The Politics of Health Care : Industry Research

Cost of Care for Youth with Diabetes is Six Times Higher than for Youth Without the Disease

Frank Irving — Fri, 29 Apr 2011 14:26:00 GMT

Much of the extra medical costs come from prescription drugs and outpatient care, according to CDC study.

Young people with diabetes face substantially higher medical costs than children and teens without the disease, according to a Centers for Disease Control and Prevention (CDC) study published in the May issue of the journal Diabetes Care. The study found annual medical expenses for youth with diabetes are $9,061, compared to $1,468 for youth without the disease.

Much of the extra medical costs come from prescription drugs and outpatient care, CDC reported. Young people with the highest medical costs were treated with insulin, and included all those with type 1 diabetes and some with type 2 diabetes. People with type 1 diabetes cannot make insulin and must receive insulin treatment. Some people with type 2 diabetes also are treated with insulin, because their bodies do not produce enough insulin to control blood glucose (sugar).

Children and adolescents who received insulin treatment had annual medical costs of $9,333, compared to $5,683 for those who did not receive insulin, but did take oral medications to control blood glucose, the report stated.

"Young people with diabetes face medical costs that are six times higher than their peers without diabetes," said Ann Albright, PhD, RD, director of CDC's Division of Diabetes Translation. "Most youth with diabetes need insulin to survive and the medical costs for young people on insulin [are] almost 65 percent higher than for those who [do] not require insulin to treat their diabetes."

The study examined medical costs for children and teens aged 19 years or younger who were covered by employer-sponsored private health insurance plans in 2007, using the MarketScan Commercial Claims and Encounters Database. The estimates were based on administrative claim data from nearly 50,000 youth, including 8,226 with diabetes.

Medical costs for people with diabetes, the vast majority of whom are adults, are 2.3 times higher than costs for those without diabetes, according to CDC's National Diabetes Fact Sheet, 2011. Authors of the Diabetes Care study suggest that the difference in medical costs associated with diabetes may be greater for youth than for adults because of higher medication expenses, visits to specialists and medical supplies such as insulin syringes and glucose testing strips.

Among youth with diabetes, 92 percent were on insulin, compared to 26 percent of adults with diabetes. Without adequate insulin, blood glucose levels rise and can eventually lead to serious health complications, including heart disease, kidney failure, blindness, nerve damage and amputation of feet and legs.

Study Shows 22 Percent Increase in Consumer-Directed Health Plans in 2010

Frank Irving — Thu, 28 Apr 2011 19:57:00 GMT

Fifty-one percent of the nation's largest companies offered workers a CDHP model last year.

Enrollment in consumer-directed health plans (CDHPs) grew by 22 percent in 2010, up from 23 million in 2009 to 28 million last year, according to an analysis of the Mercer National Survey of Employer Sponsored Health Plans commissioned by the American Association of Preferred Provider Organizations (AAPPO).

While PPO enrollment has remained steady at 69 percent since 2008, CDHPs, which provide consumers more control over the cost of their health care, were the only type of plan to show enrollment growth, from 7 in 2008 to 11 percent in 2010, according to the survey. This trend corresponds with a slight, but steady decline in HMOs over that same period.

"Last year's continued economic slowdown combined with the rising cost of health care forced employers of all sizes to seek innovative ways to reduce what they spend to cover their employees. Given the cost savings inherent in the consumer-directed model, it's clear that employers --- especially our largest ones --- are increasingly looking to CDHPs to do that," said Karen Greenrose, AAPPO president and CEO.

"From the numbers that have been released, it is apparent that CDHPS are filling both a need and a void in the marketplace," said Tennessee Representative and House Energy and Commerce Health Subcommittee Member Marsha Blackburn. "Consumers want greater control over their health care decisions and they want it at a more affordable and manageable cost."

While the survey showed that employers of all sizes increased their CDHP offerings, very large employers -- companies with more than 20,000 employees -- were the major driver of the rise in CDHP offerings in 2010. Fifty-one (51) percent of the nation's largest companies offered their employees a CDHP model compared with just 43 percent in 2009. The percentage of small employers (10 - 499 employees) offering a CDHP model increased from nine to 15 percent.

Employers of all sizes surveyed expect to increase their CDHP offerings in the future, pointing to the likelihood that this trend of growth will continue in the years to come.

Click here to view the entire study.

NIH Provides $30 Million for Medical Rehabilitation Research

Frank Irving — Wed, 27 Apr 2011 13:44:00 GMT

Network of centers will give researchers access to new technologies and resources.

The National Institutes of Health (NIH) announced on April 26 that it has provided approximately $30 million over a five-year period to fund a network of centers to advance medical rehabilitation research. The centers provide researchers with access to new technologies and resources.

The centers are located at Stanford University; Children's National Medical Center in Washington, D.C.; University of California, San Diego; University of Texas Medical Branch in Galveston; Boston University; Rehabilitation Institute of Chicago; and Dartmouth College and Simbex, Inc. in New Hampshire.

The Medical Rehabilitation Research Network connects the research community with courses and workshops, research facilities, mentorship/consultations and experts at the network centers. The network also provides researchers with small grants to test new ideas.

The aim of rehabilitation research, according to NIH, is to promote recovery, adaptation and functioning for patients with disabilities resulting from stroke, spinal cord injury or brain injury, developmental or degenerative disorders, or other persistent physical conditions.

