The persistence of low-value services

CaptureAnalysis from Health Leaders Media:

Turns out, it’s not so easy to make wise choices about healthcare. Several new studies find that, even with urging, doctors and patients are having a hard time passing on low-value services, including many identified in the Choosing Wisely campaign.  

Not that it should be a surprise. You don’t need an MD to know that change is difficult.

The specialty societies of the Choosing Wisely campaign have offered up a menu of low-value services they suggest patients can live (well) without. The trick is to convince providers and patients to abandon superfluous old-reliables and “might-as-well” tests. They waste money and can do more harm than good.

Somehow, the message isn’t getting through…

And this release today on the ACOG meeting mentioned in the story:


Breast Cancer Screening Conference Addressed Mammography Guidelines

Washington, DC – More than 50 stakeholders in women’s health convened on the 28th and 29th of January, 2016, at the headquarters of the American College of Obstetricians and Gynecologists (ACOG) to discuss recommendations on mammography for breast cancer screening. Participants reviewed current data and provided perspective on the interpretation of the data and resultant recommendations for breast cancer screening.

 

The primary issues addressed at this conference included when screening should be initiated, how frequently mammography should be performed, and if there is a point in a women’s life at which mammographic screening may no longer be beneficial. Although clearly important, other aspects of breast cancer screening – including the role of clinical breast exam and screening for high-risk women or those with dense breasts – were determined to be beyond the scope of this conference.

 

Participants in the conference included representatives from the United States Preventive Services Task Force (USPSTF), the American Cancer Society, the National Comprehensive Cancer Network (NCCN), the American College of Radiology, the American College of Surgeons, the American Academy of Family Physicians, the American College of Physicians, and ACOG. In addition, representatives from more than 22 other organizations representing women’s health care providers, radiologists, patient advocate organizations, and allied women’s health professional communities participated in the conference. Furthermore, patient representatives also provided valuable input.

 

The participants will continue the efforts at addressing breast cancer screening recommendations. It is hoped that the outcome of these conversations will help to improve informed decision-making among women and their health care providers.

 

 

 

 

 

Lown Institute seek trainees’ stories of dangerous “medical overuse”

From Lown:

The first author must be a trainee who is a professional student, intern, resident, fellow, masters or doctoral student, or post-doctoral student.logo

More here

 We are seeking clinical vignettes written by trainees that describe harm or near harm caused by medical overuse. In particular, we want to hear about medical interventions that are commonly performed and seem acceptable, rather than errors or obvious malpractice.

Applications should include a clinical vignette that provides an engaging story with pertinent clinical and historical findings. Vignettes must also include a succinct summary of the clinical issues that describes the evidence for medical overuse and suggests an alternative approach going forward.

The top two vignettes will be eligible for scholarships to participate in the fourth annual Lown Institute Conference, April 16-17, 2016 in Chicago. 

#APEC15 Emergency docs gather in Boston for annual meeting

Doctors try to get it right by listening and more #RCAW

If your doctor, nurse or anyone tending to your health seems to be giving you a little extra attention this week, he or she might be part of “RightCare Action Week.”

From Medscape:RightCareActionWeekLogo_Banner

The RightCare Alliance, … has representation from virtually all medical specialties as well as patients, patient advocates, consumer groups, community groups, business groups, and public health. The Alliance also has a specific focus on the critical evaluation of the medical evidence and promotion of evidence-based care.

A project of the Boston-based Lown Institute, the group is promoting a week-long effort that calls on providers to “take action to show patients that we have not forgotten what good medical care is. Actions can be as simple as taking a deeper social history or doing a house call.”

A bit more on the project from Health Leaders Media.

On the Brookline (Mass.) Tab website, Lown president Vikas Saini describes how that will roll out in Boston:

Everyone is fed up with the business climate in medicine that cheats patients out of the right health care and does little but bolster institutional bottom lines — all while health outcomes are poor compared to many other countries.

What can we all do about it?

The event is “a time for patients and clinicians to stand up and voice what they’d like to see their health care system become. More of the same? Or something better?…

A transformed healthcare system must be, before anything, a system that truly connects with patient needs. And we cannot make this connection if we do not listen. A listening booth is a way to publicly draw attention to the need to listen, by listening.

This week, as a part of RightCare Action Week, Lown Institute physicians will be heading out around the Boston area to set up listening booths. Tell them what you think about our healthcare delivery. They will listen.

