Category Archives: Access to Health Care
UPDATE: Sierra Leone Ends Three-Day Lockdown, Reports 130 New Cases
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Officials in Sierra Leone have ended a three-day curfew designed to help contain the continuing spread of the Ebola virus, calling the effort a success. Authorities reported 130 new cases during the lockdown and are waiting for tests on 39 more people. The West African country has been one of the hardest hit by the outbreak—more than 550 of the nearly 2,800 total deaths have been in Sierra Leone. In addition more than 100 tons of health-related supplies are being flown to Sierra Leone and Liberia. They include gloves, masks, gowns, goggles, saline, antibiotics, oral rehydration solution and painkillers. "We must do all we can to reduce further the human tragedy caused by this deadly outbreak and help communities avoid an even deeper setback than has occurred already," said Chief Executive Thomas Tighe of Direct Relief, according to USA Today. Read more on Ebola.
Study: Medicare Patients Less Likely to Receive Post-Stroke Surgery
Despite the fact that it can significantly help recovery and reduce the risk of long-term disability or even death, a common post-stroke surgical treatment is far less likely to be referred by physicians of patients with Medicare, according to a new study in the journal PLOS One. Researchers at the University of Florida (UF) analyzed data on more than 21,000 adult patients discharged from 2003 to 2008 with a diagnosis of subarachnoid hemorrhage, finding that—when compared to patients with private insurance—Medicare patients were almost 45 percent less likely to receive surgery and were more than twice as likely to die in the hospital. Azra Bihorac, MD, the study’s senior author and an associate professor of anesthesiology, medicine and surgery at the UF College of Medicine, said the results could indicate a conscious or unconscious bias. “Not every hospital has skilled neurosurgeons who specialize in subarachnoid hemorrhage,” he said in a release. “If these hospitals don’t have the necessary expertise, then they may actually overestimate the risk of a bad prognosis. They may assume that the patient won’t do well anyway, so they won’t proceed with surgery.” Read more on access to care.
Study: Weekly Text Reminders about Calories Help People Make Healthier Choices
Something as simple as a weekly text reminder may help U.S. adults develop a better understanding of basic nutrition and make healthier food choices, according to a new study in Health Promotion Practice. Researchers from the Johns Hopkins Bloomberg School of Public Health sent either a weekly text message reminder, a weekly email reminder, or no weekly reminder about the U.S. Food and Drug Administration’s recommendation of a reasonable daily caloric intake—2,000 calories—to 246 participants dining in the Johns Hopkins Hospital cafeteria. They found that at the beginning of the study approximately 58 percent knew the recommended benchmark, but after four weeks the participants who received texts were twice as likely to know the benchmark. “While daily energy needs vary, the 2,000-calorie value provides a general frame of reference that can make menu and product nutrition labels more meaningful,” said study leader Lawrence J. Cheskin, MD, director of the Johns Hopkins Weight Management Center, in a release. “When people know their calorie ‘budget’ for the day, they have context for making healthier meal and snack choices.” Read more on nutrition.
White House Announces Significant Increase in U.S. Ebola Response
Yesterday, NewPublicHealth reported President Obama’s initial planned response to the ongoing Ebola outbreak in West Africa. The White House has since expanded on the plans. They will include:
- A military command center in Liberia.
- A staging area in Senegal to help dispatch personnel and aid to affected communities more quickly
- Personnel from the U.S. Public Health Service will deploy to a new field hospitals the U.S. is setting up in Liberia.
- US AID will help distribute home kits with items such as gloves and masks to help reduce the number of Ebola cases.
Read more about Ebola.
Survey Finds Doctors are Overextended or At Capacity for Patients
A new survey of 20,000 doctors by the Physicians Foundation, a non-profit group that works with practicing physicians, finds that 81 percent of doctors say they are over-extended or at full capacity and only 19 percent indicate they have time to see more patients. Forty-four percent of doctors responding say they plan to take steps that would reduce patient access to their practices , including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking non-clinical jobs, leading to the potential loss of tens of thousands of physicians in the United States. The timing of the survey is significant because signup for health insurance coverage under the Affordable Care Act begins in just a few weeks. Read more about access to care.
