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Key Determinants for Diabetes Drug Adherence

Key Determinants for Diabetes Drug Adherence

Multiple medications are often prescribed to help adults with type 2 diabetes manage hyperglycemia, diabetes-associated conditions like hypertension and dyslipidemia, and other comorbidities. “Prior studies have shown that non-adherence to diabetes medications is associated with many adverse outcomes,” says M. Sue Kirkman, MD. Research indicates that better adherence to diabetes medications improves control of intermediate risk factors. It also reduces the likelihood of being hospitalized, can lower healthcare costs, and may decease mortality. Taking a Closer Look Studies aiming to estimate rates of adherence to diabetes medications vary widely depending on the types of patients involved in the analysis and how investigators define adherence. Most analyses tend to look at either individual-level or system-level factors independently, but few have used large generalizable cohorts. To address this research gap, Dr. Kirkman and colleagues had a study published in Diabetes Care that used a large national database to look at adherence to oral diabetes medications in more than 200,000 adults with type 2 diabetes in the United States. For the investigation, the study team used the medication possession ratio, which Dr. Kirkman notes is a fairly standard way to assess adherence. “We pre-specified a number of variables related to patient, provider, and prescription factors, and then looked at their association with adherence,” she says. “A multivariate model was then developed to look at the independent effects of each variable since many of them correlate with one another.” Important Findings Overall, about 70% of patients involved in the study were adherent to their medications. “We identified several factors that were associated with non-adherence, including younger age, being new to diabetes therapy, being...
Quality Care for Pneumonia in the Elderly

Quality Care for Pneumonia in the Elderly

Adherence to recommended processes of care for patients hospitalized with pneumonia is publicly reported throughout the United States by CMS. Despite this reporting, little is known regarding whether more physicians are now performing these process measures and how they have impacted patient outcomes. Taking a Closer Look For a study published in JAMA Internal Medicine, Jonathan S. Lee, MD, and colleagues sought to describe the processes of care, mortality, and readmissions for elderly patients hospitalized with pneumonia. “The morbidity and mortality associated with pneumonia are especially prominent in the elderly,” says Dr. Lee. “We assessed how these patients are being cared for and whether there are steps that should be taken to potentially improve their mortality and readmissions rates.” The researchers conducted a retrospective analysis that involved more than 1.8 million Medicare fee-for-service patients aged 65 and older who were hospitalized for pneumonia in 2006 to 2010. Participants were eligible for at least one of seven inpatient processes of care that are tracked by CMS during their hospitalization, including: Influenza vaccination. Pneumococcal vaccination. Smoking cessation counseling. Performance of blood cultures before antibiotic therapy in the ED. Performance of blood cultures within 24 hours for ICU patients. Appropriate antibiotic selection. Antibiotic initiation within 6 hours. Based on the processes and outcomes of care, Dr. Lee and colleagues assessed the quality of care for pneumonia from 2006 to 2010. “By 2010, more than 92% of patients were receiving all of the processes of care for which they were eligible,” Dr. Lee says. “Mortality and readmission rates both decreased slightly during the study period. All seven processes of care were associated with...
Recommendations for Sleep Duration

Recommendations for Sleep Duration

Each year, millions of Americans seek guidance regarding recommended sleep durations. Recently, the National Sleep Foundation convened a multidisciplinary panel of experts to develop new age-specific recommendations for appropriate sleep durations. The panel consisted of experts in sleep, anatomy, physiology, pediatrics, neurology, gerontology, and gynecology. The recommendations resulted from multiple rounds of consensus voting after a comprehensive review of published scientific studies on sleep and health. They were published in the journal Sleep Health and are available for free on the National Sleep Foundation’s website at www.sleephealthjournal.org. “These recommendations used a rigorous, systematic approach in which we reviewed scientific literature relating sleep duration to health, performance, and safety from around the world,” says Max Hirshkowitz, PhD, DABSM, who was lead author of the document. “They are scientifically-grounded and designed to improve the sleep health of the millions of people who rely on experts for this information.” Summarizing Key Highlights The National Sleep Foundation revised the recommended sleep ranges for all various children and teenage groups as well as for younger, middle-aged, and older adults (Table). A new range—“may be appropriate”—was added to acknowledge the variability in appropriate sleep durations that occurs within certain age groups of patients. The recommendations define times into three categories: 1) recommended, 2) may be appropriate for some individuals, and 3) not recommended. “The recommendations will hopefully help people make sleep schedules that are within a healthy range,” Dr. Hirshkowitz says. “They can also serve as a useful starting point for clinicians to have informed discussions with patients.” He adds that the National Sleep Foundation remains committed to regularly reviewing and providing the recommendations so...
Improving Pediatric Asthma Care

