Direct-to-consumer advertisements for prescription drugs have been legal in the United States since 1985, but are illegal in almost every other country. The history of consumer-directed ads in this country is that of private companies replacing public agencies as the purveyors of information on prescription drugs to the people. It has left us in a… Read More »
As the older population in the US continues to grow, simultaneously increasing the need for healthcare services and providers, patients these days might be more likely to see a physician assistant (PA) or a nurse practitioner (NP), as opposed to an physician (MD); but what’s the difference? Let’s start out with some key facts: how… Read More »
Reproductive rights have been a topic for policy making and legal jurisprudence throughout much of the past century. As the healthcare system of the United States continues to evolve, women’s health and reproductive rights remain central to the debate. I previously authored a post here at The Medical Care Blog which discussed religion-restricted healthcare and… Read More »
In the new US consumer marketplace, doing good for society is powerful. Choices that people are making about how their food is grown, how companies test household products and reduce their impact on the environment, and how companies make their profits are driving new business models. Farmers are changing their pest and weed-control methods, manufacturers are… Read More »
In a recent letter to state Medicaid directors, officials at the Centers for Medicare and Medicaid Services (CMS) encouraged states to implement work requirements in Medicaid, writing that “a growing body of evidence suggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes.” In response, 10 Republican-led states have… Read More »
Fibromyalgia is a debilitating centralized pain condition experienced by millions of Americans. “Centralized” refers to origination or amplification of pain by a sufferer’s central nervous system. It is, in a true sense, pain that is “in one’s head” — but nevertheless as real and noxious as any other pain. Ultimately, pain is always something experienced… Read More »
The day had finally come to start my first job as an EMT for a 9-1-1, emergency ambulance company. Before my first shift, I believed that most of the emergencies I would respond to were going to be serious and could be a matter of life or death. However, little did I know that many… Read More »
“A graduate student was threatened with a lawsuit and retraction of a published paper unless she paid thousands of dollars and signed a retroactive license for having used a measure without paying the fee.” This example was one of the motivating factors for a recent Medical Care commentary by Dr. Ron Hays and colleagues. The commentary… Read More »
Growing up we were encouraged to learn how to manage our time. Many of us were told that time management was the key to successful careers, personal lives, and finding the balance between the two. A cursory search online of time management brings you to a world of articles, blog posts, and books on time… Read More »
Alzheimer’s disease and related dementias (ADRD) affect about 5.7 million people in the US. Although most of those affected are covered by Medicare, many of the medical costs are not covered by insurance and must be borne by patients and their families. Total costs of care for ADRD have been estimated at more than $277… Read More »
There’s a box on my mom’s desk. It’s smaller than a shoe box, and unremarkable unless you know what’s in it, how it got there and why it represents several important things that are wrong with how we treat people with terminal cancer. The box contains 28 doses of two drugs, or one “cycle” of… Read More »
It was my first interview of the season, and I was interviewing for Obstetrics & Gynecology residency at a university-affiliated Catholic hospital. Because Catholic institutions do not allow abortion, patients are generally referred to other clinics and hospitals for termination needs. As the daughter of a religion scholar and professor, I was already very familiar… Read More »
Ironically, many healthcare providers–doctors, nurses, physician and medical assistants–are not trained in “health” at all but in “medicine” instead. Often, as providers, our instinct is to first reach for a pill bottle or a procedure and forget about lifestyle changes that could be safer and more financially feasible for our patients. As the burden of… Read More »
A fundamental question in health reform is how changes to insurance policy affect health insurance coverage. Since the passage of the Affordable Care Act (ACA) in 2010, research has demonstrated that the ACA reduced the uninsured rate across the country [pdf]. By expanding eligibility for the Medicaid program, establishing marketplaces for the purchase of private insurance, providing… Read More »
The name doesn’t exactly help. But before we discuss rebranding, a brief introduction to the concept . . . Salpingectomy refers to surgical removal of one (unilateral) or both (bilateral) fallopian tubes. It is thus a surgical option for female sterilization—but also drastically reduces a woman’s risk of ovarian cancer. This is huge. Ovarian cancer… Read More »
In a graduate course this semester (at the Temple University College of Public Health) on Healthcare Quality and Safety, one of the assignments is to explore the internet to learn about how consumers/patients without specific healthcare knowledge might get information on quality of care. When students enter “consumer healthcare information” in Google, the first result… Read More »
Crowdsourcing is defined as “a sourcing model in which individuals or organizations obtain goods and services, including ideas and finances, from a large, relatively open and often rapidly evolving group of internet users. Crowdsourcing spreads work among participants to achieve a cumulative result.” Some well-known examples of crowdsourcing include the online encyclopedia Wikipedia, the traffic… Read More »
[Editors’ note: This post was originally published on Feb. 7, 2018.] Now more than ever, we need a sensible, unified, national response to the opioid epidemic; a response that recognizes the gravity of the situation and the reality that opioid use disorder (OUD) is a chronic – and treatable – condition. While there are many… Read More »
Medication is an essential aspect of tertiary prevention, as it often addresses symptoms, may restore function, and minimizes adverse consequences associated with chronic conditions. Medication adherence is most often studied in the context of Medicare Part D. In a newly published Medical Care article, Drs. Roebuck, Kaestner, and Dougherty, instead measure the associations between medication… Read More »
Despite continuous efforts to address the problem, high rates of prescription opioid use and abuse continue to plague our country. According to the CDC, deaths involving prescription opioids in the United States have quadrupled since 1999, and so have the sales of these prescription drugs. In 2015, the American Public Health Association published a policy… Read More »
In this post, we describe five principles that guided the development of Positive Health Check, a clinic-based digital health intervention for HIV-positive patients, aimed at making it acceptable and feasible in a clinic setting.