Number of Smokers Increases in New York City
Earlier this week the New York City Health Department released new 2013 data showing that 16.1 percent of adult New Yorkers are smokers, a significant increase from the city’s lowest recorded adult smoking rate of 14 percent in 2010. For the first time since 2007, there are more than one million smokers in New York City who are at risk of developing a smoking-related illness, including heart disease, stroke, diabetes, emphysema, lung and other cancers, according to the health department. So far, the city does not have strong data to explain the uptick in smoking. Nationally, the U.S. Centers for Disease Control and Prevention estimates that 18 percent of U.S. adults are smokers, down from 20 percent several years ago. However, New York City is often a bellwether for public health issues, and the health experts across the country will be looking to see whether the city’s tobacco control efforts—including a new ad campaign that focuses on both daily and occasional smokers—have an impact on smoking rates. Read more on tobacco.
The American Heart Association (AHA) is working with dozens of state legislatures this year to develop laws that would add cardiopulmonary resuscitation (CPR) classes to middle or high school curricula. Nineteen states require in-school training for high school students, and more are expected to consider or implement the training in the next few years. In Virginia, for example, Gwyneth’s Law—named for a little girl who went into cardiac arrest and died waiting for an ambulance with no one with CPR training able to step forward to try to help—goes into effect in two years and makes CPR mandatory for high school graduation, unless students are specifically exempted.
The AHA says that by graduating young adults with the knowledge to perform CPR—now taught as a hands-only skill, with no mouth-to-mouth resuscitation so as to keep the emphasis on chest compressions—they can vastly reduce the number of Americans, currently 420,000, who die of cardiac arrest outside a hospital each year. The numbers are highest among Latinos and African-Americans, according to the AHA, largely because too many members of those communities have not been taught CPR. AHA surveys find that people who live in lower-income, African-American neighborhoods are 50 percent less likely to have CPR performed.
New AHA grants are helping fund the training in underserved areas. A 2013 study in Circulation: Cardiovascular Quality and Outcomes studied several underserved, high-risk neighborhoods to learn about CPR barriers. The researchers found that the biggest challenges for minorities in urban communities are cost (including child care and travel costs), fear and lack of information.
“Our continued research shows disparities exist in learning and performing CPR, and we are ready to move beyond documenting gaps to finding solutions to fix them,” said Dianne Atkins, MD, professor of Pediatrics at the University of Iowa. “School is a great equalizer, which is why CPR in schools is an integral part of the solution and will help increase bystander CPR across all communities and save more lives.”
The AHA has received funding from Ross, the national clothing store chain, for a program called CPR in Schools, which teaches hands-free CPR to seventh and eighth graders. As a way to increase training for minority students, AHA is partnering local Ross stores with nearby public schools where at least 50 percent of students receive free or reduced lunches.
- Read a NewPublicHealth story about a pilot kiosk CPR trainer to teach hands-free CPR in the Dallas/Fort Worth Airport. The pilot program will expand to other locations in 2015.
- Watch hands-only CPR training videos from the American Heart Association. Tip: First learn to hum “Staying Alive” by the Bee Gees. The beat is almost precisely the rhythm needed for effective CPR chest compressions.
A comment period has just opened, through September 30, on proposed minimum standards for medical respite centers for the homeless. Medical respite centers provide an indoor, supported home where discharged homeless hospital patients can convalesce instead of immediately returning to the street.
Experts on homelessness says strong standards and compliance with them can result in not just reducing hospital readmission for discharged homeless patients, but also an increase in permanent housing solutions for people who entered the hospital without a place to call home. In fact, about 80 percent of homeless people who enter a respite facility move onto housing options instead of back to the street, according to Sabrina Eddington, director of special projects at the National Health Care for the Homeless Council (NHCHC).
Eddington says that having the standards in place is critical. An estimated 150,000 people who have no permanent address are discharged from the hospital each year, based on state estimates. Going back to the street can mean reinfection, hospital readmission and an inability to keep up with care, such as daily medication that could improve, stabilize and even cure both physical and emotional health problems.
Medical respite care centers range from free-standing centers to sections of homeless shelters, and even vouchers for motels and hotels with home visits by medical and social support staff.
The proposed minimum standards were published on September 1 and a comment period runs through September 30. The NHCHC will hold a webinar tomorrow, September 12, from 1-2:30 EST. Click here to register.
The goals of the guidelines for the respite care centers are to:
- Align with other health industry standards related to patient care
- Represent the needs of the patients being served in the medical respite centers.
- Promote quality care and improved health
- Create standards for a range of respite center types with varying degrees of resources
NHCHC has dozens of stories about previously homeless patients who were discharged to medical respite care and are now living in stable housing, often with no need for hospital readmission. Take Ahmed. After losing his family and business, Ahmed moved to the street, where he struggled with alcoholism and depression. In 2005, Ahmed had a stroke and was hospitalized. Following discharge he was back on the street until an outreach team brought him to a medical respite program, where he was medically stabilized; received help for his depression; and referred to a program that specializes in treating co-occurring mental illness and addiction. Ahmed is now in supportive housing and participating in a recovery program. He continues to visit his primary care clinic and psychiatrist and has not been hospitalized since the stroke occurred.