Improving Pediatric Asthma Care

The current rate of childhood asthma in the United States is at a historically high 10%, according to recent research. Clinical practice guidelines recommend that clinicians provide parents and caregivers of children with asthma a regularly updated written asthma management plan. They are also recommended to administer annual influenza immunization for all children with asthma, prescribe daily controller medications in high-risk children, and screen for environmental tobacco exposure. Few studies have assessed compliance with recommendations that have been set forth by national medical societies and associations. It has been speculated that population-level surveys may provide such information and help identify social determinants of health and unique considerations that may benefit from tailored interventions. Learning From California For a study published in Population Health Management, Ulfat Shaikh, MD, MPH, MS, and Robert S. Byrd, MD, MPH, sought to determine the quality of life and healthcare utilization of children with asthma. “We used 2011-2012 data from the California Health Interview Survey because it is well collected and the sampling procedure used is excellent,” explains Dr. Shaikh. “The data are quite likely generalizable to the rest of the country because the population of California does not have significantly different rates of asthma than other states. We also wanted to use these data from 44,000 households to help identify ways in which pediatric asthma care could be improved.” Gaps Observed Dr. Shaikh says she and Dr. Byrd found several gaps between current practice and national recommendations for asthma care. “We found that children with asthma tended to use the emergency room more than they should,” she says. One-third of children in the study...
Aspirin Use for Primary CVD Prevention

Aspirin Use for Primary CVD Prevention

With cardiovascular disease (CVD) continuing to be the leading cause of death in the United States, greater emphasis has been placed on primary and secondary prevention strategies. “Clinical guidelines recommend aspirin as secondary prevention in patients with preexisting CVD and as primary prevention in those without CVD who have a moderate to high 10-year risk of developing it,” says Salim S. Virani, MD, PhD. However, there is no proof that aspirin use reduces adverse cardiovascular events in patients without CVD and a low 10-year CVD risk. In addition, concerns have been raised about using aspirin because it can increase the risk of gastrointestinal (GI) bleeding and hemorrhagic strokes in some patients. The American Heart Association (AHA) guidelines on primary prevention of CVD and stroke recommend that aspirin be used in patients with 10-year coronary and stroke risks of 10% or higher. However, other groups have cautioned clinicians to weigh the benefit of preventing CVD against risks for increased GI bleeding and stroke. The U.S. Preventive Services Task Force recommends using aspirin if a patient’s 5-year coronary heart disease (CHD) risk is 3% or higher (or a 10-year CHD risk of 6% or higher). In 2011, the AHA/American Stroke Association guidelines for primary prevention of stroke recommended aspirin use for primary prevention if 10-year CVD risks were at least 6% to 10%. As a result of these recommendations, aspirin use for primary prevention is considered appropriate in patients with 10-year CVD risks of 6% or higher. “However, given the risk of GI bleeding and stroke, using aspirin for primary prevention in patients at low risk of cardiovascular events would be...
Identifying Smoking-Related Disease

Identifying Smoking-Related Disease

Among current and former adult smokers, symptoms like productive cough, dyspnea, and exercise intolerance may be viewed as a part of normal aging, particularly among older former smokers. Smoking cessation may reduce respiratory symptom severity and slow the rate of lung function decline, but it does not eliminate progressive lung disease risk. Few studies have assessed the effects of smoking on patients without COPD. A group of researchers has suspected that spirometry may be insensitive to early disease or subclinical lung pathology and that current and former cigarette smokers without spirometric evidence of COPD may have impairments in physical function, quality of life, and respiratory symptoms that can go untreated. High-resolution CT scanning in this patient population may demonstrate significant lung disease, but comprehensive data has been lacking. Finding Hidden Lung Disease “There are no disease-modifying treatments for patients identified with smoking-related lung disease,” explains Elizabeth A. Regan, MD, PhD, “but there are many treatments that improve their symptoms, allow them to breath better, enable them to exercise, and improve quality of life.” For a study published in JAMA Internal Medicine, Dr. Regan and colleagues set out to determine whether or not patients with a heavy smoking history, but who did not meet spirometric criteria for COPD, had hidden lung disease. Dr. Regan and colleagues completed evaluations on more than 10,000 current and former smokers aged 45 to 80 with at least a 10 pack-year smoking history and a comparison group of more than 100 never smokers of similar ages. Evaluations included high-resolution chest CT scans, spirometry, 6-minute walking tests, and multiple questionnaires about respiratory symptoms, comorbidities, and quality...
COPD Research: The Present & Future

