John Colbert

May 23, 2019

Trends Archives

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

May 23, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 13th of many profiles and the fifth in 2019 is presented as follows:

Name and Title: Ken Johnson, PhD, FASAHP

Place of birth: Blackfoot, Idaho

University: Weber State University

How long have you been in your position? 13 years

What’s the value of a university education? Increased options, increased income

What is the value of ASAHP? Making friends, sharing solutions to problem.

Your philosophy on education in seven words: To help learners learn how to learn.

If I could teach in another field, which one and why? Occupational Psychology – it’s another field that promotes wellness in a variety of ways.

Before I retire I want to: I think I’m good...just increase my retirement fund.

In college, I was known for: Being part of the International Folkdancers as a band member and dancer. What music is playing in my car/office? Classic rock

The last book I read for fun was: Saints

My favorite trip was: Edinburgh, Scotland

If I could travel anywhere it would be: Back to Northern England and Scotland.

Four people I’d take to coffee or have a glass of wine with: I don’t do either of those, but I’d love to visit with some of my ancestors.

The best advice I ever received was: I’ve received too much good advice to just pick one thing.

My hobby is: Woodworking, golfing, fishing

My passion is: My family

My pet peeve is: Bad drivers, I suppose.

A perfect day is: In a peaceful setting with my family

Cats or dogs? Dogs, although we have cats.

E-book or hardback? Hardback

Beach or mountains? I live in and love the mountains. I like to visit the beach.

I wish I could: Travel more.

Only my friends know I: No comment

My favorite saying is . . . on my wall: “Med dig vill jag bli gammal och lite halv blind.” (You’ll have to look it up).

return to may 2019 trends

LANGUAGE TRANSMISSION AND TRANSLATION

John Colbert

May 23, 2019

Trends Archives

Samuel Beckett, a Nobel Laureate in literature from Ireland, produced some of his work in the French language. What may seem odd is that this highly gifted linguist subsequently found it difficult to translate his own material into English, his native language. Apart from variations in vocabulary that distinguish one language from another, even within the same one, communication impediments may arise.

Depending on their level of health literacy, patients can be at a disadvantage in understanding terminology and jargon used by clinicians. Superimposed on differences in understanding spoken and written words is the impact semiotics has on the process of communication in the form of facial gestures, tone of voice, clothing (e.g., white coats worn by health professionals signifying knowledge authority status), and personal appearance (e.g., age, gender, race/ethnicity, body weight, and presence of tattoos and piercings).

Hundreds of millions of interactions occur between clinicians and patients in the U.S. each year, and the quality of the experiences shared by them will help to govern what eventually transpires in the form of beneficial health outcomes. For example, an evaluation of patient–reported outcome measures (PROMs) that appeared on April 15, 2019 in the journal Cancer indicated that more than half of the most commonly used cancer PROMs do not meet plain‐language best practices. This finding may have implications for the quality of care, safety, and experience/satisfaction involving patients characterized by low health literacy.

Access to electronic health records has made it possible for patients to review information written about them. Nevertheless, depending on the branch of health care involved, there is ample room for misinterpretation. Sociolinguistic differences between patients and clinicians can lead to variable misunderstandings of written words that may limit patients’ engagement in their own health care. That outcome should come as no surprise because even within the professional community itself, a veritable Tower of Babel may exist. As an illustration, a radiologist might communicate imaging results to other members of the health care team using terms, such as “probably represents,” which in turn could be interpreted differently by referring clinicians.

Interprofessional education and practice currently is a topic of considerable interest and importance in health care. Data reported on March 22, 2019 in the Journal of Interprofessional Care reveal, however, that there was little consistency in the terminology used by accreditors to describe the learning outcomes that healthcare professions educational programs were expected to embrace. A conclusion reached was that inconsistency in terminology across accreditors found in this study is a clear impediment to healthcare professions educational programs creating a shared mental model for their IPE outcomes. A risk is that until accreditation bodies agree to one such model for all aspects of education, IPE may continue to be perceived by students as an ‘add-on’ to their curricula rather than as an integral part of becoming a health professional.

return to may 2019 trends

PLACING A MAN ON THE MOON AND SOME RELATED MUSINGS

John Colbert

April 22, 2019

Trends Archives

When Neil Armstrong planted his large boots on the surface of the moon in July 1969, one is stimulated to wonder if he could have foreseen that the next thing to soar extraordinarily high would be rhetoric from elected officials in Washington, DC who subsequently would declare to impressive effect that if we can place a man on the moon, then we should be able to cure cancer, eliminate bed bug infestation, and achieve other feats of daring do.

