Articles Posted in Emergency Medicine

clockYour time is precious, and when you are a patient, you may feel it’s more so, especially if you’re ill or even in the end stage of your life.

So why do health care providers keep us waiting, or worse, why must doctors and hospitals act downright oblivious to how valuable our time might be as opposed to theirs—and what might be done about it?

Take a look at a thoughtful piece on how one health system has tried to keep true to the idea that patients matter above everything else and the delivery of care needs to focus on them:

sepsis-300x249Although public health officials have launched national campaigns against sepsis, it may be that new initiatives at the state and local levels will be more effective in battling the deadly scourge, particularly as it harms kids.

Sepsis, experts say, happens when the body is overwhelmed by infection and responds by shutting down key organs. It can lead to tissue damage, organ failure, and death. It’s difficult to predict, diagnose, and treat. As Stat, the online news service, reports:

Sepsis hospitalizes some 75,000 children and teens each year in the United States. Nearly 7,000 will die, according to one 2013 study. That’s more than three times as many annual deaths as are caused by pediatric cancers. And some of the children who survive sepsis may suffer long-term consequencesincluding organ damage and amputated limbs.

med-records-300x200In the best of all worlds, none of us will need any time soon to race to a nearby urgent care center or to pop by the retail, walk-in clinics that have sprouted in neighborhood drug stores across the country. But if you do find yourself at one of these “doc-in-a-box” clinics, here is some good advice. A lot of this applies to regular doctor visits, too.

A tip of the hat to Dr. Peter Ubel, who posted recently at Forbes and KevinMD.com, the physician information-sharing site, his suggestions of a half dozen “essentials” that patient-consumers might need to know before a retail clinic visit. He based these on positions taken by the American College of Physicians and published in the peer reviewed  Annals of Internal Medicine.

Ubel says “doc in a box” operations (retail clinics, often staffed with physician assistants or nurses) are suitable for low-level, ordinary treatment for things like poison ivy or sore throat. When patients go to these clinics, they need later to fully inform their doctors about the care they got (see the next paragraph). They shouldn’t take referrals to specialists from staff at walk-in clinics. The facilities are OK for patients who are “relatively healthy,” and who don’t have a “complex medical history,” meaning they lack chronic or difficult conditions. Patients with greater challenges need to see their own doctors, regularly if need be. Ubel calls out his colleagues, noting that if they were more responsive to their patients, or figured out alternatives when they can’t, docs in boxes wouldn’t be flourishing as they are.

emergency-services_overviewYour kid takes a tumble and breaks an arm at a sleep-over. Your spouse, on a business trip, suffers sudden chest pain and shortness of breath. You’re in beach slippers and step by accident on a shard of glass stuck in the sand. Now, you’ve got oodles of time to check your insurance policy to  find the nearest emergency room that’s covered by your insurer, right? And you’ll be asking every physician who treats you if they’re part of your network, right?  Well, no, nobody does that.

So brace yourself: a new study says that 1 in 5 Americans gets whacked after their ER visit with added charges not covered by insurers for out-of-network care. The surprise medical bills averaged $900 but ran as much as $19,000.

“To put it in very, very blunt terms: This is the health equivalent of a carjacking,” Zack Cooper, an assistant professor of health policy and economics at Yale University, commented to the New York Times. He is a co-author of the paper on surprise medical bills, published in the peer-reviewed New England Journal of Medicine.

commty care ncHospitals and health systems are making stark choices between offering models to assist their communities and reduce medical costs−or raking in profits, no matter how outrageous and shame-provoking their charges might be. Evidence of the extremes came this week in reports about alternative realities.

Let’s start with the positive view, recognizing exemplary efforts in the Charlotte, N.C.-area to both help patients and to sharply cut medical costs. Forward-looking health policy experts decided to dive into the highest Medicaid users of emergency services, discovering, for example, that just one patient, a homeless alcoholic man, visited the ER 223 times in 15 months and had undergone 150 redundant and needless X-rays or other scans. Many of the top 100 “frequent flyers,” poor and repeat ER patients, took an exceedingly costly route to fill prescriptions or to seek pregnancy or other routine tests; 86 of these individuals were known to have behavioral woes, including depression or bipolar disease. The experts found that these individuals visited multiple ERs on the same day, sometimes crossing a street or two to do so. They appeared on hot or cold days, suggesting their real need might not be medical but for shelter.