COPD Research: The Present & Future

While research has made large strides in the assessment and treatment of patients with COPD in recent years, a number of important questions remain to be answered. The American Thoracic Society and European Respiratory Society have teamed up to publish a joint statement that describes current evidence on the diagnosis, assessment, and management of COPD; identifies gaps in knowledge; and makes recommendations for future research. Current Needs Perhaps the biggest need that spans all areas of COPD research is to determine which outcomes matter most to patients and then to ensure that research studies measure these outcomes. “Understanding what patients care about is the basis of patient-centered care,” says Kevin C. Wilson, MD, co-author of the statement, which was published in the American Journal of Respiratory and Critical Care Medicine. Physiological and/or anatomical outcomes are used frequently in studies because they tend to be easier to measure. Such surrogate outcomes, however, should strongly correlate with patient-centered outcomes if they are used in clinical research. Examples of patient-centered outcomes include quality of life, dyspnea, and frequency and severity of exacerbations. Determining the optimal method for diagnosing COPD based on spirometry is another important research need according to Dr. Wilson. It is undetermined whether the diagnosis of COPD should be based upon a fixed threshold or the lower limit of normal for the FEV1/FVC ratio. A post-bronchodilator FEV1/FVC ratio of less than 0.7 has traditionally been the criterion for airflow limitation. However, this threshold may result in more frequent identification of airflow limitation among the elderly and less frequent diagnoses among patients younger than 45 when compared with a threshold based...
Diabetes Behavior Changes & Mobile Technology

Diabetes Behavior Changes & Mobile Technology

Studies have shown that mobile technology can help patients with heart disease improve self-care and disease management. Few studies, however, have explored why these programs are effective and their broader applicability to other disease settings, including diabetes. Understanding the underlying factors that interfere with good self-care practices among patients with diabetes may help with the development of mobile technologies that targeted this population. Testing an Intervention In a pilot study, Monica E. Peek, MD, MPH, and colleagues tested an interactive, mobile phone-based intervention in which patients with diabetes received a wide range of automated text messages. These messages provided tips on things like foot care, checking blood sugar, healthy eating, and physical activity. Other messages were reminders of upcoming physician visits or alerts to take medications. “We tailored the intervention to patients’ lifestyles, treatment regimens, and personal preferences,” says Dr. Peek. A study coordinator called patients several times throughout the study to ensure that messages were received and determine if patients wanted to change the timing of any messages. With a bank of about 1,000 text messages that could be automatically delivered from a computer, Dr. Peek and colleagues expanded the intervention and published data on their findings in Diabetes Educator. For certain scenarios—such as a patient failing to respond to messages or responding three consecutive times that they had not taken their medication—an algorithm of alert messages was created so that a nurse care manager was notified directly. “Patients would then be called back by the nurse care manager and offered potential solutions to their problems,” explains Dr. Peek. “The patient’s primary healthcare provider was then emailed so...
CME: Taking a Patient-Centered Approach to Managing Cholesterol