The new network provides researchers with access to expertise in such areas as:

computer simulations for understanding movement disorders and evaluating how potential interventions might affect those movements;
techniques for analyzing of how genes and molecules influence the recovery process;
technologies for studying muscle action and function;
assistance in tracking how well treatments meet the needs of patients;
expertise in analyzing population data to evaluate the broader impact of rehabilitative treatments and health services;
robots and sensors that assist patients and help deliver therapeutic treatments; and
assessment of new rehabilitation technologies and assistance in bringing new therapeutic devices to the marketplace.

"The idea behind the network is to extend the reach of medical rehabilitation researchers by providing access to a broader array of research tools and approaches," said Ralph M. Nitkin, program director for Biological Sciences and Career Development Program in the National Center for Medical Rehabilitation Research (NCMRR).

The NCMRR is located within the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which provides funding for the network along with two other NIH Institutes, the National Institute of Neurological Disorders and Stroke and the National Institute of Biomedical Imaging and Bioengineering.

During the first year of funding, the network has supported a variety of pilot projects including studies of:

sensors in muscles to help amputees control prosthetic devices;
treatment of muscle spasms in spinal cord injury patients and promoting muscle function in patients with amyotrophic lateral sclerosis;
integration of people with disabilities into the community, especially involving behavioral or mental conditions such as post traumatic stress disorder;
promoting walking in children with cerebral palsy;
therapy for patients with degenerative muscle disorders or severe muscle injury;
devices for preventing falls in the elderly;
monitoring blood flow in the brain as a way to follow how specific brain regions respond to therapeutic treatments;
assessing bone loss, bladder function and nervous system changes in patients with spinal cord injury;
understanding the impact of cancer treatments on individual health and function; and
studies of jaw function and long-term pain complications in animal models.

NIH, a component of the U.S. Department of Health & Human Services, is the primary federal agency conducting and supporting basic, clinical and translational medical research, and is investigating the causes, treatments and cures for both common and rare diseases.

Would You Exhaust Your Personal Finances for More Cancer Care?

Frank Irving — Tue, 26 Apr 2011 15:51:00 GMT

Published study finds that people in minority groups prefer to extend life as much as possible, even if it means using all financial resources.

People in minority groups, especially black Americans, are more willing than their white counterparts to exhaust their personal financial resources to prolong life after being diagnosed with lung or colorectal cancer, according to a University of Alabama at Birmingham (UAB) study published April 26 in the online edition of Cancer, the journal of the American Cancer Society.

Lead author Michelle Martin, PhD, assistant professor in the UAB Division of Preventive Medicine and a scientist with the UAB Comprehensive Cancer Center, and her colleagues compared the willingness of 4,214 participants in a multi-center observational study of patients with newly diagnosed lung or colorectal cancer to use their personal financial resources to extend their lives.

Among other questions, patients were asked, "If you had to make a choice now, would you prefer treatment that extends life as much as possible, even if it means using all of your financial resources, or would you want treatment that costs you less, even if it means not living as long?"

The researchers found that 80 percent of blacks were willing to spend all of their personal finances to extend life, while 54 percent of whites, 69 percent of Hispanics and 72 percent of Asians were willing to do so.

After accounting for a number of factors, including income, disease stage, quality of life, age, perceived time left to live and other medical illnesses, blacks were 2.4 times more likely to expend all personal financial resources to extend life than whites, according to the study. Hispanic patients were 1.45 times more likely and Asian patients were 1.59 times more likely to expend all personal financial resources than white patients.

The availability of insurance had no statistical effect on the results, by race, the researchers reported.

Several other factors were independently associated with a decreased willingness to exhaust finances to extend life, Dr. Martin said, especially age, family size and social support.

Single, divorced or separated people were more willing to spend all their financial resources than people who were married or living with a partner. People who did not know their life expectancy or who believed their life expectancy was "in God's hands" were more willing to spend than whose life expectancy was considered five years or less.

Dr. Martin said the study did not provide concrete reasoning for the differences, but its findings create a basis for future studies.

"The next step is to obtain an in-depth understanding of the factors that influence treatment preferences," she added. "Future work could broaden the factors that we examine, and time spent with cancer patients in conversation about their experience and treatment preferences will help us better deliver cancer care that reflects those."

Aetna Foundation Funds Efforts to Measure Effectiveness of Integrated Health Care Models

Frank Irving — Fri, 22 Apr 2011 20:05:00 GMT

Grants totaling $1 million go to research studies at Baylor College of Medicine; Massachusetts General Hospital; the University of California, San Francisco; and the University of Florida.

The Aetna Foundation announced on April 20 that it will fund four research projects intended to assess new health care delivery designs that promote integrated health and patient-centered medical homes.

The Aetna Foundation made grants totaling $1 million to separate studies by Baylor College of Medicine; Massachusetts General Hospital; the University of California, San Francisco; and the University of Florida.

"Many of the highest-performing health care providers achieve great outcomes by offering well-integrated health care and serving as a medical home for patients," said Anne C. Beal, MD, MPH, president of the Aetna Foundation, who has published widely on health care issues. "The most effective primary care providers manage and coordinate care from specialists, therapists, hospitals and other providers, which ensures good communication among all parties and keeps the patient involved and informed. This coordination role is especially important for patients with chronic or complex health conditions, since most of their health care is managed by primary care providers."