Just as a major national initiative led to reaching the moon, today’s interplanetary dreams include long-duration missions that will take humans to Mars and beyond by public and private entities in the 2020s and 2030s. According to a study described in the April 12, 2019 issue of the journal Science, however, comprehensive studies are needed to assess the impact of long-duration spaceflight on the human body, brain, and overall physiology. To assess the health effects of long-duration spaceflight, one identical twin astronaut was monitored before, during, and after a one-year mission onboard the International Space Station, the time approximately required for a return journey to Mars.

The other twin served as a genetically matched ground control. Largely unknown risks imposed by microgravity and ionizing radiation (IR) exposure during spaceflight currently limit endeavors to visit Mars. Low-risks include changes in the gastrointestinal microbiome and in body mass. Mid-level risks include alterations in collagen regulation and intravascular fluid management. Genomic instability, assessed by chromosomal aberrations, potentially represents a higher risk because it confers a prospect of developing cancer. Structural abnormalities observed in the chromosomes of the traveling twin are typical of IR exposure. Other severe biological effects could relate to microgravity, causing a headward fluid shift and pronounced changes in vascular physiology (e.g., upper body distended arteries and veins). Nonetheless, perhaps there are many valuable lessons that may be learned from space adventures that will accrue to the advantage of earth-bound inhabitants who will benefit in ways involving their health.

return to april 2019 trends

PER SCIENTIAM AD SAPIENTIAM: SOME KEY STEPS IN THE JOURNEY

John Colbert

April 22, 2019

Trends Archives

The accumulation of knowledge may be viewed as a fundamental stepping stone on the road to wisdom. The professional literature is a source of factual information that over time furnishes essential building blocks in the accumulation of knowledge. Some examples are:

James Watson and Francis Crick in an article published in Nature on April 25, 1953 in the brief space of 842 words set in motion a vast panoply of studies that influence achievements to the present day involving the human genome. Their contribution led to sharing a Nobel Prize in 1962. A significant flaw was failing to acknowledge how their understanding of the helical structure of DNA was greatly aided by imagery developed earlier through crystallography by chemist Rosalind Franklin.

Luis Alvarez, a 1968 Nobel Laureate in physics at the University of California, Berkeley, was able to expand his curiosity to the fields of geology and paleontology. His efforts led to an article in the June 6, 1980 issue of Science in which he hypothesized how most life on earth was extinguished when a giant asteroid crashed into the planet at a high speed 65 million years ago (since updated to 66 million).

When John Wakefield indicated in a paper that appeared in the Lancet on February 28, 1998 that MMR vaccine can lead to the onset of autism and other conditions, he inspired a refusal among some parents that exists to the present day to have their children immunized. His assertions were proven false and the manuscript later was retracted in February 2004 by the publisher, but its effects still manage to influence opposition to interventions designed to prevent the occurrence of several infectious diseases.

When viewers stare at the sky, the experience may conjure up thoughts about the possible existence of life on other planets. Sam Levin and co-authors speculated in the February 2019 issue of the International Journal of Astrobiology how evolutionary theory can be used to make predictions about aliens. They even contemplated the possibility someday of discovering a bizarre looking alien called an “Octomite”

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

April 22, 2019

Trends Archives

Hospitals’ Use Of Electronic Health Records Data, 2015-2017

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 helped to advance the adoption and meaningful use of electronic health records (EHRs). Currently, more than 95% of hospitals possess an EHR. With this widespread adoption of the technology, policy is now shifting towards the use of EHR data, which can improve patient care by giving providers access to evidence-based tools that assist with decision making and facilitating clinical practice by automating and streamlining provider workflow. EHR data are used most commonly by hospitals to support quality improvement (82%), monitor patient safety (81%), and measure organization performance (77%). Hospitals with the capability to send, find, receive, or integrate external patient data were twice as likely to use their EHR data compared to hospitals that did not engage in these domains of interoperability. A data brief from The Office of the National Coordinator for Health Information Technology employs data from the American Hospital Association Information Technology Survey to describe trends in the use of EHR data among non-federal acute care hospitals from 2015 to 2017. EHR data are defined as a set of 10 measures that describe hospital processes for leveraging information within their EHR to inform clinical practice. The data brief also presents variation in the use of this data by hospital characteristics and over time. It can be obtained here.