There are now dozens of medical respite facilities throughout the community, and NHCHC is hopeful about expanding the models.
“We advocate that medical respite services be available in all communities serving homeless clients,” said Eddington.
Earlier this summer, NHCHC was one of 39 Health Care Innovation Award recipients announced by the U.S. Department of Health and Human Services. The $2.6 million award is administered by the Center for Medicare and Medicaid Innovation and will be used to demonstrate improved health outcomes and reduced spending when homeless patients have access to medical respite care following a hospital stay. The three-year project will test a model that will provide medical respite care for homeless Medicaid and Medicare beneficiaries, following discharge from a hospital, with the goal of improving health, reducing readmissions and reducing costs.
A new Kaiser Health News (KHN) article describes the challenges of helping people who have never had health insurance sign up for coverage. The KHN profile looks at the Arab Community Center for Economic & Social Services (ACCESS) a nonprofit agency that is helping the large Arab-American population in Dearborn, Mich., sign up for coverage and access care.
The group has found that many of the people they are helping are immigrants who know little to nothing about health insurance concepts such as enrollment, copays and deductibles—an issue that also applies to millions of other people new to health insurance across the country. Immigrant and uninsured populations all over the country face cultural and language barriers to understanding and adopting U.S. insurance practices.
Ten million non-citizens living legally in the U.S. are expected to gain health insurance under the Affordable Care Act, according to KHN. The navigators at ACCESS are also trained to teach immigrants about free public health screenings for conditions such as breast cancer, which requires specialized training and conversations because of cultural stigmas associated with cancer.. At the ACCESS center in Dearborn, for example, women coming for free mammograms enter through an unmarked door.
Read the Kaiser Health News article.
- Kaiser Health News recently reported that, on average, premiums will decline in 16 major cities for the 2015 coverage year.
- Advertising for health insurance plans has already started across the country. Sign up for the 2015 coverage year begins October 15, 2014 and ends February 15, 2015, a period that is roughly three months shorter than last year’s enrollment period. Find information at healthcare.gov.
Recently NewPublicHealth shared an interview from AlleyWatch, a Silicon Valley technology blog about SenseHealth, a new medical technology firm that has created a text message platform that health care providers can use to communicate with patients. In May, SenseHealth was picked to be part of the New York Digital Health Accelerator, which gives up to $100,000 in funding to companies developing digital health solutions for patients and providers. The accelerator is run by the Partnership Fund for New York City and the New York eHealth Collaborative. SenseHealth engaged in a clinical trial last year that used the technology to help providers engage with patients who are Medicaid beneficiaries.
Health conditions supported by the SenseHealth platform range from diabetes to mental health diagnoses, while the messaging options include more than 20 customizable care plans, such as medicine or blood pressure monitoring reminders. There are also more than 1,000 supportive messages, such as a congratulatory text when a patient lets the provider know they’ve filled a prescription or completed lab work. The platform couples the content with a built-in algorithm that can sense when a user has logged information or responded to a provider, and providers are able to set specific messages for specific patients. Early assessments show that the technology has helped patient manage their conditions, with data showing more SenseHealth patients adhered to treatment plans and showed up for appointments than patients who didn’t receive the text program.
We received strong feedback on the post, including a question from a reader about whether Medicaid beneficiaries lose contact with their providers if they disconnect their cell phones or change their numbers, a common occurrence among low-income individuals who often have to prioritize monthly bills. To learn more about SenseHealth and its texting platform, NewPublicHealth recently spoke with the company’s CEO and founder, Stan Berkow.
NewPublicHealth: How did SenseHealth get its start?
Stan Berkow: We got started about two to two-and-a-half years ago. I met one of the other founders while I was working at the Columbia University Medical Center in New York City. We were both clinical trial coordinators and were seeing—first hand—the difficulties in getting participants in our studies to actually follow through on all the exercise and nutritional changes they needed to make in order to complete the research project. That led us to step back and look at the bigger health care picture and recognize the challenges for providers to help patients manage chronic conditions, and recognizing that there’s a huge time limitation on the providers. That pushed us toward finding a way through technology to help those providers help the patients they work with more effectively to prevent and manage chronic conditions.