Activity tracker technology has come a long way. The first Fitbit released in 2009 only measured movement, sleep, and calories burned. In contrast, the Fitbit Ionic smartwatch released in 2017 has a much broader range of functions, including heart rate monitoring, personal coaching, and built-in GPS. Consequently, with this change in functionality comes a change in potential uses for… Read More »
The Affordable Care Act (ACA) had a roller-coaster of a year. It began with threats of almost certain repeal, followed by effort after unsuccessful effort to dismantle it. Then in the last days of 2017, there was the successful repeal of the individual mandate penalty. This was brazen politics, suspenseful and often agonizing. It… Read More »
What role does mental health play in preventable hospitalizations? In a new article in the January 2018 issue of Medical Care, Dr. Laura Medford-Davis and colleagues report that in Texas, mental illnesses were associated with higher odds of preventable hospitalizations. Using an administrative database of all Texas hospital admissions from 2005-2008, the authors found that 13% of… Read More »
It’s been a wonderful year for The Medical Care Blog, and we are very proud of the great work of our contributors. Thank you for reading and sharing! Here are our most-read posts of 2017: Avoiding Anticholinergic Drugs May Reduce Alzheimer’s Risk by Barbara Zabielski The Impact of Social Media in Healthcare by Alexa Ortiz and Catherine… Read More »
Each year, millions of people around the world are victims of human trafficking. In the US, the National Human Trafficking Hotline, which maintains one of the most extensive data sets, received 13,897 calls in 2017, with 4,460 human trafficking cases reported. Of the 4,460 cases reported, 3,186 cases were of sex trafficking and 689 cases were… Read More »
The Centers for Medicare and Medicaid Services (CMS) has a set of “Compare” websites – Hospital Compare, Nursing Home Compare, Home Health Compare, etc.; consumers and policymakers can compare physicians, long-term care hospitals, inpatient rehabilitation facilities, hospice care, and dialysis facilities today, and other settings may follow. Together with their associated health care quality measurement… Read More »
Working in the healthcare profession can be both physically and emotionally draining for anyone, no matter their role or job title. Over half of physicians in the US [PDF] experience symptoms of burnout, and studies estimate a large percentage of nurses experience emotional exhaustion and have a higher prevalence of depression when compared to other US workers. Exhaustion… Read More »
Improving the overall patient care experience is an essential focus for organizations as healthcare delivery continues to evolve. The US Department of Health & Human Services Agency for Healthcare Research and Quality (AHRQ) notes patient experience as an integral component of healthcare quality, which includes “several aspects of healthcare delivery that patients value highly when… Read More »
Over the last few decades, cigarette smoking has become a health burden concentrated primarily among low-income individuals in the U.S. In our recently published research study, Medicaid coverage expansions and cigarette smoking cessation among low-income adults, we sought to determine the relationship between recent expansions of Medicaid coverage and smoking cessation for low-income adults. Demographics… Read More »
As the City of Worcester Commissioner of Health and Human Services, I have developed city-wide initiatives and worked on policy change to address three primary health issues prevalent in our community, those being addiction, mental health, and homelessness, which all tend to occur hand in hand. Addiction is the largest public health and public safety… Read More »
American Indians (AIs) typically have poorer health outcomes than any other racial or ethnic minority group in the United States. This includes an increased risk for cancer, diabetes, injury related mortality, and infant mortality. AIs tend to have the highest rates of poverty and low rates of insurance coverage. Much of the AI population uses the Indian… Read More »
There are some occupations where employees are mandated to receive age-based skills and cognitive testing. For example, the National Business Aviation Association has a mandatory retirement age of 65 for airline pilots. Additionally, firefighters, employees of the Federal Bureau of Investigation, air traffic controllers, and nuclear material couriers are all subject to age-based regulations. These agencies impose age-based… Read More »
“Neonatal abstinence syndrome” (NAS) sounds deceptively innocuous, given that it is literally infant drug withdrawal. It is usually caused by prenatal exposure to opioids but can also result from maternal consumption of other substances, like alcohol and antianxiety medications. Common symptoms include excessive high-pitched crying, fever, sweating, irritability, vomiting, diarrhea, rapid breathing, sleep disturbances, and poor… Read More »
Veterans leaving military service face many challenges transitioning back to civilian life. More than a quarter of veterans report struggling with the return to civilian life, according a Pew Research Poll. Some challenges are psychological; a considerable body of research has linked veteran status with mental health concerns. Other challenges, however, can be physical. Civilian… Read More »
