This study, while not the best, or even using the good research methods, it still points out the inadequacies in our medical system. It does give us an inkling of how badly the children with diabetes in many geographical areas are needing care. It is small wonder that there are not more problems.
This is a common case throughout the US. In rural areas, there is a shortage of doctors and many people are forced to travel 50 to 150 miles (or more) one way to be seen by a doctor. Then finding a doctor or endocrinologist for children with diabetes can even be more difficult.
The study determined that there are approximately one million children in the US that live in areas with no local physician. What is shocking is that about one fifth of the US child population live in areas with more than 4400 children per child physician while another one fifth live in areas with less than 710 children per child physician.
This study has some limitations which raises some serious questions in the reliability of the data. Among these are the sources of data and mention nothing about physician assistants and nurse practitioners. They also did not evaluate insurance status and cultural disparities.
There are some measures that can help level the deficiencies, but they will take some careful study and considerations. This must be done to avoid greater health care inequities. The study authors suggest using accountability of of public funds that support medical training to encourage policies to reduce the disparities in physician distribution.
This is indeed a problem in many rural areas. The study indicates this is a problem in nearly all 50 states and needs to be addressed. With the projected increase in diabetes numbers, this is a problem that is not going away and could only get worse. Consider making this an issue with your congressional representatives and senators.
Read the article here.
01 January 2011
31 December 2010
Fragmentation Happens Across Multiple Care Facilities
Are you a person that moves from medical facility to medical facility for your treatments. Or do you know someone that does this. Many go from doctor to doctor or hospital emergency room to hospital emergency room. Well it is a known fact that you may not receive the best care following this habit.
Now a study shows that this can do damage as well. Not only are more younger patients doing this, but more of these people are young men. These were also more likely to have psychiatric diagnosis, more likely to be hospitalized, and had higher health care costs.
The study was done in Massachusetts from October 1, 2002, to September 30, 2007. During the study, there were 12,758,498 acute care visits made by 3,692,178 adult patients. Interesting to note that five or more hospitals were used by 43794 patients (one percent) and they accounted for neatly one tenth of all acute care visits.
The study authors advise clinicians to be aware of the level of fragmentation in acute care. They should also be especially attentive to the unintended outcomes of incomplete medical information and prior dispersed medical care.
More attempts need to be made to reconcile medical information from various sites of care for each patient and to consider integrated patient care. Possible solutions might be medical homes and establishment of comprehensive care networks to improve the quality of care.
The fragmentation of medical care can be a problem for those giving care and is often caused by those receiving care. Yes, we have the right to seek second opinions, but this is often taken by patients who are not happy with the diagnosis and are looking for the magic cure-all. I am not sure why this is always necessary, but I have known individuals in the past that seek care where ever their insurance will allow, and even across state lines.
Most often they end up with care that is less than desirable. Read the article here.
Now a study shows that this can do damage as well. Not only are more younger patients doing this, but more of these people are young men. These were also more likely to have psychiatric diagnosis, more likely to be hospitalized, and had higher health care costs.
The study was done in Massachusetts from October 1, 2002, to September 30, 2007. During the study, there were 12,758,498 acute care visits made by 3,692,178 adult patients. Interesting to note that five or more hospitals were used by 43794 patients (one percent) and they accounted for neatly one tenth of all acute care visits.
The study authors advise clinicians to be aware of the level of fragmentation in acute care. They should also be especially attentive to the unintended outcomes of incomplete medical information and prior dispersed medical care.
More attempts need to be made to reconcile medical information from various sites of care for each patient and to consider integrated patient care. Possible solutions might be medical homes and establishment of comprehensive care networks to improve the quality of care.
The fragmentation of medical care can be a problem for those giving care and is often caused by those receiving care. Yes, we have the right to seek second opinions, but this is often taken by patients who are not happy with the diagnosis and are looking for the magic cure-all. I am not sure why this is always necessary, but I have known individuals in the past that seek care where ever their insurance will allow, and even across state lines.
Most often they end up with care that is less than desirable. Read the article here.
30 December 2010
Will I Allow Spam?
The issue finally reared it ugly head on a recent post here. I have seen other bloggers allow some of the advertisements that appear this way. While it is not something that I like, I will continue to have comments monitored for this reason. I will delete spam.
I will admit that this was for products fitting the blog, I am having a hard time convincing myself that I should allow these. To begin with, the reason I wrote the blog was to let people know that this is not a cure for diabetes, Type 2, as some are claiming for bariatric surgery.