Care Coordination

Care coordination is a methodical approach to care that facilitates better communication between and among individuals, family caregivers, and service providers. There has been significant emphasis in the last several years on care coordination’s role in supporting older adults and in reaching the key aims of health care reform, namely improved patient outcomes, enhanced care experience, reduced costs, reduced provider burnout, and equity in outcomes. A new issue brief provides updates to a 2013 care coordination issue brief developed by Eldercare Workforce Alliance (EWA) and the National Coalition on Care Coordination (N3C). It includes a synthesis of diverse strategies in use and a vision for how services could be improved. Care coordination should be happening wherever and whenever care is provided. Efforts may be staffed within various settings: office-based primary care teams, house call programs, specialty care teams (such as oncology), hospitals (often staffed by discharge planners or transitional care coordinators), skilled nursing facilities, hospice and palliative care programs, aging network organizations, and housing programs. The issue brief can be obtained here.

Strengthening The Connection Between Health Professions Education And Practice

The National Academies of Sciences, Engineering, and Medicine’s Global Forum on Innovation in Health Professional Education with affiliates of the National Center for Interprofessional Practice and Education held a workshop on November 13 and 14, 2018 in Washington, DC entitled Strengthening the Connection between Health Professions Education and Practice. The purpose was to explore methods and methodology for bridging health professions education and practice in ways that improve information flow between learning and application. The workshop also explored various models of training by bringing together multiple health professions across the education-to-practice continuum. Workshop Proceedings can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

April 22, 2019

Trends Archives

Disparities In Prevalence Of Major Cancer Risk Factors And Screening Test Use In The U.S.

According to the April 2019 issue of the journal Cancer Epidemiology, Biomarkers & Prevention, individuals with lower educational attainment have higher prevalence of modifiable cancer risk factors and lower prevalence of screening versus their more educated counterparts. Smoking prevalence is six times higher among males without a high school education than female college graduates. Nearly half of women without a college degree are obese versus about one-third of college graduates. Over 50% of black and Hispanic women are obese compared with 38% of whites and 15% of Asians. Breast, cervical, and colorectal cancer screening utilization is 20% to 30% lower among those with less than high school education compared with college graduates. Screening for breast, cervical, and colorectal cancers also is lower among Hispanics, Asians, and American Indians/Alaska Natives relative to whites and blacks.

Foreign-Body Ingestions Of Young Children Treated In U.S. Emergency Departments: 1995–2015

The number of children in the United States who swallowed coins, toys, and other small objects nearly doubled (91.5% from 9.5 per 10,000 children in 1995 to 18 in 2015), according to an article published on April 10, 2019 in the journal Pediatrics. Some objects can cause serious harm when ingested, and possibly even death. Overall, boys more frequently ingested foreign bodies (52.9%), as did children one year of age (21.3%). Most children were able to be discharged after their suspected ingestion (89.7%). Among the types of objects ingested, coins were the most frequent (61.7%), toys (10.3%), jewelry (7.0%), and batteries (6.8%) followed thereafter. The rates of ingestion of those products also increased significantly over the 21-year period. Across all age groups, the most frequently ingested coin was a penny (65.9%). Button batteries were the most common kind of batteries ingested (85.9%). Small and flat objects, they can damage or even puncture the walls of the esophagus if they become stuck.

HEALTH TECHNOLOGY CORNER

Morning Exercise Is Better Than Evening Exercise Except When It Is Not

Exercise is considered an effective lifestyle intervention for the prevention and mitigation of various diseases. One group of researchers investigated whether the time of day and circadian clock affect exercise performance and related metabolic pathways in mice and humans. They found that exercise performance is better in the evening than in the morning hours, thereby potentially optimizing health benefits. Meanwhile, a different set of investigators observed a more robust metabolic impact of exercise in the morning (beginning of active phase) than at night (beginning of rest phase), resulting in a higher utilization of carbohydrates and ketone bodies, together with the degradation of lipids and amino acids. Both studies were published April 18, 2019 in the journal Cell Metabolism. While the results may not lead to firm conclusions pertaining to humans, they possibly could have implications for any mice that have an opportunity to exercise regularly on treadmills, which relates to how the research was conducted.

Using Voice Analysis To Evaluate And Predict Human Behaviors And Identify Health Risks

An Israeli company called VoiceSense is taking advantage of the plethora of devices that capture human speech, such as mobile phones and digital assistants in homes. Voice-analysis research is capturing individual tones, speed, emphases, and pauses, and applying machine learning to make predictions. Feeding the data to an algorithm, over time it learns to pick up subtle speaking signs that might indicate someone who experiences anxiety. Mental and behavioral health issues often prove to be difficult to monitor effectively. For example, signs and symptoms can creep up on individuals who experience depression before they realize that they might need help. Although using voice to identify anxiety, depression, and specific conditions such as Parkinson’s disease or post-traumatic stress disorder (PTSD) still is in the early stages, researchers aim to produce a sensor that can monitor and alert a patient to such problems in order to facilitate earlier intervention.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