Dr. Beal continued, "While we know that well-integrated and well-coordinated care can have a host of benefits -- improved health outcomes, better patient experiences, lower costs and fewer medical errors -- we do not fully understand the links between good coordination and good outcomes nor have we identified the best pathways to achieving strong care coordination. We believe the studies we are supporting can help bring forth models of integrated health care that will lead to healthier patients and lower costs."

The four research grants are:

$250,000 to Baylor College of Medicine in Houston to study how primary care medical homes can lower the cost of care and improve the health of children with chronic physical, developmental or behavioral conditions. Upwards of 16 percent of American children are estimated to have special health care needs, and their care accounts for 42 percent of medical expenditures on children in the United States. Using Medicaid/Children's Health Insurance Program data for Houston-area children, the researchers will identify a diverse group of children with special health care needs and survey their doctors about the children's treatment and coordination of their care. To obtain the patient perspective, the researchers will survey the children's parents about their satisfaction with their youngster's care. Additionally, the researchers will analyze claims data to see if the children treated by doctors who identify their practice as a primary care medical home have fewer emergency room visits, hospitalizations and other potentially avoidable treatments than children who receive their care from other types of medical practices.
$250,000 to Massachusetts General Hospital in Boston to study whether intensive care management and integrated care can improve the health outcomes of economically disadvantaged patients with multiple chronic conditions while decreasing the cost of their treatment. The research team will evaluate a new integrated primary care program launched in 2010 by Cambridge Health Alliance that serves a diverse population of low-income children and adults with two or more chronic conditions. The Massachusetts-based program assigns each patient to a primary care doctor who coordinates treatment, and, as needed, adds an interdisciplinary team of nurse practitioners, clinical nurse psychologists, social workers and community health workers to help patients manage their health. The two-year study will examine the barriers in implementing the program, assess patient satisfaction with the program's care coordination, communication and quality, and quantify the cost of care.
$250,000 to the University of California, San Francisco for a two-year study to create a survey tool to assess integrated care around the country. The research will be among the first to develop metrics of integrated care based on the needs, experiences and expectations of patients with chronic conditions. By focusing on the patient experience to create measurements of integrated care practices, the researchers expect their measurement tools to assess these concepts more systematically among diverse patient populations and in a wide range of practice settings.
$250,000 to the University of Florida in Gainesville for a two-year study exploring whether primary care medical homes can improve the health of patients with diabetes. Currently, 24 million Americans are living with diabetes, a chronic disease that requires patients to take an active role in monitoring their diet and glucose levels to manage the disease successfully. The researchers will examine if the primary care medical home model increases patient engagement with managing their diabetes and if increased patient engagement leads to better health. Four Jacksonville, Fla., patient-centered medical home practices, each serving a racially and socio-economically diverse population, will be the sites of the research.

Integrated care is one of the Aetna Foundation's three program areas, along with fighting obesity and promoting racial and ethnic equity in health and health care. Since 1980, Aetna and the Aetna Foundation have contributed $394 million in grants and sponsorships, including $15.6 million in 2010.

Most Employers Assessing Retiree Benefits, According to HR Consulting Firm Survey

Frank Irving — Thu, 21 Apr 2011 10:59:00 GMT

Aon Hewitt report says 61 percent of surveyed companies to evaluate long-term retiree medical programs by end of 2011.

Most large employers are beginning to rethink their retiree health care strategy as a result of federal health care reform, according to a recent report released by Aon Hewitt, the human resource consulting and outsourcing business of Aon Corporation.

In late 2010, Aon Hewitt surveyed 344 companies, representing 2.2 million retirees nationwide, and found that 61 percent were either already evaluating or were expected to evaluate their long-term retiree medical strategy by the end of 2011, due to health care reform. Meanwhile, 23 percent of respondents indicated they were still considering whether to assess their current strategy and only 16 percent had no immediate plans to review their current approach.

"Health care reform creates both challenges and opportunities for employers sponsoring retiree medical programs," said John Grosso, retiree health care group leader with Aon Hewitt. "Most employers have been studying the new legislation to understand how to effectively manage the challenges, while taking full advantage of the new opportunities going forward. Many will find that the new legislation will create significant and immediate savings opportunities."

Most immediately, among those planning to apply for the temporary Early Retiree Reinsurance Program (ERRP) to help offset a portion of the cost of health claims for retirees age 55 to 64, about half of respondents (48 percent) anticipate using the proceeds to reduce premiums, including both employer and participant share, while 21 percent intend to reduce the employer share of premiums only.

As for companies in the survey that pay a portion of health coverage for their retirees age 65 or older, three-quarters currently collect the Retiree Drug Subsidy (RDS). Of those, 73 percent said they are altering their retiree drug benefits strategy, as health reform eliminates the RDS tax advantages for 2013, and creates enhancements to the Medicare Part D program for retiree drug benefits beginning in 2011. In fact, 61 percent anticipate announcing these changes by the end of 2011 in order to begin recognizing accounting savings quickly, while 86 percent expect to actually implement these changes by 2013, the survey report stated.

