Idea #278 for November 23rd, 2009: Tag-Team Healthcare or Physicians and Pharmacists Working Together To Improve Patient Outcomes

Under normal circumstances, a physician prescribes a high-blood pressure medication and a pharmacist fills the prescription as written. But when doctor and pharmacist work together, patients with hypertension fare better. New research supports that notion: a study of 400 hypertensive patients showed that patients whose pharmacists and doctors worked together had much better outcomes.

In this case, working together meant that both physician and pharmacist had a say in the medications and dosages the patient received. In the control group, whose patients were prescribed blood pressure medications in the conventional manner, 30% of the patients saw their blood pressure drop to the recommended level within six months. On the other hand, 64% of patients who had the physician/pharmacist team working together reached that level in the same time frame. That’s a remarkable difference.

Methods like this are being employed by some practices in the country already. If the results of the study hold up, it makes sense to expand this type of collaboration. Previous research has shown similar success in treating other conditions like diabetes and high cholesterol with this system as well. The authors of the study think we can encourage more collaboration by employing incentives via Medicare payments for those who setup these partnerships.

Read more about this news here.

Idea #230 for October 6th, 2009: Low-Pressure Situation or Inexpensive Way of Managing High Blood Pressure

Less than 40% of Americans with high blood pressure are adequately keeping their condition under control, which has driven doctors to find new methods for patients managing hypertension. Letting blood pressure get out of control can lead to a number of other conditions, not least of which are heart attack, stroke, and kidney disease. A Duke study found that managing blood pressure inexpensively and effectively can be accomplished through telephone counseling and patient self-monitoring at home.

In the study, patients that were taught how to use blood pressure monitoring equipment while also receiving instructional phone calls from nurses were able to lower their blood pressure by 11%. The phone calls from the nurses consisted of nutrition and exercise advice, as well as medication side-effects. It’s important that side-effects are discussed because patients may cease taking medications if side-effects are found to be an annoyance. The per-patient cost of this program works out to about $400 for two years — a bargain in the world of healthcare. We need more of this type of thinking in medicine to lower costs and improve patient outcomes.

See more about this study here.

Idea #206 for September 12th, 2009: Free Speech or Improving Communication Between African American Patients and Doctors

Sometimes trends in healthcare emerge that show disparities in treatment across various ethnicities or races. New research suggests that African Americans with high blood pressure are not sufficiently communicating with their providers, leading to further health problems.

The study involved recording the audio from over 200 hypertensive patients in Baltimore while visiting their primary care providers. The recordings revealed that African American patients had shorter visits and had less verbal interaction with their providers than white patients. Researchers postulate that lack of trust, or a feeling of disconnect may be at play. Further, physicians may not be as apt to engage in dialogue with quiet patients, the study suggests. If trust is an issue, then efforts should be focused on correcting that issue so that communication can become more free. Lack of communication may lead to higher rates of hypertension and its complications, which is especially a concern in the African American population.

See more about this study in US News.

Idea #203 for September 9th, 2009: Hold The Salt or Cutting Back on Sodium Consumption Could Save Nation Billions

Our nation has a lot of health problems related to the food we consume, and now a study has come up with a dollar estimate of just how much one ingredient is costing our healthcare system. If we cut our collective salt intake down to recommended levels, it’s estimated that we could save $18 billion a year.

Nutritional guidelines recommend that we consume no more than 2,300 mg of sodium per day, but the average American takes in more like 3,300 mg per day — an entire gram of salt more than we should. High sodium consumption is linked to high blood pressure, which in turn leads to heart disease and kidney disorders. Right now, about 70 million Americans have high blood pressure, but that number could be reduced by 11 million if people limited themselves to the recommended 2,300 mg of sodium per day, hence the $18 billion in savings. If we cut our average salt intake to 1,500 mg per day, it’s estimated the savings would rise to $26 billion.

Changing our diets will take some vigilance on the part of the consumers, though. Foods in restaurants aren’t labeled with nutritional information, and most of us probably have no idea how much salt we consume each day. Fast food restaurants could assist the public by making sodium and caloric information more readily available, or by reducing the amount of fat, salt, and sugar in their food. That probably won’t happen, so Americans will have to be more watchful about what they consume.