April 22, 2019

Trends Archives

A major objective of the Association of Schools of Allied Health Professions (ASAHP) is to be a leading interprofessional voice for improvements in health and health care. An essential belief is that all health professions programs and schools should provide interprofessional education (IPE) opportunities for students from several health disciplines in order to foster competencies beyond clinical care, including leadership, advocacy, and evidence-based practice. Another significant step in that direction is the upcoming 2019 ASAHP Summit, a project co-sponsored by the ASAHP Interprofessional Subcommittee and the ASAHP Clinical Education Task Force, and co-hosted by Kindred Healthcare and Saint Louis University. In preparation for this event scheduled to occur on May 31, 2019 at Saint Louis University, Association members are being requested to complete a survey regarding some recommendations made by the Clinical Education Task Force. Information derived from the study will enhance Summit activities.

Developments in interprofessional education involving allied health are featured in the Association’s Journal of Allied Health. A new section called “Interprofessional Practice and Education” was created in this publication beginning with the Fall 2017 issue. Eleven IPE articles appeared in the four issues of the journal distributed in 2018. Two more appeared in the Spring 2019 issue and another two are scheduled for the Summer 2019 issue. Also, the recipient of the ASAHP Excellence and Innovation in Interprofessional Education and Collaborative Health Care Award will be announced later this year.

Secretary Devos Testifies At House Hearing On Department Of Education Policies And Priorities

Department of Education Secretary Betsy DeVos testified on April 10, 2019 at a House Education and Labor Committee hearing entitled “Examining the Policies and Priorities of the U.S. Department of Education.” The purpose of the hearing was to consider the Department’s fiscal year 2020 budget request and other Department initiatives. She discussed the Administration’s proposals to create a single income driven repayment (IDR) plan capped at 12.5% and to eliminate the Public Service Loan Forgiveness program. She opined that the current loan program provides an after-the-fact benefit that fails to help students complete their program and does not take into account borrower earnings in their chosen professions. The aim of the Administration’s proposed plan is to support all borrowers pursuing any career through the single IDR plan, which will allow them to make affordable monthly payments based on their income.

Negotiated Rulemaking On Accreditation, Innovation, And Other Topics

The U.S. Department of Education (USDE) released draft consensus language from its negotiated rulemaking on accreditation, innovation, and other topics on April 17, 2019. Negotiated rulemaking is the process used by the USDE to negotiate the terms of a proposed administrative rule or regulatory change. The negotiated rulemaking full committee met four times between mid-January and early April, 2019. Three subcommittees that addressed distance education, faith-based institutions, and TEACH Grants made recommendations to the full committee. Consensus language pertaining to revised regulatory proposals will affect accreditation in some of the following ways:

Require more transparency regarding where regional accreditors operate
Provide more flexibility for innovation for institutions and accreditors
Protect students through enhanced disclosure and teach-out requirements
Simplify and balance the recognition process for both USDE and accrediting organizations
Require arbitration of accreditation decisions prior to going to court
Make it easier for new accreditors to gain recognition

Next, USDE will publish a Notice of Proposed Rulemaking (NPRM) in the Federal Register and provide for a public comment period. For the rule to take effect on July 1, 2020, the final rule must be published in the Federal Register by November of this year.

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HEALTH REFORM DEVELOPMENTS

John Colbert

April 22, 2019

Trends Archives

The Affordable Care Act that became law in 2010 was aimed at expanding the number of individuals with health insurance coverage, reducing health care costs, and increasing the quality of care provided. Although much progress has been made since that year, certain difficulties continue to be unresolved, with a main one being a portion of the U.S. population still lacking adequate coverage.

During the 2016 Presidential campaign, Senator Bernard Sanders (I-VT) ignited great enthusiasm among his followers for his pledge to see to it that a Medicare For All bill would be enacted if he were elected. That notion is as relevant today as it was back then as evidenced by several prominent Democrats who have entered the race for the next presidential election and gone on record in support of his approach.

He introduced an updated version of his proposed legislation (S. 1129) on April 10, 2019. It would replace nearly all forms of private health insurance with a government-managed, single payer version of Medicare that guarantees coverage to all Americans. The universal health care program would include coverage of primary care, hospital stays, mental health treatment, and prescription drugs. This latest iteration also includes coverage for dental, vision, hearing, and home and community-based long- term care services, which resembles the House version of H.R. 1384 that was introduced by Rep. Pramila Jayapal (D-WA) on February 27. Under provisions of the Sanders bill, states would be allowed to provide additional benefits from their own budgets, and the Indian Health Service (IHS) and Veterans Health Administration (VHA) would remain in place. The legislation does not specify how it will be financed.