Alternatives most favored by employers making or contemplating changes to their post-65 retiree medical programs include contracting with a Part D Prescription Drug Plan (34 percent) or moving to a pure defined-contribution approach (30 percent) where post-65 retirees can purchase benefits through the individual Medicare retiree plan market. Other employers support combining access to individual Part D plans with premium subsidization (5 percent) or out-of-pocket cost subsidization (5 percent). Another 9 percent prefer eliminating employer-sponsored retiree prescription drug benefits altogether.

Of the employers favoring contracting with a Part D Prescription Drug Plan on a group basis, 57 percent will look to utilize an "Employer Group Waiver Plan (EGWP) + Wrap" approach, whereby the employer contracts for a Standard Medicare Part D plan design with a wraparound benefit that attempts to preserve the current prescription drug plan design and formulary strategy for the retiree.

"Many employers are looking to access cost-reduction opportunities created by the new changes to the Part D program," said Grosso. "For those wanting to continue to manage and control their group program, contracting with a Medicare Part D plan on a group basis, leveraging the EGWP process will make sense. Conversely, for those looking to move away from a group-based model, individual market-based benefit sourcing, supported by some level of tax-effective defined-contribution funding, may be a desirable strategy."

In addition, Aon Hewitt's survey found that 36 percent of respondents plan to make changes to their pre-65 retiree benefits strategy to directly leverage the health insurance exchanges that states, or the federal government, are required to create in 2014. Twenty-one (21) percent prefer moving to a pure defined-contribution approach, where retirees could use an account established by the employer to purchase coverage through the exchanges. The balance of those employers anticipate eliminating pre-65 coverage in response to the creation of exchanges.

Milind Desai, retirement actuary with Aon Hewitt, commented, "Individual market benefit-sourcing, supported by state and private exchanges, can create cost-effective coverage opportunities for retirees that do not exist today, even within most employer-sponsored retiree group health plans. This is a primary reason why employer programs will evolve toward individual market-based benefit strategies over time."

Alzheimer’s Diagnostic Guidelines Updated for First Time Since 1984

Frank Irving — Tue, 19 Apr 2011 16:33:00 GMT

NIH-supported revision also proposes staging of disease, potential use of biomarkers.

On April 19, the National Institutes of Health (NIH) announced the release of revised clinical diagnostic criteria for Alzheimer's disease dementia. NIH also reported that research guidelines for earlier stages of the disease have been characterized to reflect a deeper understanding of the disorder. The diagnostic guidelines had not been updated since 1984. NIH and the Alzheimer's Association led development of the new guidelines.

"The National Institute on Aging/Alzheimer's Association Diagnostic Guidelines for Alzheimer's Disease outline some new approaches for clinicians and provides scientists with more advanced guidelines for moving forward with research on diagnosis and treatments," according to NIH. "They mark a major change in how experts think about and study Alzheimer's disease.

The original criteria were the first to address the disease and described only later stages, when symptoms of dementia are already evident. The updated guidelines announced April 19 cover the full spectrum of the disease as it gradually changes over many years. They describe the earliest preclinical stages of the disease, mild cognitive impairment, and dementia due to Alzheimer's pathology. NIH noted that the guidelines now address the use of imaging and biomarkers in blood and spinal fluid that may help determine whether changes in the brain and those in body fluids are due to Alzheimer's disease. Biomarkers are increasingly employed in the research setting to detect onset of the disease and to track progression, but cannot yet be used routinely in clinical diagnosis without further testing and validation, NIH added.

"Alzheimer's research has greatly evolved over the past quarter of a century. Bringing the diagnostic guidelines up to speed with those advances is both a necessary and rewarding effort that will benefit patients and accelerate the pace of research," said National Institute on Aging Director Richard J. Hodes, MD.

"We believe that the publication of these articles is a major milestone for the field," said William Thies, PhD, chief medical and scientific officer at the Alzheimer's Association. "Our vision is that this process will result in improved diagnosis and treatment of Alzheimer's, and will drive research that ultimately will enable us to detect and treat the disease earlier and more effectively. This would allow more people to live full, rich lives without -- or with a minimum of -- Alzheimer's symptoms."

The new guidelines appear online in Alzheimer's & Dementia: The Journal of the Alzheimer's Association. They were developed by expert panels convened last year by the National Institute on Aging (NIA), part of the NIH, and the Alzheimer's Association. Preliminary recommendations were announced at the Association's International Conference on Alzheimer's Disease in July 2010, followed by a comment period.

The original 1984 clinical criteria for Alzheimer's disease, reflecting the limited knowledge of the day, defined Alzheimer's as having a single stage, dementia, and based diagnosis solely on clinical symptoms. It assumed that people free of dementia symptoms were disease-free. Diagnosis was confirmed only at autopsy, when the hallmarks of the disease, abnormal amounts of amyloid proteins forming plaques and tau proteins forming tangles, were found in the brain.

Since then, research has determined that Alzheimer's may cause changes in the brain a decade or more before symptoms appear and that symptoms do not always directly relate to abnormal changes in the brain caused by Alzheimer's. For example, some older people are found to have abnormal levels of amyloid plaques in the brain at autopsy yet never showed signs of dementia during life. It also appears that amyloid deposits begin early in the disease process but that tangle formation and loss of neurons occur later and may accelerate just before clinical symptoms appear.