To me they are promoting this as a way to have more people do unnecessary surgery to bring in more money for surgeons and referring doctors. Many people go this route as an easy way to lose weight rather than following a strict regimen of exercise and nutrition. What many don't realize is that bariatric surgery requires an even more strict nutritional diet to gain the benefits and if they go off this, there are severe consequences to pay health-wise.
So for the future, I will closely monitor comments to prevent spam. I will weigh the posts for positive support, but I haven't seen any yet that qualify for this. Personal comments are still welcome. I have not had any that I felt compelled to delete other than spam.
And then again, I was not aware of how slick some of these people can be. I actually thought someone wanted to carry on a discussion about homeopathy, but it was all a rouse to spout their homeopathic religion. I had to delete the posts after I realized the purpose. The person was not interested in any discussion, only to spout the homeopathic way and none of the disadvantages. This is a type of spam and I will not allow it.
I will admit that this was for products fitting the blog, I am having a hard time convincing myself that I should allow these. To begin with, the reason I wrote the blog was to let people know that this is not a cure for diabetes, Type 2, as some are claiming for bariatric surgery.
To me they are promoting this as a way to have more people do unnecessary surgery to bring in more money for surgeons and referring doctors. Many people go this route as an easy way to lose weight rather than following a strict regimen of exercise and nutrition. What many don't realize is that bariatric surgery requires an even more strict nutritional diet to gain the benefits and if they go off this, there are severe consequences to pay health-wise.
So for the future, I will closely monitor comments to prevent spam. I will weigh the posts for positive support, but I haven't seen any yet that qualify for this. Personal comments are still welcome. I have not had any that I felt compelled to delete other than spam.
And then again, I was not aware of how slick some of these people can be. I actually thought someone wanted to carry on a discussion about homeopathy, but it was all a rouse to spout their homeopathic religion. I had to delete the posts after I realized the purpose. The person was not interested in any discussion, only to spout the homeopathic way and none of the disadvantages. This is a type of spam and I will not allow it.
29 December 2010
Is Medicare Going to Remain Viable?
This is starting to bother me in so many undefined ways. I must ask some questions. Has your doctor started to spread out your appointments? Is your doctor only seeing you once a year. Have you wondered why? Or has you doctor said you won't be rescheduled?
If you have read a few of my earlier blogs, you might have an idea. Yes, now I can say based on my own experience that our government is slowly making Medicare a problem and leaving its senior citizens to wander aimlessly without medical help. Many will have too much income to qualify for Medicaid and with Medicare decreasing the reimbursement to doctors, many of us senior citizens will not have a doctor to see in a year or two. And in these economic times, many states are having trouble meeting their expenses for Medicaid.
My primary care doctor is reducing my visits, as is my endocrinologist, and heart doctor. Some of the doctors I do not need to see but occasionally, which is fine by me. However, when a doctor says s/he is reducing the number of visits by one fourth, one third, or a half, you do need to be concerned.
Some doctors are putting signs up that they will no longer see Medicare patients. I have only seen one of these in a city about two hour's distance. I have talked to friends and acquaintances that are being turned away by doctors. Some are just starting Medicare on January first and they are being told that they must find another doctor because at December 31, they will no longer be served by the current office.
A few doctors are posting signs that they will take no new Medicare patients, but will work with those they have presently. How far this goes is going to depend on the new congress and what is funded or unfunded in the Affordable Care Act. A larger factor is going to be how the rules and regulations are handed down about the Accountable Care Organizations (ACOs).
This is going to be very interesting as this is mandated, but not precisely defined by the law. ACOs are to be affiliations of health care providers that are held jointly accountable for achieving improvements in quality of care with reductions in spending. The ideas that have been bouncing around are varied. Some will be cumbersome, while others will create legal headaches. This may be a topic for a future blog.
Prior blogs of mine that are related in nature - blog 1, blog 2, blog 3.
If you have read a few of my earlier blogs, you might have an idea. Yes, now I can say based on my own experience that our government is slowly making Medicare a problem and leaving its senior citizens to wander aimlessly without medical help. Many will have too much income to qualify for Medicaid and with Medicare decreasing the reimbursement to doctors, many of us senior citizens will not have a doctor to see in a year or two. And in these economic times, many states are having trouble meeting their expenses for Medicaid.
My primary care doctor is reducing my visits, as is my endocrinologist, and heart doctor. Some of the doctors I do not need to see but occasionally, which is fine by me. However, when a doctor says s/he is reducing the number of visits by one fourth, one third, or a half, you do need to be concerned.
Some doctors are putting signs up that they will no longer see Medicare patients. I have only seen one of these in a city about two hour's distance. I have talked to friends and acquaintances that are being turned away by doctors. Some are just starting Medicare on January first and they are being told that they must find another doctor because at December 31, they will no longer be served by the current office.