CME: Taking a Patient-Centered Approach to Managing Cholesterol

The National Lipid Association (NLA) has released new recommendations to guide healthcare providers in the diagnosis and treatment of dyslipidemia using a patient-centered approach. The American College of Cardiology and the American Heart Association have previously developed clinical guidelines for managing cholesterol, but the NLA recommendations are different in that they offer an alternative perspective that may benefit clinicians in their care of patients. “The NLA recommendations aim to help clinicians collaborate with patients to ensure that they understand their treatment options and the importance of reducing cardiovascular risk,” explains James A. Underberg, MD. “They emphasize that a strong patient-provider relationship is essential to achieving long-term success. They’re intended to inform—not replace—clinical judgment.” The recommendations, published in the Journal of Clinical Lipidology and available for free online at www.lipidjournal.com, are intended to be a complimentary tool to currently available guidelines. In order to take a patient-centered approach, clinicians must use their own judgment but also take into account the circumstances, objectives, and preferences of each individual patient. Patients should be active participants in the process and engage with clinicians in conversations about objectives of therapy, potential risks and side effects, and expected benefits and costs. “Patients who better understand their options and participate in treatment decisions tend to be more committed to sticking with therapies for the long term,” adds Dr. Underberg. Key Highlights According to the NLA expert panel that developed the recommendations, non-HDL cholesterol (non-HDL-C) and LDL cholesterol (LDL-C) are key lipoproteins by which success of treatment is assessed. Non-HDL-C is preferred over LDL-C because it more accurately predicts risk among patients who are on or off...
Taking a Patient-Centered Approach to Managing Cholesterol

Taking a Patient-Centered Approach to Managing Cholesterol

The National Lipid Association (NLA) has released new recommendations to guide healthcare providers in the diagnosis and treatment of dyslipidemia using a patient-centered approach. The American College of Cardiology and the American Heart Association have previously developed clinical guidelines for managing cholesterol, but the NLA recommendations are different in that they offer an alternative perspective that may benefit clinicians in their care of patients. “The NLA recommendations aim to help clinicians collaborate with patients to ensure that they understand their treatment options and the importance of reducing cardiovascular risk,” explains James A. Underberg, MD. “They emphasize that a strong patient-provider relationship is essential to achieving long-term success. They’re intended to inform—not replace—clinical judgment.” The recommendations, published in the Journal of Clinical Lipidology and available for free online at www.lipidjournal.com, are intended to be a complimentary tool to currently available guidelines. In order to take a patient-centered approach, clinicians must use their own judgment but also take into account the circumstances, objectives, and preferences of each individual patient. Patients should be active participants in the process and engage with clinicians in conversations about objectives of therapy, potential risks and side effects, and expected benefits and costs. “Patients who better understand their options and participate in treatment decisions tend to be more committed to sticking with therapies for the long term,” adds Dr. Underberg. Key Highlights According to the NLA expert panel that developed the recommendations, non-HDL cholesterol (non-HDL-C) and LDL cholesterol (LDL-C) are key lipoproteins by which success of treatment is assessed. Non-HDL-C is preferred over LDL-C because it more accurately predicts risk among patients who are on or off...
An Update on Hyperglycemia in Type 2 Diabetes

An Update on Hyperglycemia in Type 2 Diabetes

In 2012, the American Diabetes Association and the European Association for the Study of Diabetes published a position statement on the management of hyperglycemia in patients with type 2 diabetes. “This was needed because of an increasing array of anti-hyperglycemic drugs and growing uncertainty regarding their proper selection and sequence,” says Silvio E. Inzucchi, MD. “However, the 2012 document was less prescriptive than prior consensus reports because of a paucity of comparative effectiveness research on long-term treatment outcomes with many of these medications.” Recently, the American Diabetes Association and the European Association for the Study of Diabetes requested an update to the position statement that incorporates new data from recent clinical trials. Dr. Inzucchi, who served as co-chair to the 2015 update, notes that the writing group focused on areas where revisions were suggested by a changing evidence base rather than developing an entirely new position statement. He adds that the most recent position statement should be viewed as an addendum to the previous full account that was released in 2012. A Patient-Centered Approach Previous position statements have recommended individualizing treatment targets and strategies when managing type 2 diabetes. According to the update, patient-centered care and shared decision making continue to be a focus for the management of hyperglycemia in type 2 diabetes. “Glycemic targets should be personalized based on a variety of factors.” says Dr. Inzucchi. These include those that are potentially modifiable factors, such as patient attitudes, resources and support systems, and those are usually non-modifiable factors, such as disease duration, life expectancy, prevalent comorbidities, and established vascular complications. Personalization is necessary to balance the benefits of...
Emergency Management of Sepsis