Community Care North Carolina — an umbrella group, with cooperation and support from hospitals, social workers, nurses, and social service agencies — searched out the heaviest using Medicaid-ER patients. They needed to comb the streets, jails, and even a strip club. They helped the patients find responsive primary care doctors, and other assistance, for example, in managing chronic illnesses and conditions. They connected them with social service agencies for assistance with existing housing, nutrition, jobs, and transportation programs. As the Charlotte Observer reports:

38_Special_mushrooming_side_viewA lethal epidemic is sweeping Baltimore neighborhoods, costing taxpayers millions of dollars, as well as demoralizing caregivers who struggle with its casualties daily. Researchers, tragically, are barred from developing detailed data about this scourge to try to curb its increasingly deadly harm.

Kudos to the Baltimore Sun and reporter Justin George for investigating for a year the gun violence that torments the city, sending at least 200 patients to area hospitals already just in 2016. The Sun says hospitals in the poor city have spent in five years more than $80 million caring for patients involved in gun crimes. Hospitals have seen their gunshot caseload double, and the costs of this care increase by 30 percent. Taxpayers end up footing most of the bill under Medicaid, the federal-state insurance for the poor.

The Sun’s multi-part series looks at gun violence from many aspects but the violence’s effects on the city’s health care is tragic and distressing.

ICUThe spots in hospitals where patients in the direst shape receive specialized treatment are themselves in need of urgent care, experts say, explaining that antiquated intensive care units (ICUs)

contribute to needless harm. But how exactly to yank them and the therapies they provide into the 21st century?

Usha Lee McFarling, a Pulitzer Prize winner, examines ICU reforms for the online health news site Stat, finding that these crucial and “heroic” hospital facilities fundamentally have changed little in a half century, although they now are jammed with new technology and devices. They serve almost 6 million Americans in grave condition, but in them, she says, “studies show serious and sometimes fatal medical errors are routine. And a recent review published in the journal Critical Care found no major advances in ICU care since the field’s inception in the 1960s.”

prescription-bottles (1)The federal government has issued one of its toughest warnings against the dual prescribing and use of opioid painkillers like oxycodone and hydrocodone with benzodiazepines.  Benzos are muscle relaxants and anti-anxiety meds more commonly known by brand names like Valium and Xanax.

The Food and Drug Administration said tandem prescriptions of these medications soared 41 percent between 2002 and 2014, meaning more than 2.5 million patients taking the powerful painkillers also received doctors’ orders for benzodiazepines.

“The rate of emergency department visits involving non-medical use of both drug classes increased significantly,” the FDA said, “with overdose deaths (from taking prescribed or greater than prescribed doses) involving both drug classes nearly tripling during that period.”

EPIPEN2PAK03mgpngMylan, the maker of the EpiPen, the hyper-allergy protection device, hasn’t gotten itself out of the public fire over its decision to jack up its product prices. Instead, the continuing revelations about this company, its product, and schemes is providing some blood-boiling information about the avarice and mendacity that seems almost integral to Big Pharma and its relentless push to stick it to American patient-consumers.

Journalists have surfaced more news about the role that insurers and their allies play in soaring drug prices. Yes, part of the public anger can be traced to parents struggling with high-deductible insurance plans. But new attention has focused on prescription benefit managers (PBMs), giant operations that seek to aggregate the market power of small companies, insurers, and, yes, consumers in negotiating prices with drug makers like Mylan and with providers like pharmacies. It has become critical for drug makers to get on the PBMs’ approved medication lists, for them to be allowed to provide product for distribution to their customers.

This has turned into a lucrative slice of health care, with companies like Express Scripts, CVS Caremark, and Optum Rx becoming big, influential, and profitable.

300px-EpipenMartin Shkreli, the smirking Pharma CEO, has been replaced for now as the national symbol for outrage over Big Pharma’s price gouging. Enter, stage right: Heather Bresch, a 47-year-old executive−who also happens to be the daughter of a prominent U.S. senator. Bresch has become the villainess of the moment for her firm’s jacking up the cost of a drug that millions of Americans rely on to protect them from life-threatening allergy reactions.

Mylan is her company, and it is at the heart of the public furor over the adrenaline-dispensing device known as the EpiPen. (Adrenaline and Epi or epinephrine are the same drug.) The company’s name may sound as if it were taken from a Disney  movie. But it is unclear whether there will be a happy ending to its current tale.

Will a sustained public outcry lead to real change in its business practices? Will this incident curb the ever-escalating efforts by Big Pharma to extract sky-high prices for products, some of which have been around so long the industry is far beyond recouping any research-and-development costs?

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