Kim’s public health blog

The AP reports that a study, “conducted by the Lewin Group consultants,” puts the total financial costs for diabetes “at $218 billion last year — the first comprehensive estimate of the financial toll diabetes takes.” The Lewin Group “figure includes direct medical care costs, from insulin and pills for controlling patients’ blood sugar to amputations and hospitalizations, plus indirect costs such as lost productivity, disability and early retirement.” The figure “amounts to about 10 percent of all U.S. healthcare spending by government and the public, about $2.1 trillion in 2006, and nearly half the $448.5 billion cost of heart disease and stroke.” In addition, “the new study adds estimates for people who haven’t been diagnosed yet ($18 billion), women who develop diabetes temporarily during pregnancy ($636 million) and those on track to develop diabetes, an increasingly common condition called pre-diabetes ($25 billion).”

CNN reports that almost “half the respondents in a survey of U.S. primary care physicians said that they would seriously consider getting out of the medical business within the next three years if they had an alternative.” After sending “questionnaires to more than 150,000 doctors nationwide,” of which 12,000 responded, the Physicians’ Foundation also discovered that “many said they are overwhelmed with their practices, not because they have too many patients, but because there’s too much red tape generated from insurance companies and government agencies.” If such predictions eventually manifest, it “could be devastating to the healthcare industry,” as a “U.S. shortage of 35,000 to 40,000 primary care physicians by 2025 was predicted at last week’s American Medical Association annual meeting.”
Comment: This issue keeps showing up but there is no move by the medical schools and accrediting agencies to start the process needed to solve this problem.

Published in “Health Affairs” this week, a study sponsored by the Commonwealth Fund finds that chronically ill adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States show major differences among countries in access, safety, and care efficiency. U.S. patients were at particularly high risk of forgoing care because of costs and of experiencing inefficient, poorly organized care, or errors. The Dutch, who have a strong primary care infrastructure, report notably positive access and coordination experiences. Still, deficits in care management during hospital discharge or when seeing multiple doctors occurred in all countries. Findings highlight the need for system innovations to improve outcomes for patients with complex chronic conditions. [Health Affairs 28, no. 1 (2009): w1-w16 (published online 13 November 2008; 10.1377/hlthaff.28.1.w1)]

In a study just published by the American Physiological Society, young and healthy African-American men have higher central blood pressure and their blood vessels are stiffer compared to their white counterparts, signs that the African American men are developing hypertension early and with little outward sign. The findings suggest that high blood pressure may be developing undetected in young African-American men and that measuring central blood pressure may be a better means of detecting the problem as it develops.

This week’s the New England Journal of Medicine has a wonderful set of articles, viewable without a subscription, that suggest ways to fix the nation’s infrastructure based on the ecology of primary care, and the epidemiology of the major diseases that present to primary care physicians; as the problems besetting us have changed from acute infections of the young  to chronic diseases of the aged. The Editorials are accompanied by an excellent video where 5 recognized leaders discuss the US medical and health  care systems.

An estimated 19.8 percent of U.S. adults (43.4 million people), were current smokers in 2007, down from 20.8 percent in 2006, according to a study in CDC′s Morbidity and Mortality Weekly Report, released in advance of the Great American Smokeout. However, based on the current rate of decline, it is unlikely that the national health objective of reducing the prevalence of adult cigarette smoking to 12 percent or lower will be met by 2010. Comment: Not an impressive reduction.

National Institutes of Health analyzed results from the annual HealthStyles survey of American public health attitudes. The fourth leading cause of death in the United States, COPD is a serious lung disease affecting an estimated 24 million Americans. More than 12 million people are currently diagnosed with COPD and another 12 million may have COPD but remain undiagnosed despite recognizable symptoms. COPD typically affects people over 45, especially those who smoke or have smoked, and those with risk factors associated with genetics or environmental exposures. Smoking is attributed to as many as 9 out of ten COPD-related deaths, yet most survey respondents — 66 percent — did not recognize smoking as a risk factor. This was especially true among the current smokers surveyed. Just 22 percent recognized that their smoking puts them at greater risk for COPD.

A new UCLA School of Nursing study is the first to reveal the devastating consequences of smoking on the nursing profession. The Nurses’ Health Study (237,648 female registered nurses) is the largest study of women’s health in the world. “From a workforce perspective, however, the findings also hold a mirror up to the well-being of nurses, the largest group of health care professionals in the country.” “Quitting smoking made a big difference in enhancing longevity, especially among nurses in their late 70s. “Death rates among former smokers that age were 1.5 times higher than those of non-smokers, while current smokers were 2.3 times more likely to have died by that age than nurses who never smoked.” According to the most recent data, the smoking rate among registered nurses nationwide is nearly 12 percent.

“Medicare beneficiaries with heart failure have many more doctor visits and take more medications than those without heart failure,” according to a study presented at the American Heart Association’s annual scientific sessions. Professor Robert Page, of the University of Colorado, and colleagues, analyzed “data on 173,000 Medicare beneficiaries. The overall average age of the beneficiaries was 70.7 years, while the average age for those with heart failure was between 76 and 77 years.” The researchers found that “patients with severe heart failure saw an average of 23 different Medicare providers a year, compared with about 7.9 providers for typical Medicare beneficiaries.” The authors calculated that, for “2005, beneficiaries with heart failure accounted for 37 percent of all Medicare spending, and almost 50 percent of all hospital inpatient costs.”

There is one born every minute: the U.S. Food and Drug Administration is warning consumers about a fraudulent scheme to extort money from consumers by callers who falsely identify themselves as “FDA special agents” or other FDA officials. Several instances have been reported to the FDA of calls enticing consumers to purchase discounted prescription drugs by wiring funds to one of several locations in the Dominican Republic. No medications are ever delivered.