Empowered Patient: Top tips for 2010

Here's an excellent article to get you started towards empowering yourself for the new year:

The top ways to empower yourself and take your health care into your hands this year

http://rss.cnn.com/~r/rss/cnn_health/~3/uSyw4UWdILY/index.html
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Mortality Impact of Obesity Said To Be Underestimated

Obesity may have an even greater impact on mortality than anticipated, according to a new method of adjusting for confounding.

http://www.medpagetoday.com/PrimaryCare/Obesity/17690

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5 tips for getting what you need from your doctor

This is a great article. Doctors definitely need to learn how to be better communicators.

I tell all my patients to bring with them a list of all the medicines they take. I tell them to please write down questions prior to our visit. I give them paper to takes notes during our visit. I try and provide them with a list of websites I have visited that I think provides good quality info (see my blog for a list of these sites).

Here's the article:

"Doctors are often rushed, so patients must come to appointments prepared. Learn five steps to having a successful doctor appointment."

http://rss.cnn.com/~r/rss/cnn_health/~3/J655gMaI74M/index.html

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Strongest evidence yet that Lp(a) causes heart disease

Please do not forget that there is a overwhelming amount of data supporting lowering LDL as the most important marker for primary and secondary prevention of cardiac disease.

Research on sub-lipid particles, like LP(a), will be useful to measure to help reduce patients "residual risk", once LDL is < 70mg/dL.

"A novel genetic study provides the strongest evidence to date that Lp(a) is a causative factor for coronary disease; the results suggest that medications targeting Lp(a) could lower the risk of..."

For complete story visit theheart.org.

http://feedproxy.google.com/~r/Theheartorg/~3/hUUOufRwL5U/1036877.do
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How medication mistakes happen in the hospital

What a great idea -- give patients a list of their medications not only at discharge but everyday while in the hospital!

Originally published in MedPage Today

by Katrina Woznicki, MedPage Today Contributing Writer

Hospitalized patients were often clueless when asked about their medications, with almost all of them unable to name all their medications and many leaving out as many as a half-dozen drugs they have been prescribed, according to a small survey of patients in a Colorado hospital.

Ninety-six percent of the 50 patients surveyed left out at least one drug when they were asked to list their medications, and, on average, patients omitted 6.8 medications, Ethan Cumbler, MD, of the University of Denver, and colleagues reported in the Dec. 10 issue of Journal of Hospital Medicine.

Moreover, 44% of the patients thought they were taking a medication that had not been prescribed.

The researchers conducted the patient survey as part of a larger project examining a potential role for patients in reducing medication errors and improving patient safety.

"This study is a first for raising the questions How involved should patients be in their hospital medication safety?' and How do you involve them?'" Cumbler told MedPage Today.

"We don't live in a perfect healthcare system and errors do occur. If you have a patient who wants to be involved in their medication safety, you have to let him or her know what they're taking and to let them be an active participant."

Among scheduled medications, patients commonly omitted several important therapeutics, including antibiotics, cardiovascular drugs, and antithrombotics.

When asked about PRN medications, patients were most likely to omit analgesics and gastrointestinal medications.

"The patient, as the last link in the medication administration chain, represents the final individual capable of preventing an incorrect medication administration," Cumbler et al wrote in the journal article.

But if the survey reflects the average hospital patient, this is a weak link.

The majority of the participants, 81%, said seeing a hospital medication list would improve their satisfaction with the care they received; however, only 28% reported that they saw such a list.

A total of 50 participants answered questions about their outpatient and inpatient medications and described their attitudes about hospital medications and level of interest in patient involvement in hospital safety.

The findings, Cumbler added, only provide a snapshot of one small group of inpatients at one hospital.

The average age of participants was 54, 46% were men, and 74% were non-Hispanic white.

Patients were on an average of 5.3 outpatient prescription medications, 2.2 over-the-counter medications, and 0.2 herbal remedies.

Age did prove to be a factor in patients' ability to accurately identify their hospital medications. Patients age 65 and younger omitted 60% of their PRN medications, whereas patients 65 and older failed to report 88% (P=0.01).

Hospital organizational culture and the complexity of medicine itself pose challenges for inpatients to keep track of their medications, said Ruth S. Day, PhD, Director of the Medical Cognition Laboratory and Associate Professor of Psychology and Neuroscience at Duke University, who was not involved in the study.

"People have trouble perceiving, pronouncing, and remembering medication names even under the best of circumstances," Day said in an interview.