To reflect what has been learned, the NIA/Alzheimer's Association Diagnostic Guidelines for Alzheimer's Disease cover three distinct stages of Alzheimer's disease:

Preclinical -- The preclinical stage, for which the guidelines only apply in a research setting, describes a phase in which brain changes, including amyloid buildup and other early nerve cell changes, may already be in process. At this point, significant clinical symptoms are not yet evident. In some people, amyloid buildup can be detected with positron emission tomography (PET) scans and cerebrospinal fluid (CSF) analysis, but it is unknown what the risk for progression to Alzheimer's dementia is for these individuals. However, use of these imaging and biomarker tests at this stage are recommended only for research. These biomarkers are still being developed and standardized and are not ready for use by clinicians in general practice.
Mild Cognitive Impairment (MCI) -- The guidelines for the MCI stage are also largely for research, although they clarify existing guidelines for MCI for use in a clinical setting. The MCI stage is marked by symptoms of memory problems, enough to be noticed and measured, but not compromising a person's independence. People with MCI may or may not progress to Alzheimer's dementia. Researchers will particularly focus on standardizing biomarkers for amyloid and for other possible signs of injury to the brain. Currently, biomarkers include elevated levels of tau or decreased levels of beta-amyloid in the CSF, reduced glucose uptake in the brain as determined by PET, and atrophy of certain areas of the brain as seen with structural magnetic resonance imaging (MRI). These tests will be used primarily by researchers, but may be applied in specialized clinical settings to supplement standard clinical tests to help determine possible causes of MCI symptoms.
Alzheimer's Dementia -- These criteria apply to the final stage of the disease, and are most relevant for doctors and patients. They outline ways clinicians should approach evaluating causes and progression of cognitive decline. The guidelines also expand the concept of Alzheimer's dementia beyond memory loss as its most central characteristic. A decline in other aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment may be the first symptom to be noticed. At this stage, biomarker test results may be used in some cases to increase or decrease the level of certainty about a diagnosis of Alzheimer's dementia and to distinguish Alzheimer's dementia from other dementias, even as the validity of such tests is still under study for application and value in everyday clinical practice.

NIH said the panels purposefully left the guidelines flexible to allow for changes that could come from emerging technologies and advances in understanding of biomarkers and the disease process itself.

"The guidelines discuss biomarkers currently known, and mention others that may have future applications," said Creighton H. Phelps, PhD, of the NIA Alzheimer's Disease Centers Program. "With researchers worldwide striving to develop, validate and standardize the application of biomarkers at every stage of Alzheimer's disease, we devised a framework flexible enough to incorporate new findings."

Research Points to Lack of Patient-Provider Communication on Alternative Medicines

Frank Irving — Thu, 14 Apr 2011 13:27:00 GMT

New survey from AARP and NCCAM finds that although many people 50+ use CAM, they often do not inform their provider.

Despite their high use of complementary and alternative medicine (CAM), Americans over the age of 50 often do not discuss CAM use with their health care providers, according to survey results released April 13. AARP and the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health collaborated on the research.

The AARP/NCCAM survey was conducted by telephone interview in October 2010, with a random sample of 1,013 people aged 50 and older.

Overall, 53 percent of survey respondents reported that they had used CAM at some point in their lives. Among those, 58 percent said they had discussed CAM with a health care provider.

That dialogue is important, the researchers reported, because, while CAM is a part of health and wellness for many Americans, some CAM products can interact with conventional medicine.

The researchers defined CAM as "a group of diverse medical and health care interventions, practices, products, or disciplines that are not generally considered part of conventional medicine." Under that definition, CAM includes natural products such as herbal supplements, and manual therapies and mind/body practices such as chiropractic care, massage, acupuncture and meditation.

Use of CAM among the 50 and older population is widespread. The 2007 National Health Interview Survey found that 44 percent of people aged 50-59 use some form of CAM, compared to the average adult use rate of 38 percent.

"Older Americans want to lead healthy, active lives, and that means using health care safely," said AARP Vice President Elinor Ginzler. "For many people, CAM is an important part of staying healthy, but some CAM products may make conventional medicines less effective or lead to potentially dangerous interactions. Health care providers and patients need to start talking together to ensure [patients] get the full benefit of both CAM and [their] medications."

Other findings from the AARP/NCCAM survey suggest that if CAM is discussed at a medical appointment, it is most likely to be brought up by the patient. Respondents were twice as likely to say they raised the topic rather than their health care provider. According to the survey, the two main reasons that patients gave for a lack of discussion with their health care providers are that the provider never asked (42 percent) and the patients did not know they should bring it up (30 percent).

The most frequently cited reasons for using CAM were for general wellness (77 percent), to help reduce pain or treat a painful condition (73 percent), to treat a specific health condition (59 percent), and to supplement conventional medicine (53 percent). Respondents were allowed to provide more than one reason for using CAM.

"In this survey, we found that 37 percent of respondents have used an herbal product or dietary supplement in the past 12 months. Some of these natural products can interact with conventional treatments," said Josephine P. Briggs, MD, director of NCCAM. "As we've learned from NCCAM-funded research into herbal and dietary supplements, natural does not always mean safe. Thus, an open dialogue about CAM use, particularly herbals and dietary supplements, is vital to ensuring safe and coordinated care."

Click here for a copy of the survey report.