You can read more about the study here.

Idea #101 for May 30th, 2009: Just a Few Minutes of Your Time or Online Cardiovascular Health Assessment

A hospital near Chicago has a simple online tool that it hopes will lower the incidence of preventable heart disease. It’s a risk assessment calculator that takes only a couple minutes to complete. A staggering number of heart disease cases are preventable, and health workers’ are trying to make potential victims more aware of their risk. In fact, a physician at that hospital estimates that 90-95% of their cases of heart disease are preventable. With almost a million deaths a year in the US related to heart disease, there is clearly a need to catch early warning signs and risks of cardiovascular issues before they become deadly.

The tool asks for some basic information like age, weight, blood pressure, and family history, as well as checkboxes for a number of symptoms. Then, your estimated risk level is displayed and if the risk is determined to be high, a free cardiac screening is offered. In those cases, users enter their contact information and a nurse will follow-up by telephone.

Of the 7,000 people who’ve taken the test this year, more than a third have been deemed high-risk. Similar tools are available on other hospital websites as well. It’s a pretty low-cost way to reach out to patients who may otherwise be unable or unwilling to see a doctor. This is an example of a simple tool that should be publicized more and, hopefully, will compel potential heart disease patients to take the necessary steps to thwart the problem.

Read the story about this in the Chicago Tribune and try the test yourself here

Idea #95 for May 24th, 2009: A Painful Reality or Kidney Stones Among Children Climbing

Pediatricians across the country are seeing a new, unusual trend: higher incidence of kidney stones in children. Kidney stones are most common among middle aged males, but in the last few years, they are becoming more frequent among children — and even toddlers. What’s likely responsible for the trend is childhood obesity. Factors like high blood pressure, high cholesterol and diabetes are believed to contribute to the formation of kidney stones.

Dietary factors like too much sodium and too little calcium intake may also be at play here. In 2005, children were found to be getting 50% more sodium in the diets than in 1995. And in 2001, a study found that 68% of 7 to 9 year-olds exceed the daily recommended amount of sodium intake. Consuming too much sodium can cause kidney stones.

This is another wake-up call for us regarding the state of our nation’s health. The vast majority of cases of childhood kidney stones are preventable, so there shouldn’t be a need for us to spend time and money on treating this disorder.  Just changing kids’ lifestyles should be enough to make this problem go away. That means encouraging them to become more physically active and steering them away from diets high in sodium and calories. Continuing on the current track will surely lead to much more serious problems than just kidney stones.

See more about the kidney stone problem in the LA Times and on naturalnews.com

Idea #94 for May 23rd, 2009: Reaching Out or Free Health Screenings

In rough economic times, citizens are cutting back on spending across the board, including on healthcare. A survey found that about 60% of people are forgoing health spending amid the recession. But skipping preventive care now can have dire consequences late. One way to reach out to people who would otherwise forgo care is through free health screenings.

Various free screenings are available from time to time in regions across the country. For instance, hospitals may offer free cholesterol screenings once a year. Walgreens and the AARP have teamed up to provide mobile health screenings over the next two years. In this case, buses full of staff and equipment will tour the country and offer their services for free.

The Walgreens/AARP program is estimating they will be able to conduct 2.5 million screenings in 3000 communities over that period. The scope of their screenings will include measuring cholesterol, blood pressure, and glucose levels in an attempt to identify chronic conditions like diabetes and hypertension. Last year, their screenings found that about 73% of people tested had high blood pressure. That just underscores the need for more outreach and patient education, especially in an economic climate where more patients are unable to afford proper care.

Read about the Walgreens/AARP program here, and see other screening information in the LA Times.

Idea #81 for May 10th, 2009: Cutting The Red Tape or Encouraging Employee Wellness Programs

Employers have figured out that a healthful workforce is a more productive and less costly (in terms of insurance premiums) workforce. That’s why some companies offer employees incentives for adopting healthier lifestyles. It’s a win-win situation. Now Congress is considering changing laws to make those kinds of wellness programs easier for companies to implement.