Protocols for outpatient medication monitoring have garnered a lot of attention, added Derung Mimi Tarn, MD, PhD, Assistant Professor of Family Medicine at the University of California at Los Angeles Medical Center, who was not a part of the study.

However, there has been very little focus on the inpatient setting, and it is not routine to give patients medication lists in the hospital. The issue, Tarn said in an interview, warrants further investigation.

Moreover, whether patients could even be effective at reducing hospital medication errors is uncertain.

Patients with dementia or delirium or those in the ICU may not prove helpful in ensuring hospital medication safety, said Tang. "However, there are definitely patients in the hospital who could serve as a valuable stopgap for example, obstetrics patients and parents of pediatric patients," she said. "The level of patient participation would need to be individually based."

Cumbler agreed that "one solution will not work for all," and that approaches to inform inpatients may have to be customized depending on factors such as condition and age.

The study, he added, was only designed to assess whether patients were informed about their hospital medications and whether they were interested and prepared to be more active participants in their care.

Visit MedPageToday.com for more hospital news.

Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.
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http://www.kevinmd.com/blog/2009/12/medication-mistakes-happen-hospital.html

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Letter to me From Senator Dodd

Dear Friend, Thank you for contacting my office. My staff and I are reviewing your e-mail and will get back to you shortly. In the meantime, please sign up for the Dodd Digest, my e-newsletter. I'll be e-mailing these updates to let you know about the work I'm doing on behalf of our state and our nation. Please go to my website, Dodd.Senate.Gov, to sign up. You'll be hearing from me soon. Chris- Please note, due to the high volume of mail I receive, I am only able to respond to residents of Connecticut.

Letter to me from Senator Lieberman

Dear Dr. Portnay:

Thank you for contacting me regarding your concerns about decreased Medicare payments to physicians and other providers of Medicare services. I, too, am very concerned about a viable long-term solution to the payment formula and have taken numerous actions in the Senate to achieve this. Fair payments to physicians and other health care providers are critical to preserving access for more than 44 million American senior citizens who depend on the Medicare program for their essential health services.

I understand and share your views that the rising costs attributable to physicians' services must be taken into consideration when determining Medicare reimbursement. As you know, Medicare law specifies a formula for calculating the annual update in payments for physicians' services. Many Members of Congress, myself included, continue to be concerned about the potential impact of payment reductions on patients' access to services. During my time in the Senate, I supported a number of efforts to examine Medicare updates for payments under the physician fee schedule, as well as legislation designed to undo any impending Medicare cuts to physicians, hospitals, nursing homes, home health care agencies, and other health care providers; and I will continue to do so.

While legislative interventions have prevented payment reductions from occurring in the past, Congress has not addressed the underlying issue of the payment formula accurately reflecting practice costs. Because of my continued concerns about ensuring sufficient payments to physicians, last Congress I sent letters to the Administrator of the Centers for Medicare and Medicaid Services in support of a viable solution to the Medicare physician reimbursement formula and asked congressional leadership to bring legislation to the floor to stop impending cuts and find a long-term solution to the issue. I understand these cuts in physician payments for Medicare services are unsustainable, especially given the rising costs of health care services; and I made my concerns known to those who serve on the Senate Finance Committee as they worked to craft physician payment legislation. In addition, I was supportive of legislative efforts to pass a two-year payment fix so that Congress would not have to repeat this process every year and physicians would have stability in payments beyond one calendar year.

Medicare payment policies and potential changes to these policies are of continuing interest to Congress. The Medicare program has been a major focus of deficit reduction legislation since 1980. With certain exceptions, reductions in program spending have been achieved largely through regulating payments to providers, primarily hospitals and physicians.

Although the task confronting Congress in rectifying the Medicare physician payment formula is formidable, it is one to which I remain committed to finding a more lasting solution. Any actions the Administration can take to more accurately account for the realities of spending on practitioner services under this formula, both as to actual spending and target spending, will help facilitate Congress' efforts and enhance access to the high-quality care that Medicare patients need and deserve.

Please be assured that I remain firmly committed to restoring adequate funding to Medicare physician and patient services during this 111th Congress and beyond. As we debate comprehensive health care reform policy, this issue is critical toward ensuring the ability of providers to deliver high-quality care and services and for Medicare beneficiaries to continue to access essential health care services.

Thank you again for sharing your views and concerns with me. I hope you will continue to visit my website at http://lieberman.senate.gov <http://lieberman.senate.gov/> for updated news about my work on behalf of Connecticut and the nation. Please contact me if you have any additional questions or comments about our work in Congress.

Sincerely,

Joseph I. Lieberman
UNITED STATES SENATOR
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