Fundraising Outlook Improves for Hospitals

Frank Irving — Mon, 11 Apr 2011 15:29:00 GMT

Vast majority of AHP survey respondents reported negative effects on their programs in 2010, but fewer fundraisers had to trim their budgets.

Following two years of recessionary losses and cutbacks, health care fundraising bounced back in relative terms last year, according to a survey conducted by the Association for Healthcare Philanthropy (AHP).

AHP directs development efforts for more than 2,000 non-profit hospitals and health care providers throughout North America. While the vast majority (71 percent) of AHP members who answered a January survey reported negative effects on their programs in 2010 due to the recession, those responses represented a 16 percent improvement over 2009. Respondents noted year-over-year advances for investment income, donations from hospital staff, and funds raised through special events.

"Perhaps the most promising news is that far fewer fundraisers are reporting significant reductions in their operating budgets," observed William C. McGinly, PhD, CAE, president and COO of AHP. "In 2009, fully 52 percent of fundraisers told of having to trim their budgets. Last year, half of respondents made no changes in their budgets, and 12 percent actually increased them."

Fundraisers who answered the AHP survey reported some progress, or at least diminished harm due to the economy, in several key areas:

Thirty-seven percent found annual fund direct-mail revenue was down in 2010, compared to 50 percent in 2009.
Declines in major gift revenue were reported by 44 percent of respondents last year, which was an improvement over the 59 percent who saw major gift revenue losses in 2009.
Less than one-third said they had reduced their giving forecast in 2010, compared to 45 percent in 2009.

Mary Anne Chern, FAHP, ACFRE, who chairs AHP's board of directors and is president of White Memorial Medical Center Charitable Foundation in Los Angeles, pointed out that health care development professionals continued to intensify their efforts in 2010.

"AHP members worked hard to step up their involvement with donor stewardship, major gift programs, annual fund campaigns and grant programs to cultivate donations for the institutions they support," she said. "Some succeeded in increasing funding for charity care, equipment purchases, health care operations and capital improvements or expansions. Hopefully, we will continue this trend as economic conditions improve."

National Study Finds Potential for Abuse in Opioid Prescribing Practices

Frank Irving — Thu, 07 Apr 2011 17:22:00 GMT

More than half of patients with painkiller prescriptions had filled another prescription for pain from the same or different providers within the past month.

An analysis of national prescribing patterns shows that more than half of patients who received an opioid prescription in 2009 had filled another opioid prescription within the previous 30 days.

A report from the study, conducted by researchers from the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health, was published in this week's Journal of the American Medical Association (JAMA). The report suggested potential opportunities for intervention aimed at reducing abuse of prescription opioids.

"More research is needed to see if current practices are working, with a closer look at why so many patients are getting multiple prescriptions within a short period of time," said NIDA Director Nora D. Volkow, MD. "As a nation, it is important that we all become better informed about effective pain management and the risks of abusing prescription painkillers."

NIDA said the analysis comes on the heels of a nearly 20-year increase in the use of prescription painkillers: from 1991 to 2009, prescriptions for opioid analgesics increased almost threefold, to over 200 million. According to the Drug Abuse Warning Network system, which monitors drug-related emergency department visits and drug-related deaths, emergency room visits related to the nonmedical use of pharmaceutical opioids doubled between 2005 and 2009.

NIDA noted that while these medications are crucial for pain management, their wide availability may also result in leftover pills in family medicine cabinets, increasing opportunities for abuse, as well as a host of serious medical consequences, including addiction. Most abusers report getting these medications from friends and relatives who had been prescribed opioids, or they are abusing their own medications.

This study sample included 79.5 million prescriptions dispensed in the United States during 2009, which represent almost 40 percent of all the opioid prescriptions filled nationwide. Researchers broke down the prescriptions by physician specialty, patient's age, duration of prescription, and whether or not the patient had previously filled a prescription for an opioid analgesic within the past 30 days. The researchers looked at prescribing practices for younger patients, who are more at risk than older adults for opioid abuse and later addiction.

The records showed that approximately 56 percent of painkiller prescriptions were given to patients who had filled another prescription for pain from the same or different providers within the past month. In addition, nearly 12 percent of opioids were prescribed to people aged 10-29. Most of these were hydrocodone- and oxycodone-containing products, such as Vicodin and Oxycontin. Dentists were the main prescribers for youth aged 10-19 years old. Nearly 46 percent of opioid prescriptions were given to patients between ages 40 and 59, and most of those were from primary care providers.

The current issue of JAMA also includes an accompanying commentary from Dr. Volkow and Dr. Thomas McLellan of the University of Pennsylvania School of Medicine. They point out that, according to the Centers for Disease Control and Prevention, prescription opioid overdose is now the second leading cause of accidental death in the United States, killing more people than heroin and cocaine combined. They also state that this is compelling evidence for the need to develop smart strategies to curtail abuse of opioid analgesics, without jeopardizing pain treatment.

According to the researchers, many states are looking at prescription drug monitoring programs that will give physicians access to information on prescriptions previously received by their patients.

Click here to access the research report and commentary.

Mayo Clinic Study Finds Cost of Heart Drugs a Major Barrier to Patient Compliance

Frank Irving — Wed, 30 Mar 2011 15:54:00 GMT

Even among patients eligible for Medicare, medication costs were an important issue.

