Primary care telemonitoring to support diabetes management

From the Agency for Healthcare Research & Quality (AHRQ):

According to a new study supported by the Agency for Healthcare Research and Quality (AHRQ), adding telemonitoring to the routine care diabetes patients receive did not significantly change outcomes. “Effect of home telemonitoring on glycemic and blood pressure control in primary care clinic patients with diabetes,” appeared online January 3 in Telemedicine and e-health. Researchers compared 53 people who received routine care with 55 people who got routine care plus telemonitoring. After 12 weeks of care, hemoglobin A1c (A1c) and blood pressure levels were not significantly different between the two groups. The study findings suggest that the addition of technology alone is unlikely to lead to improvements in outcomes and that telemonitoring of patients should be limited to those who have a significant change to their care plan. More research is needed to determine how primary care practices can effectively use telemonitoring to support patient’s abilities to manage diabetes.

Read the abstract at PubMed.

For mothers-to-be, finding health care in a group

From the Fixes Blog at the New York Times:

Recently in a nondescript conference room near Union Square in Manhattan, eight very pregnant women, husbands, boyfriends and a sister sat in a circle around a small patchwork quilt for two hours and talked about managing the discomforts of pregnancy.

The remedies discussed ranged from the ultimate — epidural: yes or no? — to the prosaic, including that cliché of pregnancy: “I don’t get acid reflux if I have a pickle,” said a woman named Kimberly, to general laughter. “I have two pickles right before bed and it’s fine.”

They drank seltzer and ate strawberries, bananas, hummus and carrots and cereal bars. They watched videos about labor pain and interviewed doulas. The meeting looked like a social gathering or a support group.

It did not look like what it was: a doctor’s appointment.

The Institute for Family Health runs the group, using a model created by the Centering Healthcare Institute. Centering Pregnancy sites provide group medical visits for pregnant women; Centering Parenting sites gather new mothers and their babies for the first year of life.

When they arrived, one by one the patients rotated through stations to get their regular prenatal checkups. They took their own blood pressure, weighed themselves, stretched out on a cot behind a screen so Dr. Insung Min could listen to the baby’s heartbeat, and sat with Dr. Rachel Rosenberg (no relation) in another corner for the traditional chat with the doctor. The usual checkups, however, are only part of the health care the group provides. Being part of a community, the research shows, is also good medicine.

The idea behind Centering (the name refers to care that is centered on the patient) is to help mothers — especially low-income mothers — become more involved in their own care, to acquire the skills and confidence to take care of themselves and their babies, and to have a community.

Read more here.

Sugar-sweetened beverages playbook

One of the 4 legal tools discussed in the current issue of the CDC’s Public Health Law News, is a Sugar-sweetened beverages playbook from ChangeLab.  The playbook offers a sequence of ten strategies—from public education campaigns to restrictions on the availability of sugar-sweetened beverages—communities and states can use to reduce consumption of SSBs. Find more information and download a poster and the playbook.

Sports-Related Concussions in Youth

New from the National Academies Press:

In the past decade, few subjects at the intersection of medicine and sports have generated as much public interest as sports-related concussions – especially among youth. Despite growing awareness of sports-related concussions and campaigns to educate athletes, coaches, physicians, and parents of young athletes about concussion recognition and management, confusion and controversy persist in many areas. Currently, diagnosis is based primarily on the symptoms reported by the individual rather than on objective diagnostic markers, and there is little empirical evidence for the optimal degree and duration of physical rest needed to promote recovery or the best timing and approach for returning to full physical activity.

Sports-Related Concussions in Youth: Improving the Science, Changing the Culture reviews the science of sports-related concussions in youth from elementary school through young adulthood, as well as in military personnel and their dependents. This report recommends actions that can be taken by a range of audiences – including research funding agencies, legislatures, state and school superintendents and athletic directors, military organizations, and equipment manufacturers, as well as youth who participate in sports and their parents – to improve what is known about concussions and to reduce their occurrence. Sports-Related Concussions in Youth finds that while some studies provide useful information, much remains unknown about the extent of concussions in youth; how to diagnose, manage, and prevent concussions; and the short- and long-term consequences of concussions as well as repetitive head impacts that do not result in concussion symptoms.

For more information & to read the free PDF, go to the NAP website.

Educating the Student Body: Taking Physical Activity and Physical Education to School

New from The National Academies Press:

Physical inactivity is a key determinant of health across the lifespan. A lack of activity increases the risk of heart disease, colon and breast cancer, diabetes mellitus, hypertension, osteoporosis, anxiety and depression and others diseases. Emerging literature has suggested that in terms of mortality, the global population health burden of physical inactivity approaches that of cigarette smoking. The prevalence and substantial disease risk associated with physical inactivity has been described as a pandemic.