Emergency Management of Sepsis

Studies have shown that rates of sepsis have steadily increased over the past decade and account for 2% of all hospital admissions. Nearly half of sepsis patients are eventually managed in ICU settings and account for more than 10% of all ICU admissions overall. Today, more than 750,000 patients are seen each year for sepsis and sepsis-related conditions in the United States, accounting for 4% of all inpatient costs. In response to increasing sepsis trends, “sepsis pathways” have been developed in hospital settings, aimed at targeting clinical, regulatory, and coding issues that are designed to ultimately improve patient outcomes. The Surviving Sepsis Campaign, for example, has enhanced the public and clinical awareness of sepsis. As a result, evidence-based guidelines have been adopted in an effort to improve severe sepsis and septic shock outcomes by facilitating early identification and evidence-based management. Taking a Bundled Approach “Sepsis bundles” have emerged in various forms in an effort to simplify the complex processes of care required for assessing and managing septic patients. The ultimate goals of these bundles are to use evidence-based processes, which when implemented, collectively improve outcomes beyond the effect of any single measure. Although outcomes are difficult to quantify, recent data support processes for early sepsis recognition and strategic interventions. After implementing sepsis bundles, several published studies have demonstrated decreases in mortality and hospital and ICU length of stay, with corresponding rates improving as more hospitals comply with sepsis-related bundle practices. The Role of Blood Cultures In addition to strategic interventions, the early collection of laboratory blood cultures is also demonstrating value in the identification and management of sepsis. One...
Managing Cholesterol in Specific Patient Groups

Managing Cholesterol in Specific Patient Groups

The National Lipid Association (NLA) has released recommendations that specifically address the importance of managing blood cholesterol levels in special patient populations. “Over the years, we’ve learned that taking a ‘one size fits all’ approach to managing cholesterol is ineffective,” says Terry A. Jacobson, MD, who was part of the NLA group that developed the recommendations. “Our goal was to highlight groups of patients who are at high risk for cholesterol problems and to develop recommendations for each of these groups based on their unique characteristics.” The NLA recommendations—published in the Journal of Clinical Lipidology and available for free at www.lipid.org—offer guidance on managing cholesterol among diverse ethnic and racial groups. They also provide recommendations for conditions that cover the lifespan. Chronic conditions not previously identified as being high-risk for heart disease are also covered in the recommendations (Table). Lifestyle is the Cornerstone According to Dr. Jacobson, the NLA recommendations reinforce the importance of lifestyle changes as the cornerstone of therapy. “Lifestyle therapies like nutrition, physical activity, and exercise often get short-changed during patient care,” he says. “Clinicians need to refocus the bullseye on lifestyle modifications and become more comfortable offering practical strategies to assist their patients.” The recommendations provide new detailed advice for specific changes in diet, dietary patterns, and the amount of physical activity and exercise required for cardiovascular health. “For example, patients should understand that there are many types of cardioprotective diets available to them that may help manage cholesterol, but the key is to change their patterns of eating and incorporate a greater variety of plant foods and leaner sources of protein,” explains Dr. Jacobson....
Can E-Reminders Reduce SSI Risk?

Can E-Reminders Reduce SSI Risk?

An estimated 400,000 surgical site infections (SSIs) occur each year in the United States, leading to nearly 10,000 deaths, significant morbidity, and excess healthcare resource utilization. Preadmission antiseptic showers with chlorhexidine gluconate (CHG) have been shown to effectively inhibit or kill microbial florae on the surface of the skin, thereby reducing the risk for SSIs. However, research has suggested that patient compliance with preadmission showering protocols appears to be lower than expected. Testing Electronic Reminders A preadmission shower product organization recently built an electronic alert, web-based system that provides reminders for patients to take their preadmission shower with CHG via text message, email, or voice mail. For a study published in the Journal of the American College of Surgeons, Charles E. Edmiston, Jr., PhD, and colleagues analyzed the benefits of using the electronic alert system for enhancing compliance with a preadmission showering protocol. Participants were instructed to take preadmission showers and then randomized to receive either electronic reminders or no reminders. Compliance was measured by assessing skin surface concentrations of CHG. “Patients who received the electronic alerts had significantly higher skin surface concentrations of CHG than those who didn’t get the reminders,” says Dr. Edmiston. Patients who were not alerted had 65% lower average concentrations of CHG on their skin surface when compared with those who received electronic reminders. “Our findings suggest that patients can be empowered to be an intimate part of the process using electronic alerts,” adds Dr. Edmiston. “We found that 85% of participants—both young and old—wanted to receive texts rather than emails (10%) or voicemail messages (5%). It appears that texting is an important mechanism...
Estimating Risk for Potential ACS in the ED