Encouraging healthy living among workers can really put a dent in the massive amounts of money our nation spends on healthcare. Chronic conditions like diabetes, high blood pressure, and obesity account for a tremendous amount of health spending, yet they are mostly preventable. Additionally, employee smoking cessation programs can help thwart the many illnesses associated with cigarette smoking. Lawmakers have recognized the benefits of employee wellness programs and are now taking action.

One possible Congressional proposal focuses on giving tax credits to employers that use health screenings and wellness counseling. There are also plans to cut the red tape that’s making it unnecessarily burdensome for companies to adopt wellness programs. Things like complex tax rules and insurance laws are getting in the way of companies implementing ideal programs. Anything Congress can do to make these types of programs more prevalent can really help our health — and our health spending.

See the story in the New York Times.

Idea #57 for April 16th, 2009: Sodium Chloride Overload or Cutting Salt Intake

Americans have yet another reason to avoid sinking their teeth into that cheeseburger: we’re all consuming too much salt, according to the CDC. The average person in this country consumes about 3,500 mg of sodium a day, which dwarfs the 2,300 mg recommended limit in federal nutritional guidelines. Further, the CDC recommends limiting that amount to 1,500 mg for the 70% of Americans who are in higher risk categories.

Consuming too much sodium is linked to high blood pressure, which in turn is a major risk factor for heart disease and stroke. Researchers from UC San Francisco believe that cutting our daily salt intake by 1,000 mg over ten years will result in about 250,000 fewer cases of heart disease and cut cases of stroke by almost 200,000. Eliminating too much salt from your diet can also be deadly, but that’s a problem most of us will probably never have, considering the ubiquity of salt in available foods.

Avoiding sodium may not be an easy task, especially if you don’t prepare most of your own food. Salt is prevalent in fast food and processed food, as it is an easy and cheap way to boost flavor. Consumers should read nutrition labels and choose processed foods carefully. Also, try to be judicious with the salt shaker. When you’re eating out, knowing the nutritional profile of your meals can be tricky, so it might require a little homework on the part of the consumer. If enough consumer pressure is put on major food chains and producers, they may be forced to offer lower-sodium options.

To read more about the CDC and salt recommendations, see these stories from US News, the Atlanta Journal Constitution, and the Chicago Tribune.

Idea #6 for February 24th, 2009: Exercise is Good For Our Wallets or Health Care Cost Cutting

High blood pressure (hypertension) is one of those exponential things: once diagnosed, it is a well into which we pour our health care spending. More troubling still is that in a variety of ways, hypertension has treatments that don’t always have a strong correlation between cost and results. In 2002, the last numbers I had handy, roughly 21% of Americans or 45 million people had been diagnosed with problematic BP. We spend at least $7 billion each year (maybe as high as $15 billion) on medications to control blood pressure, with an average around $350 per patient per year. This does not include the $170 billion economic burden we bear each year as a result of the associated MIs (myocardial infarctions, i.e. heart attacks) and strokes that may have been avoided with better control. Blood pressure medication spending has also been among the leaders in annual cost increases for the last decade, so expect the numbers above to climb. Numerous studies also show that the older diuretic based treatments, which are substantially less expensive than newer therapies, are equally (if not more) effective at treating high BP. I will save the when-older-drugs-are-better-and-cheaper-why-aren’t-doctors-using-them post for a later date.

One thing about hypertension, though, is that it can be readily and well controlled with one simple thing: exercise. There are countless studies that show exercise in combination with drug therapy (or on its own) along with a better diet are excellent ways to control high BP and substantially reduce the risks and costs associated with treating all those MIs and strokes. We need to start thinking out of the box. Using the numbers above, it would actually be cheaper as a nation to pay everyone with high blood pressure $1000 to exercise and control it, or $500 to exercise and cover drug expenses each year, than what the current system is costing Americans. Hypertension is just one example; take a look at cholesterol, diabetes and more and we might just find that we can all stop working and get full time jobs exercising.

Here is some further reading on the subject: http://www.mayoclinic.com/health/high-blood-pressure/HI00024 ; http://www.ajmc.com/Article.cfm?ID=3046 ; http://www.medscape.com/viewarticle/550448_2, and http://jama.ama-assn.org/cgi/reprint/291/15/1850.pdf