EBOLA UPDATE: NIH to Begin Human Trials of Experimental Vaccine
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Following an expedited review by the U.S. Food and Drug Administration, the National Institutes of Health will this week begin human testing of an experimental Ebola vaccine. This will be the first safety trial for this type of vaccine, which was developed by GlaxoSmithKline and the National Institute of Allergy and Infectious Diseases (NIAID). The vaccine will first be given to three people to determine its safety, and then to 20 volunteers ages 18 to 50. “Today we know the best way to prevent the spread of Ebola infection is through public health measures, including good infection control practices, isolation, contact tracing, quarantine, and provision of personal protective equipment,” said NIAID Director Anthony Fauci, MD. “However, a vaccine will ultimately be an important tool in the prevention effort. The launch of Phase 1 Ebola vaccine studies is the first step in a long process.” Read more on Ebola.
Study: Low-Carb Diets May Be Better than Low-Fat Diets for Losing Weight, Reducing Heart Disease Risk
Low-carbohydrate diets may be more effective than low-fat diets for both losing weight and reducing the risk of heart disease, according to a new study in the Annals of Internal Medicine. Researchers assigned 148 patients either a low-carbohydrate or a low-fat diet, collected data at the start of the study, then again at three, six and 12 months. Of the people who completed the study—59 in the low-carbohydrate group and 60 in the low-fat group—researchers determined that the low-carbohydrate diet was the more effective of the two, concluding that “[r]estricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors.” Read more on obesity.
Study: Many People Have Difficulty Understanding their Electronic Health Records
While electronic lab results are increasingly used to keep patients up to date on their health, a new study out of the University of Michigan’s schools of Public Health and Medicine found that many people have difficulty understanding the information. The researchers pointed to people with low comprehension of numerical concepts and low literacy skills as the most likely to have difficulty understand their results, make them less likely to use the data to decide whether a physician follow-up might be needed. "If we can design ways of presenting test results that make them intuitively meaningful, even for people with low numeracy and/or literacy skills, such data can help patients take active roles in managing their health care," said Brian Zikmund-Fisher, associate professor of health behavior and health education at the university’s School of Public Health, in a release. "In fact, improving how we show people their health data may be a simple but powerful way to improve health outcomes." Read more on access to health care.
It’s no secret that kids perform better in school when they are healthy and feel motivated to learn. But not all kids have access to the quality health care that can help them get healthy, stay healthy or treat any chronic health conditions they have. That’s where school-based health centers come in.
School-based health centers are partnerships between schools and community health organizations. They help students get the preventive care they need—including flu shots, annual physicals, dental exams, vision exams and mental health counseling—right where they spend most of their daytime hours: On school grounds. There are currently more than 2,000 school-based health centers across the country. Besides removing barriers to health care that many families face, school-based health centers help reduce inappropriate visits to emergency departments by up to 57 percent, research has found. They also help lower Medicaid expenditures, decrease student absences from school and do a better job of getting students with mental health issues the services they need.
Moreover, with growing recognition that health disparities affect academic achievement, school-based health clinics help close the gap by providing crucial access to health care for students who might not otherwise get it. A study by researchers at the University of Washington, Seattle, found that high school students who used school-based health centers experienced greater academic improvements over the course of five semesters than students who didn’t use these centers; the effect was especially pronounced among those who took advantage of mental-health services. Another study found that high school students who were moderate users of school-based health centers had a 33 percent lower dropout rate in an urban setting that has a high dropout rate.
The exact services offered by these centers vary by community. At Santa Maria High School in Santa Maria, Calif., the health center’s offerings include crisis intervention sessions; a grief group for students dealing with loss; and ongoing opportunities for students to build important social skills and skills that will help them maintain a healthy lifestyle. In Oakland, Calif., the Native American Health Center offered at a middle school and a high school provides medical care, dental care, mental health services and a peer health education program in one setting. At the Maranacook Health Center in central Maine, kids can get support for chronic health problems (such as asthma, diabetes, or seizures), medications they need, counseling or other mental-health evaluations and services.
The ultimate goal behind these centers is for all children to enjoy and benefit from good health and school success.
“Children and adolescents are at the heart of the mission,” said John Schlitt, president of the School-Based Health Alliance, based in Washington, D.C. But the “scope of the health center’s influence extends beyond the clinic walls to the entire school, its inhabitants, climate, curriculum, and policies. The school is transformed as a hub for community health improvement.”