Educating the Student Body makes recommendations about approaches for strengthening and improving programs and policies for physical activity and physical education in the school environment. This report lays out a set of guiding principles to guide its work on these tasks. These included: recognizing the benefits of instilling life-long physical activity habits in children; the value of using systems thinking in improving physical activity and physical education in the school environment; the recognition of current disparities in opportunities and the need to achieve equity in physical activity and physical education; the importance of considering all types of school environments; the need to take into consideration the diversity of students as recommendations are developed.

From more information & to read the free PDF, go to the NAP website.

Chats on change: Using social media to reduce childhood obesity

From the Agency for Healthcare Research & Quality (AHRQ):

Join us on Twitter Tuesday, September 10, at 3:00 pm ET for a live TweetChat with Dr. Victoria Rogers, Director of the Kids CO-OP at the Barbara Bush Children’s Hospital at Maine Medical Center. We will discuss how the Let’s Go! program has worked to slow the increase of childhood obesity in Maine and how the program can be adapted by other providers in different settings across the country.

Use the #AHRQIX hashtag to join.

For more information, click here.

Culturally appropriate care and health education

AHRQ_InnovationsExFrom the AHRQ Health Innovations Exchange from August 14:

  • The featured Innovations describe three programs that provided culturally and linguistically appropriate health care and education to specific target populations. The programs include one that delivered a community-based, culturally tailored education program to low-income, predominantly elderly Korean immigrants with type 2 diabetes to improve self-management; another that increased awareness of, attitudes about, and willingness to accept hospice services in a local Hispanic community; and a third that provided culturally sensitive mental health screening for arriving refugees.
  • The featured QualityTools include a cancer education tool geared toward Asians and Pacific Islanders, a screener to help assess the emotional distress of refugees, and a toolkit to help mental health clinicians and agency administrators evaluate evidence-based practices for possible modification for cultural groups..
  • To access more innovation profiles, tools, and resources related to culturally appropriate health care on the Innovations Exchange Web site, go to http://www.innovations.ahrq.gov/innovations_qualitytools.aspx?categoryID=54551,63451&taxonomyID=54558,46058. For resources and information related to cultural and linguistic competence, visit http://www.innovations.ahrq.gov/CulturalCompetence.aspx.

 

Patient engagement is the key

From the Health Affairs Blog:

Everywhere outside of health care, the consumer is in the driver’s seat. From Angie’s List to Yelp to Uber, consumers have never had more tools, and more ability, to get what they want and need. But “health care is different.” Although 72 percent of Internet users have searched for health information in the past year, many consumers find health care lagging behind in supporting their needs for information and support. The good news is this is changing — fast. A new report published in this month’s Health Affairs describes how health plans and other payers can use patient engagement strategies and financial incentives to engage consumers to improve their health while lowering costs.

We’ve found (along with many others) that patient engagement — the actions that people take to better control their health and benefit from care — is crucial to achieving better health outcomes and a more efficient health system. But we’ve also found that while there’s great promise in patient engagement, a serious gap exists between that promise and current reality. And payers, along with care providers and consumer groups, can play an important role in closing this gap.

“UnitedHealthcare Experience Illustrates How Payers Can Enable Patient Engagement,” published in the August issue of Health Affairs, describes our experience with helping support both consumers and care providers with patient engagement. The report details UnitedHealthcare’s programs for analyzing information to identify gaps in care, using information to enable better treatment decisions, comparing care provider quality and cost to help inform care choices, and promoting better health and disease prevention using financial incentives and rewards.

Read the complete blog post here.

In nursing homes, an epidemic of poor dental hygiene

From the Well blog at the New York Times:

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush. His teeth, she found, had not been brushed recently, so she began doing it herself after their lunches together.

But after he complained of a severe, unrelenting headache, she said, she badgered the staff to make an appointment for him with his dentist. The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

“I was livid,” said Ms. Ford, 57, a court reporter. “I’m there every day, pointing out he’s in pain — and he had dental insurance. So there’s no reason this wasn’t addressed.”

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean. While residents now require more dental care than in the past, nursing home employees are rarely prepared to provide it. Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University. “Aides change someone’s Depends, change a catheter or turn somebody every few hours, but teeth often don’t get brushed twice a day.”

The neglect can lead to terrible pain for the residents. Worse, new studies suggest that this problem may be contributing to another: pneumonia, a leading killer of  institutionalized older people.

Read the complete post here.