Provision Of Non-Medical Services For Social Needs That Affect Health

The Trump Administration at the beginning of April 2019 released guidance indicating that beginning in 2020, Medicare Advantage plans, private health plans that contract with Medicare, will be allowed, but not required, to offer chronically ill enrollees non-medical services for social needs that affect health. Plans will be able to select which non-medical services they offer, as long as there is a “reasonable expectation that the services will help people with chronic conditions improve or maintain their health or overall function.” Examples of services include: home-delivered meals, transportation for non-medical needs, pest control, indoor air quality equipment (e.g., an air conditioner for a patient with asthma), and minor home modifications (e.g., permanent ramps, widening of hallways or doorways to accommodate wheelchairs). The new coverage flexibility was made possible by the Creating High Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act (S. 870), which was a component of the Bipartisan Budget Act of 2018 (P.L. 115-123) that the President signed into law in February 2018.

House Reaction To A Lawsuit To Invalidate The Affordable Care Act

In February 2018, attorneys general in 20 states filed a lawsuit claiming that the 2017 Tax Cut law and the Jobs Act’s reduction of the individual responsibility tax penalty to zero, in effect made the Affordable Care Act’s individual mandate unconstitutional. The following December, a federal court judge in Texas entered a judgment that if the suit is upheld, the entire ACA would become invalidated. Democratic attorneys general in 17 states subsequently intervened to defend the entirety of the health reform law. The U.S. House of Representatives in April 2019 joined the fray by passing a measure (H.Res. 271) by a vote of 240-186, condemning the Trump Administration’s support for the lawsuit that would invalidate the ACA. Eight Republicans joined their Democratic colleagues in supporting the resolution, essentially agreeing that a replacement plan must be installed before the law is repealed.

Despite being rebuffed in their efforts in 2017 when Republicans controlled both chambers in Congress, a desire by that party to repeal and replace the ACA has not vanished totally. Its members recognize that a comprehensive replacement plan will have to be designed prior to attempting to launch any repeal effort in the future.

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100th DAY OF THE 116TH CONGRESS

John Colbert

April 22, 2019

Trends Archives

Tuesday, March 16 marked the 100th day of the 116th Congress, a period of considerable activity. Both the House Energy and Commerce Committee and the Ways and Means Committee have marked up bills involving the Affordable Care Act and drug pricing. On the Senate side of Capitol Hill, the Health, Education, Labor, and Pensions Committee has sought information from a wide range of sources regarding how to reduce health care costs for taxpayers, employers, and families after concluding a series of five Senate health committee hearings exploring the same topic.

Congress already has enjoyed a measure of success by having some health care bills signed by President Trump, including: the Medicaid Services Investment and Accountability Act of 2019 (H.R. 1839) and the Medicaid Extenders Act of 2019 (H.R. 259). Progress is being made to enable other pieces of health legislation to advance, such as the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 (H.R. 269) and the Poison Center Network Enhancement Act of 2019 (H.R. 501). Other items requiring attention this session involve legislation to renew expiring programs that involve Community Health Centers and Teaching Health Centers.

A hearty perennial that keeps Congress active is completing work on 12 appropriations bills. House Democrats were forced to cancel a vote on top-line budget numbers because of intra-party disagreement. Some party members supporting H.R. 2021 want to increase defense spending in 2020 by $17 billion for a total of $664 billion and non-defense spending by $34 billion for a total of $631 billion. Other Democrats insist that non-defense spending be raised to the same level as defense spending.

In the health arena, there is little support for the Trump Administration’s FY 2020 budget request involving medical research. Many Republican legislators are inclined to reduce government spending whenever possible, but Subcommittee Chairman Roy Blunt (R-MO) of the Senate Subcommittee for Labor-HHS Appropriations indicated that re-prioritizing funding for the National Institutes of Health (NIH) after a decade of stagnation has been his number one priority. The Administration’s budget request to reduce NIH support by $4.9 billion (a 13% cut) is not a choice he intends to make when the Labor-HHS spending bill is written.

The release of the Mueller Report on April 18 regarding whether President Trump was involved in collusion with Russia or obstruction of justice involving the U.S. presidential election in 2016 has not resulted in producing total calm in political waters that have been roiled for the past two years. A traditional role of Congress is to conduct hearings to examine the performance of federal agencies and to investigate suspected wrongdoings. As of April 2019, it is clear that Democrats in the House of Representatives will use that power to hold hearings on important matters they believe remain insufficiently addressed by the Mueller Report.