Estimating Risk for Potential ACS in the ED

Throughout EDs in the United States, acute coronary syndrome (ACS) is a common concern and frequently leads to more extensive evaluations using accelerated diagnostic protocols. When ACS is a suspected, disposition decisions usually depend heavily on perceptions of the risk of near-term adverse events, such as death or myocardial infarction (MI). Theoretically, the primary purpose of hospital admission is to mitigate these risks. “Decisions to admit patients with suspected ACS should be based, in part, on an assessment of how much hospitalization will decrease their risks for adverse events,” explains David H. Newman, MD. Characterizing Discussions In a study published in Annals of Emergency Medicine, Dr. Newman and colleagues sought to characterize risk assessment discussions between patients and physicians at admission and assess accuracy of risk estimates when ACS is suspected. “Our exploratory study primarily aimed to characterize the content of conversations surrounding disposition decisions,” adds Dr. Newman. It was hypothesized that the conversation content may reflect inaccurate risk estimates and poor convergence of risk perceptions between patients and their physicians. For the research, investigators collected 425 matched-pair surveys of patients admitted for possible ACS and their physicians in two EDs. After the disposition conversation, trained research assistants administered surveys that asked about perceived and communicated risk estimates and the purpose of admission. The primary outcome measure was agreement in assessment of the risk of MI, which was defined as the proportion of patient-physician pairs whose risk estimates were within 10% of each other. Important Findings According to the results, patients reported discussing the likelihood of their symptoms’ being due to MI in 65% of cases, whereas physicians reported...
Bladder Cancer & Tobacco Use

Bladder Cancer & Tobacco Use

According to research, about half of all bladder cancer cases diagnosed in the United States are the result of cigarette smoking. The disease is the second most common tobacco-related malignancy, a fact that is not well known among the general public. “Quitting smoking after being diagnosed with cancer can prolong survival, improve prognosis, and decrease the risk of developing second cancers,” says Jeffrey C. Bassett, MD, MPH. “Ensuring that patients are aware of the relationship between smoking and bladder cancer is paramount to their diagnosis being a ‘teachable moment’ to quit.” Few studies have looked at tobacco use knowledge and attribution of cause in patients with newly diagnosed bladder cancer. In a study published in Cancer, Dr. Bassett and colleagues sought to characterize patients’ knowledge of the link between tobacco use and bladder cancer risk using 2006-2009 data obtained from 790 respondents from the California Cancer Registry. The authors also looked at the impact of different sources of information on patients’ knowledge and beliefs regarding the cause of their bladder cancer. Degrees of Knowledge The study found that 68% of patients had a history of tobacco use, and 19% were active smokers when they were diagnosed with bladder cancer. Tobacco use was the most cited risk factor for bladder cancer, but active smokers were more knowledgeable on this association than former or non- smokers (90% vs 64% vs 61%, respectively). “Urologists also played a critical role in ensuring patients’ knowledge of the connection between smoking and bladder cancer,” Dr. Bassett says. The study showed that urologists were patients’ predominant source of information and were cited most often by active...
CME: Strategies for Improving Diabetes Care

CME: Strategies for Improving Diabetes Care

According to the most recent estimates, more than 29 million Americans—or slightly more than 9% of the population—have diabetes. Nearly 2 million new cases of diabetes are diagnosed each year, highlighting the need for greater prevention efforts. When managing patients with diabetes and those at risk for the disease, the American Diabetes Association recommends that clinicians strive to provide patient-centered care, consider diabetes across the life span, and serve as advocates for patients with diabetes. “A key management strategy for patients with diabetes is to recognize that one size does not fit all,” says Alka Kanaya, MD. “When following evidence-based guidelines for managing the disease, it’s important to adapt care based on each individual patient’s specific characteristics.” Because patients with diabetes are also at higher risk of heart disease, a patient-centered approach should be used. This includes a comprehensive plan to reduce cardiovascular risk by addressing blood pressure (BP) and lipid control, smoking cessation, weight management, and healthy lifestyle changes that include adequate physical activity. Fragmented Care Delivery Systems In addition to taking a patient-centered approach, improving coordination between clinical teams is critical as patients pass through different stages of life. “Ongoing efforts are needed to prevent the complications that can occur in patients with type 2 diabetes,” Dr. Kanaya says. “Studies suggest that there has been steady improvement in the proportion of patients achieving recommended levels of A1C, BP, and cholesterol in the last 10 years, but many patients still do not meet their personal targets. Variations in quality of diabetes care have persisted, indicating that there is potential to improve care delivery systems.” A major barrier to...