In a study appearing in the April issue of peer-reviewed Mayo Clinic Proceedings, Mayo Clinic researchers found that many patients with heart failure do not take the medications they've been prescribed, The drugs' cost is one of the biggest deterrents to patient compliance.

The study recruited patients from Olmsted County, Minn., and tracked their pharmacy records. Previous studies looked only at electronic prescription claims data, possibly missing drugs purchased with cash or not covered by insurance, according to Shannon Dunlay, MD, Mayo Clinic cardiologist and lead author. The 209 patients in the study, ages 60 to 86, were asked how often they missed doses or didn't take drugs at all, and why.

Researchers found that younger patients were slightly more likely to skip certain heart medications than older patients. Men were less likely than women to stick to certain drug regimens. Among patients who did a poor job following prescriptions, financial concern was the main reason: 46 percent reported that they had stopped taking statins or not filled a prescription because of cost, and 23 percent acknowledged skipping doses to save money.

Although 77 percent of patients in the study were eligible for Medicare, medication costs were still an important issue for some of them, the study found.

Dr. Dunlay emphasized that heart failure patients worried about medication costs should tell their physicians. There often are lower-cost alternatives, she said.

More than 5 million Americans have heart failure, according to the researchers.

AHRQ Report Links Low Health Literacy with Poorer Health Status

Frank Irving — Tue, 29 Mar 2011 11:05:00 GMT

Literature review also finds association between low health literacy and increased use of ERs and inpatient care.

The Agency for Healthcare Research and Quality (AHRQ) reported on March 28 that low health literacy in older Americans is linked to poorer health status and a higher risk of death. According to AHRQ, part of the Department of Health & Human Services (HHS), more than 75 million English-speaking adults in the United States have limited health literacy, making it difficult for them to understand and use basic health information.

The report, an update of a 2004 literature review featuring findings from more than 100 new studies, also found an association between low health literacy in all adults, regardless of age, and more frequent use of hospital emergency rooms and inpatient care, compared with other adults.

The report's authors also found a link between low health literacy and a lower likelihood of getting flu shots and of understanding medical labels and instructions and a greater likelihood of taking medicines incorrectly compared with adults with higher health literacy. They also found evidence linking poor health literacy among adult women and underuse of mammograms.

AHRQ also pointed out that evidence from a small but growing body of studies suggests that differences in health literacy levels are related to racial and ethnic disparities. For example, flu shot rates among seniors, enrollment of children in health insurance programs and taking medications as instructed by a health care professional are lower among minorities.

"Ensuring that people understand health care information is critical to a high-quality, safe health care system," said AHRQ Director Carolyn M. Clancy, MD. "Improving health literacy will be a major step in the nation's efforts to enhance health care quality and safety."

The authors were led by Nancy D. Berkman, PhD, and Stacey Sheridan, MD, MPH, of the AHRQ-supported RTI International-University of North Carolina Evidence-based Practice Center. They concluded that intensive self and/or disease management programs appear to reduce disease severity, emergency room visits and hospital admissions among patients with limited health literacy.

In May 2010, HHS launched the National Action Plan to Improve Health Literacy to engage organizations, professionals, policymakers, communities, individuals and families in a linked, multi-sector effort to improve health literacy.

The plan calls for improving the complex and difficult-to-understand explanations that often fill patient handouts, medical forms, health Web sites and recommendations to the public. Among the other objectives of the plan are promoting changes in the health care system that improve health care information, as well as improving patient-provider communication, low health literacy individuals' ability to make health care decisions based on evidence, and access to health care.

Click here to access the report.

SAMHSA Reports Spike in Ecstasy-Related ED Visits

Frank Irving — Fri, 25 Mar 2011 01:51:00 GMT

Agency's new study finds nearly 75 percent increase from 2004 to 2008.

According to a report released March 24 by the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of hospital emergency visits involving the drug MDMA (street names Ecstasy, X, XTC) increased from 10,220 in 2004 to 17,865 visits in 2008 -- nearly a 75 percent increase. SAMHSA, an agency of the Department of Health & Human Services, reported that most of these Ecstasy-related visits (69.3 percent) involved patients aged 18 to 29, but notably 17.9 percent involved adolescents aged 12 to 17.

Ecstasy use can produce psychedelic and stimulant side effects such as anxiety attacks, tachycardia, hypertension and hyperthermia, SAMHSA noted. The variety and severity of adverse reactions associated with Ecstasy use can increase when the drug is used in combination with other substances of abuse --- a common occurrence among Ecstasy users. The drug is also addictive, according to SAMHSA.

This SAMHSA study showed that 77.8 percent of the emergency department (ED) visits involving Ecstasy use also involved the use of at least one or more other substances of abuse. Among Ecstasy-related ED cases involving patients aged 21 or older, nearly 40 percent of the patients had used Ecstasy with three or more other substances of abuse.

"The resurgence of Ecstasy use is cause for alarm that demands immediate attention and action," said SAMHSA Administrator Pamela S. Hyde, JD.

The SAMHSA report suggested that prevention efforts with a focus on the potentially dangerous consequences not only of Ecstasy alone but also of Ecstasy in combination with other drugs may be most compelling. The agency also said that, for the age cohorts most affected, the medium of the message, particularly the use of social networking sites, may be the most effective mechanism for both reaching and persuading potential users to abstain from use of Ecstasy and other illicit drugs.