EBOLA UPDATE: CDC Issues Travel Warning for Three African Countries
(NewPublicHealth is monitoring the public health crisis in West Africa)
The U.S. Centers for Disease Control and Prevention (CDC) has issued a Level 3 Travel Warning for Guinea, Liberia and Sierra Leone, calling for Americans to avoid nonessential travel to the West African countries due to the growing Ebola outbreak. CDC officials are also on the ground:
- Tracking the epidemic including using real-time data to improve response
- Improving case finding
- Improving contact tracing
- Improving infection control
- Improving health communication
- Advising embassies
- Coordinating with the World Health Organization and other partners
- Strengthening Ministries of Health and helping them establish emergency management systems
“This is the biggest and most complex Ebola outbreak in history. Far too many lives have been lost already,” said CDC Director Tom Frieden, MD, MPH. “It will take many months, and it won’t be easy, but Ebola can be stopped. We know what needs to be done. CDC is surging our response, sending 50 additional disease control experts to the region in the next 30 days.” Read more on global health.
FDA Takes Steps to Improve Diagnostic Testing
The U.S. Food and Drug Administration (FDA) is taking new steps to ensure that patients have access to accurate, consistent and reliable diagnostic testing. The agency announced today that it was issuing a final guidance on the development, review and approval or clearance of companion diagnostics, which are used to determine whether patients should receive certain drugs. The FDA is also notifying Congress that it will publish a proposed risk-based oversight framework for laboratory developed tests. “Ensuring that doctors and patients have access to safe, accurate and reliable diagnostic tests to help guide treatment decisions is a priority for the FDA,” said FDA Commissioner Margaret A. Hamburg, MD, in a release. “Inaccurate test results could cause patients to seek unnecessary treatment or delay and sometimes forgo treatment altogether.” Read more on the FDA.
CDC: New Online Resource on Opportunities in U.S. Health System
The U.S. Centers for Disease Control and Prevention’s (CDC) Office for State, Tribal, Local and Territorial Support (OSTLTS) has launched a new website, Health System Transformation and Improvement Resources for Health Departments, to provide information, resources and training opportunities related to ongoing efforts to improve efficiency and effectiveness in the U.S. health system. This includes the public health, health care, insurance and other sectors. Topics covered by the new site range from shared services, community benefit assessment and accountable care organizations to public health law, workforce, return on investment and financing. Read more on access to health care.
HHS: $83.4M to Improve Community Access to Primary Health Care
The U.S. Department of Health and Human Services (HHS) is awarding $83.4 million to 60 Teaching Health Centers as part of the Affordable Care Act. The funds will go toward training more than 550 residents during the 2014-15 academic year, with the goal of strengthening primary care and improving access to health care in U.S. communities. Areas covered will include family medicine, internal medicine, pediatrics, obstetrics, gynecology, psychiatry, geriatrics and general dentistry. “This program not only provides training to primary care medical and dental residents, but also galvanizes communities,” said Health Resources and Services Administration Administrator Mary K. Wakefield, PhD, RN. “It brings hospitals, academic centers, health centers, and community organizations together to provide top-notch medical education and services in areas of the country that need them most.” Read more on access to care.
Community Preventive Services Task Force Recommends Universal Motorcycle Helmet Laws
Universal motorcycle helmet laws can prevent injuries and save lives while also saving communities the high health care costs associated with collisions, according to a new review of 69 studies and a separate economic review of 22 studies by the Community Preventive Services Task Force. Based on the conclusions, the task force—an independent, nonfederal, unpaid panel of public health and prevention experts—recommends all U.S. communities adopt universal helmet laws, with are more effective than no law or partial helmet laws at preventing severe injuries. The study found that the United States and other high-income communities saw substantial decreases in motorcycle-related deaths and injuries after enacting universal helmet laws, but the inverse when universal laws were repealed or replaced with other laws. Read more on injury prevention.
Study: Fungus Behind 2013 Yogurt Recall a Larger Threat than Previously Believed
The fungus behind an outbreak that led to the September 2013 recall of Chobani brand Greek yogurt is more dangerous than first believed, according to a new study in mBio, the online journal of the American Society for Microbiology. Initially the company believed that the Murcor circinelloides fungus was only a potential danger to people with compromised immune systems. However, as additional gastrointestinal were reported researchers continued their study, concluding that the “harmless” fungus was actually a strain with the ability to cause disease. “When people think about food-borne pathogens, normally they list bacteria, viruses, and maybe parasites. Fungal pathogens are not considered as food-borne pathogens. However, this incidence indicates that we need to pay more attention to fungi. Fungal pathogens can threaten our health systems as food-borne pathogens” said Soo Chan Lee of Duke University, an author on the study. Read more on food safety.