How to Use Technology to Activate and Engage Patients at Different Points of Care

Physicians across the country are facing pressure to become more proactive about delivering care to patients. The old way of reacting to a patient’s current illness, treating it and sending them on their way no longer works in the age of new healthcare payment models and rising chronic illnesses. Keeping patients healthy, and receiving compensation for doing so, requires ongoing effort from doctors and patients alike. With this in mind, physicians need to plan and execute ongoing patient outreach campaigns in order to engage people and activate them to participate in their own healthcare. Engagement outreach can include things like automated phone calls, text messages or emails between visits to keep patients on track with their treatment plans, remind them to pick up medications, or prompt them to schedule preventive screenings and keep already-scheduled appointments. All of these things can be accomplished using electronic health records and appointment reminder systems. Here are steps your practice can take to develop a systematic patient engagement plan that addresses multiple points along the care continuum: Use patient data to learn about your patients. In order to successfully engage patients in their healthcare, you need to speak to them in a language that makes sense and is meaningful. Analyze the data within your electronic medical records system to gain an understanding of various patients. Then look for insights that can help you draw conclusions about common illnesses and diseases among your base of patients. Are a large number of your patients overweight? What percentage of your patients have high blood pressure? Familiarize yourself with patients collectively and decide where you want to focus...

The Ultimate Resident Evaluation

It comes as no shock to me, and probably many other current and former program directors, that a recent study showed faculty overall performance evaluations of residents do not correlate with their scores on the yearly American Board of Surgery in Training Examination. According to the JAMA Surgery paper, faculty evaluations encompassed technical skill and the six core competencies—medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and system-based practice. The paper analyzed data for 150 residents at different levels of training over 4 years and also found that even faculty evaluations of the category medical knowledge couldn’t predict who would get a good or a bad score on the test. It’s great to know that at the authors’ institution, the average annual evaluation scores ranged from just over 75 to 100 with means and medians both slightly above 92—like Garrison Keillor’s mythical Lake Wobegon, “where all the women are strong, all the men are good looking, and all the children are above average.” “…the other parameters are so subjective that they border on meaningless. They remind me of the infamous ‘smiley face’ numerical pain scale.”   Medical knowledge can be measured, but the other parameters are so subjective that they border on meaningless. They remind me of the infamous “smiley face” numerical pain scale that means different things to different patients. Some examples. Earlier this year, I wrote about the difficulty defining professionalism. Using a numerical scale, how can you rate one resident as more professional than another? And I always had trouble ranking one resident over another in system-based practice. It might be...
Conference Highlights: AHA 2015

Conference Highlights: AHA 2015

New research was presented at AHA 2015, the American Heart Association’s annual Scientific Sessions, from November 7 to 11 in Orlando. The features below highlight some of the studies that emerged from the conference. Gender & Salary in Cardiology The Particulars: Research has shown that women are paid less than men across numerous professions. However, little is known about how salaries differ by gender among cardiologists, particularly after controlling for various job factors. Data Breakdown: For a study, researchers assessed self-reported salaries of more than 2,500 cardiologists in 2013. Women had an average salary of $400,162, compared with an average salary of $510,996 for men. Women worked significantly fewer half-days, and fewer women worked full time. However, based on measured job and productivity characteristics, the researchers expected women to have an average salary that was more than $30,000 higher than what was actually observed. For most services evaluated in the study, procedure volumes were similar for men and women who performed at least five of those services in the previous year. Take Home Pearl: Significant gender disparities appear to exist between male and female cardiologists.    Hypertension & Arousals of Sleep Disorders The Particulars: Previous studies have suggested that limb movement disorders during sleep may influence cardiovascular morbidity as well as being associated with hypertension. However, few studies have investigated arousals of sleep disorders—limb movement or respiratory—and their relationship to ambulatory blood pressure monitoring (ABPM). Data Breakdown: Study investigators reviewed data from patients who had undergone ABPM and polysomnography within 6 months of each other. Among participants, 64% had nocturnal hypertension, 32% had uncontrolled hypertension and 61% had a...
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