The study was based on data from SAMHSA's 2004 - 2008 Drug Abuse Warning Network (DAWN) reports. DAWN is a public health surveillance system that monitors drug-related hospital ED visits reported throughout the nation.

Click here to access the report.

NIH Looks to Accelerate Diabetes Research

Frank Irving — Wed, 23 Mar 2011 23:31:00 GMT

New strategic plan addresses types 1 and 2, as well as gestational diabetes.

On March 18, the National Institutes of Health (NIH) announced a new strategic plan to guide diabetes-related research over the next decade. The plan, developed by a federal workgroup led by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), identifies research opportunities with the greatest potential to benefit the millions of Americans who are living with or at risk for diabetes and its complications, according to NIH.

"By setting priorities and identifying the most compelling research opportunities, the strategic plan will guide NIH, other federal agencies and the investigative community in efforts to improve diabetes treatments and identify ways to keep more people healthy," said NIDDK Director Griffin P. Rodgers, MD.

The plan focuses on 10 areas of diabetes research with the most promise. The goal is to accelerate discovery on several fronts, including:

the relationship between obesity and type 2 diabetes, and how both conditions may be affected by genetics and environment;
the autoimmune mechanisms at work in type 1 diabetes;
the biology of beta cells, which release insulin in the pancreas;
development of artificial pancreas technologies to improve management of blood sugar levels;
prevention of complications of diabetes that affect the heart, eyes, kidneys, nervous system and other organs; and
reduction of the impact of diabetes on groups disproportionately affected by the disease, including the elderly and racial and ethnic minorities.

Under the plan, NIH will continue to emphasize clinical research in humans, which already has led to highly effective methods for managing diabetes and preventing complications, Dr. Rodgers said.

The NIH strategy for fighting diabetes addresses both type 1 and type 2 diabetes. Type 1 diabetes, which affects about 5 percent of individuals with diagnosed diabetes, is an autoimmune disease that most often develops during childhood. Type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes cases in the United States, and is strongly associated with patients who are overweight or obese. In addition, the plan addresses gestational diabetes, a condition that some women develop during pregnancy, but which usually goes away after their child is born. Women who develop gestational diabetes during pregnancy are at increased risk for developing type 2 diabetes, and the child of that pregnancy may also be at increased risk for obesity and type 2 diabetes.

About 1 in 10 adults in the United States has diabetes, according to the Centers for Disease Control and Prevention. About 1.9 million Americans aged 20 years or older were newly diagnosed with diabetes in 2010. In addition, an estimated 79 million American adults have pre-diabetes, a condition in which blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes. By 2050, as many as 1 in 3 adults could be diagnosed with diabetes if current trends continue, the CDC reported. The projection assumes that recent increases in new cases of diabetes will continue and people with diabetes will also live longer, which adds to the total number of people with the disease.

Diabetes eventually damages nearly every organ system in the body. People with diabetes are at increased risk for blindness, kidney failure and lower limb amputation. Overall, the risk for death among people with diabetes is about twice that of people of similar age without diabetes. In addition, it is an expensive disease to manage. Total costs of diabetes, including medical care, disability and premature death, reached an estimated $174 billion in 2007 in the United States.

The plan was developed by the Diabetes Mellitus Interagency Coordinating Committee (DMICC), a congressionally authorized workgroup chaired by the NIDDK. DMICC facilitates cooperation, communication and collaboration on diabetes research across the federal government.

Click here to access the strategic plan.

CDC Statistics Show U.S. Death Rates Declined in 2009 for Tenth Straight Year

Frank Irving — Wed, 23 Mar 2011 01:24:00 GMT

Age-adjusted death rates declined significantly for 10 of the 15 leading causes of death in 2009.

The age-adjusted death rate for the U.S. population fell to an all-time low of 741 deaths per 100,000 people in 2009 -- 2.3 percent lower than the 2008 rate, according to preliminary 2009 death statistics released March 16 by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). U.S. deaths rates have declined for 10 straight years, according to the report.

Life expectancy at birth increased to 78.2 years in 2009, up slightly from 78.0 years in 2008. Life expectancy was up two-tenths of a year for males (75.7 years) and up one-tenth of a year for females (80.6 years). Life expectancy for the U.S. white population increased by two-tenths of a year. Life expectancy for black males (70.9 years) and females (77.4 years) was unchanged in 2009. The gap in life expectancy between the white and black populations was 4.3 years in 2009, two-tenths of a year increase from the gap in 2008 of 4.1 years.

The findings were based on death certificates provided to NCHS through the National Vital Statistics Reporting System from all 50 states, the District of Columbia and U.S. territories.

The research also found that age-adjusted death rates declined significantly for 10 of the 15 leading causes of death in 2009: heart disease (declined by 3.7 percent), cancer (1.1 percent), chronic lower respiratory diseases (4.1 percent), stroke (4.2 percent), accidents/unintentional injuries (4.1 percent), Alzheimer's disease (4.1 percent), diabetes (4.1 percent), influenza and pneumonia (4.7 percent), septicemia (1.8 percent) and homicide (6.8 percent).

Overall, there were 2,436,682 deaths in the United States in 2009 -- 36,336 fewer than in 2008 (a 1.5 percent decrease).

Click here to access the full report.