Idea #175 for August 12th, 2009: Manning Up or The Role of Masculinity in Seeking Preventive Care

Lack of insurance isn’t the only thing keeping some Americans out of the doctor’s office. A study found that middle-aged men who can be considered “macho” are about half as likely as other men to seek out routine medical care. This may be one reason that men as a whole are less likely to see doctors than women. In turn, that stat may play a part in the lower life expectancy of men compared to women.

Researchers used a questionnaire to evaluate the men’s views on masculinity, and those who fit the macho mold were 26% less likely to have gone for a physical in the last year and 30% less likely to have gotten a prostate exam than other men. The socioeconomic status of the men surveyed did not seem to matter, as long as the men held macho beliefs, they were less likely to seek preventive care.

The results of this study suggest that getting more men to participate in preventive care will take more than just expanding access to care. There is a cultural problem here that has to be resolved, and that is the perception among men that seeking preventive care signifies weakness, or is emasculating. Changing behaviors can be difficult, but at least understanding the role that macho-ness plays in men’s health will be key in developing future strategies.

Read more about the study in the LA Times, MSNBC, and in HealthDay.

Idea #168 for August 5th, 2009: New Curriculum or STD Testing In Schools

In past posts, I’ve mentioned the growing problem of certain STDs among teenage populations. The rise of gonorrhea and chlamydia is particularly worrisome. In Washington DC, where there are high rates of STDs and teenage sexual activity, there are plans underway to offer STD testing to high school students. In a pilot testing program involving 3,000 DC students, 13% tested positive for a STD, underscoring the need for some kind of intervention.

Officials are planning on rolling out testing programs in high schools city-wide, but they will be not be mandatory. However, there is a mandatory STD education facet of the program. Two years ago in a smaller-scale testing program, 68% of the students agreed to providing a urine specimen for STD testing. Results were given by telephone and treatment was provided at the school or a clinic, at no cost to the student.

A number of other major cities are planning programs along the same lines, and Philadelphia has had a similar program for several years. Catching and treating STDs before they spread is important enough that testing in schools makes sense, especially in cities where STDs are rampant among teens.

For more, see the story about this in the Washington Post.

Idea #162 for July 30th, 2009: Tightening The Belt or Reversing The Obesity Trend

There have been a number of posts here on the topic of obesity. It’s an epidemic in this country, and while it’s undoubtedly a health concern for those who suffer from it, it is also a major contributor to ever-growing health expenditures. The journal “Health Affairs” published a study that claimed health problems related to obesity were responsible for $147 billion in health spending in 2008 — about 10% of all medical spending.

The average obese person spends 42% more on healthcare than others. When you consider that an astounding 30% of Americans are obese (the highest rate in the world) you can start to see why this is a $147 billion problem. Of course, combating this problem will take a lot effort on several different fronts, including encouraging Americans to be more physically active and changing their eating habits. Kathleen Sebelius indicated that some of the $1 billion earmarked for preventive health in the stimulus package will go towards fighting obesity. That’s a start, but this new report underscores the need for major action on the obesity crisis if we want to reduce health expenditures in the upcoming years.

For more, see this article in the NY Times and this story in the LA Times.

Idea #107 for June 5th, 2009: Medicine on Wheels or Saving Money with Mobile Care

A Harvard Medical School program illustrates how a small amount invested in preventive care can reap impressive cost-saving benefits. For 17 years now, the school has sent a mobile “Family Van” to local low-income neighborhoods, offering free tests and services. The average cost per encounter that Harvard incurs is about $117, totaling $566,000 per year. However, a study has estimated that the program saved the healthcare system about $20 million last year.

Part of that huge estimated savings figure comes from the assumption that about 80% of the patients would otherwise receive their care in ERs, where similar care would cost about $800 more per patient. The remainder of the savings was estimated by assigning value to the years added to patients’ lives as a result of the care. Regardless of how those numbers were derived, the benefits of the Family Van, and similar programs across the country, cannot be ignored. They are keeping uninsured patients out of emergency rooms and assisting them in managing chronic conditions. More communities would be wise to invest in such programs.

Read more about the program in the Boston Globe and sciencedaily.com

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 #56 for April 15th, 2009: You Can’t Afford to Neglect Diabetes or The Economy and Diabetes Care

The ripples from the global economic crisis are reaching many areas outside the world of finance, including healthcare. People are losing their jobs, and consequently, their benefit packages. In fact, 3.7 million Americans have lost their insurance since the crisis began. Even in cases where employees were not insured in the first place, the recession has now made it more difficult for them to pay for healthcare out of pocket. Because of this, patients have been cutting back on health spending.

The Associated Press reports that the recession has led to diabetes sufferers increasingly neglecting their illness since the economy faltered last fall. Close to 2 million new cases of diabetes are diagnosed each year, yet sales of diabetes drugs and devices for monitoring the disease have dropped recently. Meanwhile, the average co-pay of an office visit has risen in the past decade, making seeing a doctor more pricey even for the insured. Emergency rooms are now seeing more patients experiencing complications from untreated diabetes.

While ignoring or delaying treatment for diabetes might save money in the short term, the effects of the disease will be costly down the road. Diabetes can lead to blindness, neuropathy and amputations, and even death, if not monitored and treated correctly. The recession doesn’t have to mean you are stuck without treatment options. For those who can afford it, enrolling in the federal COBRA program allows the recently unemployed to continue their employee health insurance for up to three years. Also, low-income patients can qualify for discounted clinic visits and prescription assistance programs.

Read more stories about the economy and its effect on diabetes from: the LA Times, Associated Press, and a Wisconsin local news site.

Idea #21 for March 11th, 2009: Do You Really Need That Check-Up? or The Physical Exam Debate

Annual physical exams have long been lauded for their role in preventive care. Moreover, they allow physicians to chart changes in patients’ medical histories, and they can help in fostering a rapport between provider and patient. A growing number of doctors, though, feel that physical exams are not a yearly necessity in most cases.

Currently, about 20% of adults get annual physical exams at a cost of $7.8 billion per year. The exams account for 8% of total doctor visits, and an oftentimes unnecessary battery of tests during physicals, like urinalysis and blood tests, account for $350 million a year in health spending. Some healthcare experts wonder if the benefits of annual physicals are worth the costs and diversion of resources. Nobody doubts the importance of preventive care, but experts do question the way it is administered. It turns out that most preventive care is not administered during physical exams; 80% of preventive care actually occurs during other office visits, like when a patient comes in for an illness.

So should patients do away with the yearly physical? Not in all cases. For one thing, they should discuss it with their physician first. Screenings for diseases, like breast cancer or prostate cancer, are still important and require doctor visits. And people who never find themselves in doctors offices for illnesses or any other reason should probably be on annual physical exam regimens, if only so doctors will have a chance to give preventive care. For the rest of us, who may see a doctor now and then for various reasons, a yearly physical exam is probably not worth the time or money.

In the media, Time magazine, the NY Times, and CBS news have stories on the debate.