risk of acquiring the disease can be decreased through frequent screening. Once women began regularly getting Pap tests and HPV vaccinations, for example, deaths resulting from cervical cancer decreased by nearly 70 percent in the United States from 1955-1992.

Cervical cancer is preventable because of the availability of a vaccine for HPV and effective screening tests, according to an announcement from the Centers for Disease Control and Prevention (CDC) of Cervical Cancer Awareness Month last year. Although highly treatable, the CDC shows that half of all cervical cancer cases occur in women who rarely or never were screened for cancer. In another 10-20 percent of cases, patients were screened but did not receive adequate follow-up care. The CDC has also issued information regarding the availability and importance of preventative HPV vaccines.

The National Cervical Cancer Coalition (NCCC) and the American Sexual Health Association (ASHA) also advocate for increased awareness of the disease. In its promotion of the event the NCCC provides numerous suggestions on how to spread the word, including:

  • Enlist radio stations to issue PSAs;
  • Share tweets and Facebook posts to educate their networks;
  • Distribute ASHA/NCCC’s news release to local media, with a guide on how to reach out to media networks; and
  • Write to their mayors or local legislative offices to recognize Cervical Health Awareness Month.

It’s also important for providers to know how to most effectively engage families with girls, according to ASHA/NCCC President and CEO Lynn B. Barclay.

“Only about 35 percent of girls and young women who are eligible for these vaccines have completed the three-dose series,” Barclay says. “Parents are strongly influenced by the recommendations of the family doctor or nurse, so we’ll continue developing cervical cancer information and counseling tools designed specifically for health professionals.“

Now we want to hear from you. How can you increase awareness about cervical cancer in your communities? What can organizations, places of employment and other stakeholders do to help heighten visibility around cervical cancer prevention strategies?

Editorial Note: At press time, information regarding expected estimates of cervical cancer rates in the U.S. for 2014 had not been released. Please note that we will include the latest statistics as soon as data becomes available.

Be a HealthWell Hero for Patients This Holiday Season

“HealthWell literally saved my life.”

If we told you that the perfect holiday gift could help save a life, you probably wouldn’t believe us. Think again. You’ll make a sick person’s wish come true when you give the gift of health to patients in urgent need of financial assistance by donating to the HealthWell Foundation.

100% of contributions to HealthWell will go directly to help patients access critical, often life-saving services. Your generous gift — whether it’s $10, $25, $50 or more — could make all the difference for people who are struggling to get better. Just ask Sharon, from Detroit, MI.

Feeling drained and not knowing where to turn, Sharon wasn’t sure how she was going to afford the high cost of her lupus medications. Then she discovered HealthWell, which gave her the financial help she desperately needed, just in time. Now Sharon can continue working and her family no longer has to pinch pennies to help her pay for treatments:

“What people sometimes fail to realize is that people with chronic conditions are dependent on prescribed therapies,” Sharon said. “The absence of these treatments means that we can potentially miss out on an enhanced quality of life. That’s a terrible notion to fathom because who doesn’t want to live their best life possible?”

We couldn’t agree more. At HealthWell, we believe no patient – adult or child – should ever go without the treatments they need because they can’t afford it.

When you donate to us for the holidays, you’ll be a hero for patients like Brad from Myrtle Beach, NC.

“Thanks to grants from HealthWell, I can now get the medication I need to keep my disease at bay!”

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Financial assistance from HealthWell enables Brad to get the medication he needs to manage Rheumatoid Arthritis.

The generosity of supporters made it possible for him to afford the care that empowers him to control his severe/aggressive Rheumatoid Arthritis. Without a grant from HealthWell, he says he would live “a life of degrading joints, pain and disfigurement.”

Amy from Whitesburg, GA, was diagnosed in May 2010 with stage IV non-Hodgkin’s lymphoma, a blood cancer. Because supporters like you were there for her, she’s now living to celebrate her children’s birthdays and watch them grow up.would live “a life of degrading joints, pain and disfigurement.”

“After each of my eight chemo treatments, I received a treatment to boost my white blood cell count,” she said. “Your donation helped pay for those very expensive treatments, and they helped! I NEVER got sick during my treatment phase. I have now been in remission for 14 months!”

Amy, Brad, and Sharon are not alone. Our work is not done.

Folks all over the country – mothers, fathers, children, friends, neighbors and loved ones – are getting sick and watching the bills pile up, with no end in sight. The need is great and patients are counting on you to step up so we can continue to be a lifeline in these tough financial times.

Join us in saying Happy Holidays to patients and families by giving them some relief so they can start the New Year off right.

Categories: Cost-Savings