Here is a list of their locations:


Tuesday

10 am to 12 pm – Davis Square,  park across from T station (Somerville)
2- 4 pm – Cambridge City Hall or Central Square TBA (Cambridge)
Contact person on site: Aaron Stupple, MD

 

Wednesday

10 am – 12 pm –Andrew Square, park across from T station (South Boston)
2-4pm    Boston Common (can you list across from ….?)
Contact person on site: Vikas Saini, MD

 

THURSDAY

10 am – 12pm 510 Broadway Chelsea – park across from City Hall (Chelsea)
2- 4pm –    421 Broadway, Everett – park in front of library (Everett)
Contact person on site: Aaron Stupple, MD

FRIDAY

10 am – 12pm – Jamaica Plain (TBD) Check back for updates
2-4pm Dorchester/Mattapan – location TBD
Contact person on site: Vikas Saini, MD

Or, go online to Tell your story .

 

 

 

Nurses and nursing homes: Watchdog health reporting at the Globe

CaptureHow evil is it to charge people for Alzheimer’s care and not deliver it? How dangerous is it for people to go around saying they’re licensed nurses when they are not?

CaptureStuff like this is hard to track because, last we checked, the people in charge of records like these were not real helpful.  Liberal Massachusetts is known for its strict public records laws.

Kay Lazar of the Globe had this yesterday:

State regulators are citing more than four dozen Massachusetts nursing homes for advertising dementia care services when they don’t actually offer the kind of care required to make such a claim, according to the Department of Public Health.

and Felice Freyer had this Sunday, with a follow up Monday:

Massachusetts regulators revoked or suspended the professional licenses of 13 nurses after discovering recently that the health care workers lied about having nursing degrees or being licensed in other states, health department documents show.

The action sparked questions about the background checks state regulators rely on to issue licenses to thousands of nurses and applicants in 10 other health fields, including pharmacists, psychologists, podiatrists, and optometrists.

My latest from Health Leaders: disparities, quality & TripleAim

by Nora Valdez. Click for more.

by Nora Valdez. Click for more.

Fueled by the financial incentives built into the healthcare reform law, the Institute for Health Improvement’s concept is generating meaningful changes in the way healthcare is delivered, research finds.

Value-based care brings new urgency to the effort to end disparities in healthcare access and outcomes for minorities.

Is female Viagra a scam? Boston women’s health group questions drug, supporters

indexThe non-profits pressuring the FDA to approve a drug billed as female Viagra do not quite make up a top ten list or women’s health advocacy organizations. This health writer has never heard of most of the groups cited in Sunday’s New York Times story.

But familiar women’s health groups, like Boston’s Our Bodies, Ourselves, are siding with the FDA on this one. From their response to an earlier review of the drug.

imagesWomen taking the drug had less than one additional “sexually satisfying event” (orgasm not required) than women taking a placebo. And in the meantime, the drug caused dizziness, nausea and fatigue, particularly with long-term daily use, in some women — hardly the recipe for sexual excitement.

The FDA also considered whether the drug had increased women’s desire — a crucial element of the HSDD diagnosis, which involves low or no sexual interest to the point of distress in people who are physically healthy and not depressed — and found that the drug failed in this area.

The FDA takes another look — and offers  a live webcast of the deliberations —  on Thursday.

In it’s report on the 2010 FDA rejection of the drug, the OBOS  website notes another Bay State-based critic of the drug:

According to Julia Johnson, the panel’s chairwoman and head of the department of obstetrics and gynecology at the University of Massachusetts Medical School, the impact of the drug flibanserin … was “not robust enough to justify the risks.”

More here from another independent, feminist women’s health group, The National Women’s Health Network:

Members of the campaign called “Even the Score” are challenging the FDA on what they claim is a perpetuation of a gender bias by virtue of the claim that the FDA is holding drugs that treat women’s sexual problem to a higher standard than those for erectile dysfunction.  Even the Score has engaged prominent women’s rights organizations, health care providers, the media and members of Congress in a public relations misinformation campaign to criticize the FDA.  There are Female Sexual Dysfunction drugs currently under FDA review, and Even the Score is attempting to move the discussion away from the safety and effectiveness of these drugs and towards controversy about gender bias. 

The reality is that no amount of public relations or slick marketing can get around the fact that the drugs currently being proposed for Female Sexual Dysfunction simply don’t work and may be quite dangerous. Poor efficacy, a strong placebo effect, and valid safety concerns have plagued all of the drugs that have been tested so far. There are many reasons why the proposed drugs may not have been effective in increasing women’s sexual enjoyment; chief among them is the heterogeneity of female sexuality and, of course, research demonstrating that sexual problems are mostly shaped by interpersonal, psychological, and social factors. Nevertheless, pharmaceutical executives will continue to drum up hype over the possibility of a “pink Viagra” because the profit market for this type of drug is estimated to be over $2 billion a year.

Note that neither of these groups accept funding from the pharmaceutical industry. Even the score supporter include Sprout, the company seeking approval for the drug and Trimel Pharmaceuticals, a company testing a nasal testosterone gel for “female orgasmic disorder.”

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