A few doctors are posting signs that they will take no new Medicare patients, but will work with those they have presently. How far this goes is going to depend on the new congress and what is funded or unfunded in the Affordable Care Act. A larger factor is going to be how the rules and regulations are handed down about the Accountable Care Organizations (ACOs).
This is going to be very interesting as this is mandated, but not precisely defined by the law. ACOs are to be affiliations of health care providers that are held jointly accountable for achieving improvements in quality of care with reductions in spending. The ideas that have been bouncing around are varied. Some will be cumbersome, while others will create legal headaches. This may be a topic for a future blog.
Prior blogs of mine that are related in nature - blog 1, blog 2, blog 3.
28 December 2010
Drug Companies are Costing Health Care Billions
This is interesting because it is coming from the British, specifically the British Medical Journal and the British Media. They are taking the drug industry, Big Pharma to us, to task for a campaign promoting the more expensive types of insulins. These analogue insulins for people with Type 2 diabetes are costing the British National Health Service about $390 million extra over the past five years.
They are also stating the the extra cost does not translate into equivalent benefits. They have determined that the five times of the cost when compared to conventional insulins and that published evidence did not improve glucose control or safety in Type 2 diabetes.
Even the World Health Organization is raising concerns about the more expensive analogue insulins displacing proven insulins and the way the insulin manufacturers are not producing the cheaper human insulins. With no proven cost effectiveness the companies are pushing the more expensive insulins.
In the UK analogues have about 80 percent of the market, in the USA about 70 percent, and in Europe about 60 percent of the insulin market. The two dominate analogues are detemir (Levemir) and glargine (Lantus).
So world wide, the total extra costs could be in the billions that are flowing into Big Pharma's coffers. On December 30, Nova Nordisk will end the manufacture and distribution of Mixtard 30, a well tolerated human insulin. Others will follow in removing good, cheaper insulins from the market.
This is a case of Big Pharma promotions and glitzy marketing strategies, plus the push to increase the size of profit margins at the expense of diabetes patients or taxpayers paying the costs in government health care plans. Those in the US will be forced to pay the higher costs of medical health insurance.
Read the article here.
They are also stating the the extra cost does not translate into equivalent benefits. They have determined that the five times of the cost when compared to conventional insulins and that published evidence did not improve glucose control or safety in Type 2 diabetes.
Even the World Health Organization is raising concerns about the more expensive analogue insulins displacing proven insulins and the way the insulin manufacturers are not producing the cheaper human insulins. With no proven cost effectiveness the companies are pushing the more expensive insulins.
In the UK analogues have about 80 percent of the market, in the USA about 70 percent, and in Europe about 60 percent of the insulin market. The two dominate analogues are detemir (Levemir) and glargine (Lantus).
So world wide, the total extra costs could be in the billions that are flowing into Big Pharma's coffers. On December 30, Nova Nordisk will end the manufacture and distribution of Mixtard 30, a well tolerated human insulin. Others will follow in removing good, cheaper insulins from the market.
This is a case of Big Pharma promotions and glitzy marketing strategies, plus the push to increase the size of profit margins at the expense of diabetes patients or taxpayers paying the costs in government health care plans. Those in the US will be forced to pay the higher costs of medical health insurance.
Read the article here.
27 December 2010
New Way to Control Blood Sugar Levels?
Normally I dislike writing about topics in the development stage. This topic is an exception for me. It is not quite the breakthrough on a cure level, but may have implications of importance for future treatment of Type 2 diabetes.
There are still unanswered questions about the level of pancreas output of insulin and whether this will be for the very early diagnosed only or will have factor in any treatment of those who already have reduced insulin capabilities. This should still be of interest to everyone in the Type 2 community.
They have discovered a protein that is present on the cells that release insulin and this protein has to be active. The protein named M3-muscarinic receptor is not only active, but must undergo a specific change to trigger insulin release for the control of blood sugar. They are testing to see if this change is one of the mechanisms disrupted in diabetes.
Read the article here.
There are still unanswered questions about the level of pancreas output of insulin and whether this will be for the very early diagnosed only or will have factor in any treatment of those who already have reduced insulin capabilities. This should still be of interest to everyone in the Type 2 community.
They have discovered a protein that is present on the cells that release insulin and this protein has to be active. The protein named M3-muscarinic receptor is not only active, but must undergo a specific change to trigger insulin release for the control of blood sugar. They are testing to see if this change is one of the mechanisms disrupted in diabetes.
Read the article here.
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