Opioid addiction seems to be in the news every day. But what’s the difference between an opioid user and an opioid addict? First, let’s define our terms. Opioids are drugs derived from the opium poppy, including heroin and morphine. The class also includes synthetic opium-derived prescription painkillers including oxycontin and fentanyl, as well as drugs… Read More »
Medicine, alongside achievements in sanitation and public health, remains one of the major achievements of modern society. The reduction (or eradication) of many infectious diseases from the developed world, breakthroughs in anesthesiology and surgery, and advances in the care of chronic diseases (including HIV) are just a few of the multitudes of achievements. But these… Read More »
Hurricane Irma was the first major hurricane to hit Florida in over a decade, causing catastrophic damage in many areas. The human impact of the hurricane was also devastating, with reports of more than 50 deaths in the state. Among these deaths were ten residents of a nursing home in Hollywood Hills that lost power… Read More »
As unconscious bias and discrimination comes to the forefront of national conversation, it is fitting to discuss bias in the healthcare system. Though we pledge to treat all patients fairly and to the best of our capacity, regardless of their background, increasing evidence suggests that healthcare providers, too, have bias and exhibit behaviors perceived by… Read More »
What do you use your cell phone for on a daily basis? Many people would say using social media, texting, and placing phone calls– but have you ever considered your smartphone as a tool to improve medication adherence? Our phones are an integral part of our lives, and consequently, researchers, clinicians, and patients have all… Read More »
In a recent Health Affairs blog post, Universal Health Coverage? Why?, Walter McClure, Alain Enthoven, and Tim McDonald make a convincing case for expanding health insurance coverage in the United States. They argue that universal coverage is a “wise public investment” that “expands the workforce and makes it more productive,” similar to universal public education.… Read More »
Enrollment in Medicaid has been shown to enhance access to health care for our nation’s most vulnerable citizens. Yet despite these benefits, a substantial number of beneficiaries lose coverage at the time of renewal. An article by Xu Ji and colleagues, published in this month’s issue of Medical Care, demonstrates how critical maintaining continuous Medicaid coverage… Read More »
Annual routine check-ups, flu shots, and mammograms are among the basic preventive services for which the Patient Protection and Affordable Care Act of 2010 established a mandate for insurance plans: full coverage, with no out-of-pocket costs. In making it a little easier for some parts of the US population to access basic services, did the… Read More »
The pursuit of health equity – ensuring equal access to opportunities that enable all communities to lead healthy lives – is a critical task for the U.S. The direct and indirect medical costs associated with sickness and premature death resulting from health care inequities are enormous (estimated to be $230 billion and $1.24 trillion, respectively,… Read More »
“I’ve fallen, and I can’t get up!” Remember that catchphrase of the late 1980s and early 1990s, based on the television commercial for LifeCall? Well, the Mrs. Fletcher of yesterday would be amazed by the wearable devices of today – they might even be able to prevent her fall in the first place! According to… Read More »
One of the challenges in delivering efficient medical care is identifying people who are at risk of a negative outcome, so we can focus our efforts on screening and treating those at elevated risk. We do this in individual face-to-face encounters through clinical, diagnostic processes: taking a patient’s history, performing a physical examination, recording signs… Read More »
Cancer is a dreaded disease – and in the US, a typical response to a cancer diagnosis is to try every treatment available in hopes that something might work. Understandable! But cancer overtreatment is a serious problem that drives up costs, causes avoidable morbidity and mortality, and reduces the quality of care. What is overtreatment?… Read More »
Recently, I sat down to talk with Arlene Ash, PhD about risk adjustment. Dr. Ash is Professor and Chief of the Division of Biostatistics and Health Services Research, Department of Quantitative Health Sciences at the University of Massachusetts Medical School. As a methods expert on risk adjustment in health services research, she has pioneered tools… Read More »
Reproductive rights have been a topic for policy making and legal jurisprudence throughout much of the past century. As the healthcare system of the United States continues to evolve, women’s health and reproductive rights remain central to the debate. A recent policy update by Aishwarya Rajagopalan and Lisa Lines here at The Medical Care Blog discusses… Read More »
The burden of contraception falls primarily on women. In the United States, women need prescriptions for the majority of contraceptive methods, and so are vulnerable to changes in the healthcare system affecting access to care. Recently, President Trump has issued executive orders on religious liberty and related subjects that have paved the way for a rule… Read More »