Category Archives: Preventive care
By Craig Pollack, MD, MS, MHS, a Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholar alumnus (2006-2009), assistant professor of medicine and associate director of the General Internal Medicine Fellowship program at Johns Hopkins University
The United States Preventive Services Task Force, a group never to shy away from controversy, recently released its final recommendations on prostate cancer screening. The Task Force gave prostate-specific antigen (PSA) testing a grade D, indicating that it should be discouraged as part of routine testing. They noted that there were substantial harms associated with testing and subsequent diagnosis and treatment: worry and anxiety; infections from biopsies; incontinence and erectile dysfunction. And the benefits were likely to be small—on the order of 1 life saved for every 1,000 men screened.
However, the recommendations have caused tremendous controversy. Critics question whether the Task Force has appropriately weighed the risks and benefits and balanced the existing evidence. Our research suggests that even those who agree with the recommendations will find it hard to stop screening. We are now working on a set of decision-making tools for primary care providers (PCPs) and patients to minimize unnecessary screening.
By David Krol, MD, MPH, FAAP, Robert Wood Johnson Foundation Human Capital Portfolio Team Director and Senior Program Officer
For many Americans, a visit to the dentist is a rarity—not by choice, but because their health plans don’t cover dental care, they can’t afford it, or because there is no dentist anywhere near where they live or work. If you’re on Medicare, you know that dental isn’t covered. If you’re part of the VA system, you know that dental benefits are treated differently. If you’re an adult on Medicaid or serve adult patients who are on Medicaid, you know the chances are slim that there’s great coverage for dental care, unless you are lucky to be in a state that still covers it. Why does this happen and what can result?
A study recently released by the Pew Center on the States offers startling data on the scope of the problem and its consequences. In 2009, some 830,000 Americans visited an emergency department for a preventable dental condition. It should be obvious that the emergency department isn’t the best place to seek dental care. The same year, 56 percent of Medicaid-enrolled children got no dental care whatsoever, not even a routine exam. That’s no care even with insurance for it!
Those numbers are alarming for many reasons, but mostly because they reveal a significant public health challenge confronting the nation: Many Americans simply aren’t getting the oral care they need, at any age, including the basic preventive services and education that can detect oral disease in early stages. They are putting their health at risk, and increasing the strain on an already-overwhelmed health care system.
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Laura Brennaman, MSN, RN, CEN, a fellow at the RWJF Nursing and Health Policy Collaborative at the University of New Mexico.
As we enter 2012, my resolution and wish for the U.S. health care system is a fundamental and transformative shift from a focus on disease management to one of health promotion. As Americans and health professionals, we must recognize that even the most advanced and best interventions to remedy diseases do not improve the overall health status of our country. Only preventing epidemics of chronic problems like metabolic syndromes, heart disease, and lung disease that plague our population can have significant wellness and economic benefits.
The Affordable Care Act offers a mechanism to foster such a change in emphasis with the establishment of the National Council for Prevention, Health Promotion, and Public Health that intertwines the governance of 17 executive agencies. Leadership from diverse arenas such as transportation, trade, agriculture and labor concentrating on health promotion strategies from within and across domains provides opportunities to affect many of the determinants of poor health and transform them into positive scenarios to improve health status of all Americans.
Actualizing new health promotion strategies through shifting spending from direct care provision to prevention mechanisms of social programs like job training, housing supports, public transportation systems, and childcare services has greater potential to improve health outcomes for Americans than new technology or pharmaceuticals for disease management.
In this coming election year, the candidates for office will propose a bevy of ideas concerning health care. However, we must pay heed to all programs they propose to enhance or curtail through a lens of health outcomes. Proposals dealing with environment, energy and economic issues will affect our health as surely as any health care reform plan.
Hence, my resolution for our health care system is holistic and comprehensive consideration of the health impact of every policy. Through such integrated deliberation, we will achieve improvement in health outcomes and reductions in health disparities for all Americans.
A newly released study from RWJF Clinical Scholar (2009-2011) Lenard Lesser, M.D., finds that Medicare covers only a fraction of the preventive care services recommended by a government task force, and that health care reform should be able to mend the current disconnect between Medicare reimbursement policies and the recommendations of the U.S. Preventive Services Task Force (USPSTF), charged by the government with reviewing clinical preventive health services. In particular, Lesser’s study points to the need to improve coordination between assessing the risk for certain illnesses and ensuring that patients receive the appropriate tests and follow-up clinical services. In addition, Lesser finds a persistent and disturbing lack of coverage for obesity and nutritional services, both of which are recommended by the task force and important for maintaining good health.
The study was published in the January/February issue of the Annals of Family Medicine.