Meanwhile, the 2020 election cycle appears to be in full swing even though votes will not be cast for another 19 months. The Democrats lack no shortage of candidates who deem themselves worthy of residing in the big house at 1600 Pennsylvania Avenue, N.W. come January 2021.

return to april 2019 trends

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

April 22, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 12th of many profiles and the fourth in 2019 is presented as follows:

Name and Title: Yasmen “Yas” Simonian, PhD, MLS(ASCP)CM, FASAHP Dean and Brady Presidential Distinguished Professor

Place of birth: Tehran, Iran

University: Weber State University

How long have you been in your position? Eleven years

What’s the value of a university education? Opens a world of opportunities. The sky is the limit.

What is the value of ASAHP? Networking, CE, opportunities to present, share ideas, and more.

Your philosophy on education in seven words: Learn lots and then make a decision.

If I could teach in another field, which one and why? History of Medicine, I like the subject.

Before I retire I want to: Leave a legacy that will make a difference for many years to come.

In college, I was known for: Helping others and partying.

What music is playing in my car/office? In the car Greek dancing music and in the office mellow classical.

The last book I read for fun was: Becoming Michelle Obama

My favorite trip was: Greece any day

If I could travel anywhere it would be: Spain, Italy, Greece, Armenia, Serbia, Romania, Middle East

Four people I’d take to coffee or have a glass of wine with: Farogh, Hassan, Helen, mom

The best advice I ever received was: Listen before you talk.

My hobby is: Dancing, cooking, traveling, music.

My passion is: Being with my family and friends.

My pet peeve is: People not putting things back from where they got it from.

A perfect day is: A sunny day on a beach under an umbrella

Cats or dogs? Dog

E-book or hardback? Both

Beach or mountains? Both

I wish I could: Cure cancer

Only my friends know I: Ask me later.

My favorite saying is: You can do it.

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VARIETIES OF PLAGUES BOTH OLD AND NEW

John Colbert

April 22, 2019

Trends Archives

The word plague is versatile, whether used as a noun to describe the assault of a communicable disease on a population or as a verb to convey chronic emotional distress. The first category may best be exemplified by the endemic Black Plague that devasted human life in late Medieval and Renaissance Europe. One historical account in the journal Bulletin of the History of Medicine led to an estimate that the mortality rate from the Black Death and its collateral effects devastated 60% of the entire European population (50 million of its estimated 80 million inhabitants).

Often referred to as the White Plague, during the first half of the 20th century in the U.S., large county tuberculosis (TB) hospitals across the nation housed patients requiring specialized care. A most deadly disease, a provisional total of only 9,029 TB cases were reported in the U.S. in 2018, (an incidence of 2.8 cases per 100,000 persons). The rate among patients born outside this country, however, was more than 14 times higher than that of individuals born here. Risk factors include HIV infection status, a history of homelessness, and residence in a congregate setting.

Until the mid-1950s, polio outbreaks triggered fears of becoming a patient confined for the rest of one’s life in an iron lung. When the Global Polio Eradication Initiative (GPEI) began in 1988, cases of poliomyelitis were reported from 125 countries. Since then, only Afghanistan, Nigeria, and Pakistan have experienced uninterrupted transmission of wild poliovirus (WPV).

Although declared eliminated in the U.S. in 2000, total cases of measles nationwide as of April 11, 2019 already have surpassed those of 2018 and likely soon will eclipse totals for 2017 and 2018 combined, according to the CDC. During the 1940s and early 1950s, the editor of this newsletter in his youth was afflicted with mumps, measles, whooping cough, German measles, chickenpox, and scarlet fever. None of those conditions was considered rare back then, which happily is quite the opposite of the present day, reflecting the current widespread availability of vaccines, effective drugs, and improved standards of living.

Meanwhile, the relative disappearance of some diseases has been replaced by the emergence of other conditions primarily associated with a sense of being plagued by doubts and uncertainties about the purported advantages of modern day life. For example, despite evidence of the positive role that vaccines play in preventing disease, some parents refuse to have their children immunized because of a fear that it causes autism. According to a recent national Pew Research Center study, when Americans peer 30 years into the future, they see a country in decline economically, politically, and on the world stage. Such grim predictions reflect a sour public mood while more extreme forms of hopelessness contribute to suicide continuing to remain among the top 10 causes of mortality in the U.S. since 2008.

Nevertheless, poking through a cloud of despair is a hearty ray of sunshine in the form of knowledge that the health professions remain a sound career choice. An aging population characterized by chronic ailments will require health care services that are not easily transportable to other countries or replaceable by robots.

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GLOBAL SYNDEMIC OF OBESITY, UNDERNUTRITION, AND CLIMATE CHANGE

John Colbert

March 26, 2019

Trends Archives

A syndemic is a portmanteau term, constituting a style of writing often employed by James Joyce in Finnegans Wake and Lewis Carroll in Through The Looking-Glass, to denote a fusion between the words synergy and epidemic. The 23 February-1 March 2019 issue of the British journal The Lancet furnished readers with an opportunity to obtain an enhanced understanding of how obesity, undernutrition, and climate change affect most inhabitants of every nation and region worldwide. A proposition is advanced that the entities do so by co-occurring in time and place; interacting with each other to produce complex sequelae; sharing common underlying societal drivers; and representing three of the gravest threats to human health and survival. One form of purported multifold damage linking the problematic threesome is agriculture's drive towards higher value products, such as processed and animal-source foods that consume great amounts of energy, generate methane and other waste products, and are marketed and consumed heavily in unhealthy quantities.

For example, conceptualizing obesity as a global syndemic might have some utility. Obesity illustrates a pivotal syndemic problem that would appear to require international-level policy interventions to curb the power and influence of multinational corporations, representing Big Sugar and Big Food, which are seen as targeting low-income populations. Viewed within this particular context, advocating in favor of a global syndemic might serve as a constructive political tool to propel positive alliances to take action against multinational corporations. A related perspective is that tearing down silos in the academy and health policy; strengthening government action and community voices; dismantling corporate power to better designate who eats what and where; and promoting improved, more sustainable business models for a healthier future should be syndemic in nature.

return to march 2019 trends

IMPACT OF MARIJUANA LAWS ON HEALTH AND LABOR SUPPLY

John Colbert

March 26, 2019

Trends Archives

As the proportion of the older segment of the population continues to increase both numerically and proportionately, a useful exercise might be to examine how various laws affect them. For example, given the increased popularity of state legislation to legalize the use of marijuana for medical purposes (now legal in 33 states and the District of Columbia) and also for recreational purposes (currently legal in 10 states and DC), use of that substance can be assessed from the standpoint of health and the labor supply for older individuals. A step in that direction is represented by the results of a study reported in the Journal of Policy Analysis and Management on February 6, 2019. Investigators quantified the effects of state medical marijuana laws (MML) on the health and labor supply of adults age 51 and older, focusing on the 55% with one or more medical conditions with symptoms that may respond to medical marijuana.

Three principle findings emerged from the analysis. First, active state MMLs lead to lower pain and better self‐assessed health among older adults, including a 3.4% increase in the probability of reporting very good or excellent health. Second, state MMLs lead to increases in older adult labor supply, with effects concentrated on the intensive margin, with post-MML full-time employment increasing by 5%. Third, the effects of MMLs are largest among older adults with a health condition that would qualify for legal medical marijuana use under current state laws. These findings highlight the role of health policy in supporting work among older adults and the importance of including them in assessments of state medical marijuana laws. Age patterns of disease suggest that the health benefits of MML passage could be concentrated among older adults. The authors contend that if the implementation of an MML, by promoting access to marijuana for medical use, reduces symptoms associated with work‐impeding health conditions, then MMLs could enhance labor supply among the fastest growing segment of the population. This policy effect could facilitate greater retirement savings and also potentially delay the initiation of Social Security benefit claims

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

March 25, 2019

Trends Archives

Emerging Technologies To Support An Aging Population

Emerging technologies that have significant promise to improve quality of life for all Americans, particularly those with physical or cognitive burdens due to aging or disability, are identified in a new report from the White House Task Force on Research and Development for Technology to Support Aging Adults. The report, Emerging Technologies to Support an Aging Population, highlights innovations with the potential to improve quality of life, enhance individual choice, reduce caregiver stress, reduce healthcare costs. Research and development needs also are identified. The report outlines six areas in which technology has the potential to improve the lives of aging adults: key activities of independent living; cognition; communication and social connectivity; personal mobility; transportation; and access to healthcare. The report can be obtained here.

School Success: An Opportunity For Population Health

The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Population Health Improvement hosted a workshop in Oakland, California, at the California Endowment’s Oakland Conference Center on June 14, 2018. The workshop featured presentations that described the relationship between the health and education sectors and shared examples of public health interventions and activities in schools that support school success and are potential opportunities for population health action. The day began with two keynote presentations reflecting on how educational attainment influences health outcomes and how health status affects educational performance. Keynote speakers were followed by Ted Talk style presentations describing school-based public health interventions and the workshop concluded by addressing policies, issues, and opportunities pertaining to shared measurement, legal issues, payment mechanisms, and equity. Steven Woolf from the Center on Society and Health at Virginia Commonwealth University articulated why educational success matters for health. He stated that although the health and education systems work toward similar ends, they have functioned as silos for many years without much communication. Woolf presented an overview of what shapes health through five domains: (1) health systems, (2) individual behaviors, (3) the physical and social environment, (4) public policies and spending, and (5) socioeconomic factors. The public policy and spending domain is of specific importance given that it drives the other domains. Proceedings of the workshop can be obtained here.

CARE Act Implementation: Progress And Promise

The AARP Public Policy Institute published a Spotlight report, The CARE Act Implementation: Progress and Promise. The Caregiver Advise, Record, Enable (CARE) Act became law in 40 states and territories in just four years, while additional states have initiated the legislative process. The swift uptake indicates policy maker recognition of the support family caregivers need to perform the medical/nursing tasks they face at home after a family member or friend is discharged from the hospital. The landmark 2012 AARP and United Hospital Fund report Home Alone: Family Caregivers Providing Complex Chronic Care, funded by The John A. Hartford Foundation, drove the rapid policy adoption of the CARE Act. The report also inspired the creation of the Home Alone AllianceSM, a partnership of public, private, and nonprofit organizations coming together to change the way health care organizations and professionals interface with family caregivers. This Spotlight provides an update on CARE Act implementation, bringing in views from the field. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

March 25, 2019

Trends Archives

Selected Estimates Based On National Health Interview Survey, January To September 2018

Some results for the period January to September 2018 are: (1) the percentage of persons who had a usual place to go for medical care was 87.7%, which was lower than, but not significantly different from, the 2017 estimate of 88.3%; (2) the percentage of the population that failed to obtain needed medical care due to cost at some time during the past 12 months was 4.7%, which was not significantly different from the 2017 estimate of 4.5%; (3) the prevalence of obesity among U.S. adults aged 20 and over was 31.7%, which was not significantly different from the 2017 estimate of 31.3%; (4) the percentage of persons who had excellent or very good health was 66.3%, which was not significantly different from the 2017 estimate of 66.4%; and (5) the percentage of adults aged 65 and over who needed help with personal care from other persons was 7.0%, which was not significantly different from the 2017 estimate of 6.7%.

Electronic Health Behaviors Among U.S. Adults With Chronic Disease

As reported on March 3, 2019 in the Journal of Medical Internet Research, a study explored (1) the differences in technology use; (2) Web-based health information seeking and use behaviors; (3) attitudes toward seeking health information on the Web; and (4) the level of eHealth literacy between adults aged 18 and 64 years with and without chronic disease. About one in three (37.2%) participants reported at least one chronic disease diagnosis. Seventy-five percent of all participants reported having ever searched for health information on the Web. Participants with a chronic disease reported significantly higher instances of visiting and talking to a health care provider based on health information found on the Web (40.0% vs 25.8% and 43.3% vs 27.9%). The uses of health information found on the Web also significantly differed between participants with and without chronic diseases in affecting a decision about how to treat an illness or condition (49.2% vs 35.0%), changing the way they cope with a chronic condition or manage pain.

HEALTH TECHNOLOGY CORNER

Use Of Toilet Seats To Detect Chronic Heart Failure

A paper published on January 18, 2019 in JMIR mHealth and uHealth indicates that a toilet seat–based cardiovascular monitoring system with an integrated electrocardiogram, ballistocardiogram, and photoplethysmogram developed by a Rochester Institute of Technology team is capable of clinical-grade measurements of systolic and diastolic blood pressure, stroke volume, and peripheral blood oxygenation. Toilet seat–based estimates of blood pressure and peripheral blood oxygenation were compared to a hospital-grade vital signs monitor. This system could be positioned uniquely to capture trend data in the home that previously has been unattainable. Demonstration of the clinical benefit of the technology requires additional algorithm development and future clinical trials. With one million new cases of congestive heart failure diagnosed each year, if the FDA eventually approves the product, it could make it easier for hospitals to monitor patients with this condition in the comfort of their own homes.

Medical And Health Data Wearable

OneLife Technologies Corp., a mobile medical software/data collection company, offers the first AT&T LTE-M certified medical wearable. The OnePulse smartwatch goes beyond tracking steps by providing activity trackers, reminders, and alert technologies. Powered by AT&T wireless connectivity, the advanced wearable securely and independently transmits certain critical medical and health data to the cloud, allowing clinicians, patients, and their caregivers to monitor user status and well-being. The AT&T LTE-M connection allows clinicians near real-time access to patient data in a highly secure environment, offering caregivers the ability to intervene when necessary. The OnePulse technology provides data at the wrist for heart rate, location, movement, and sleep. OneLife’s proprietary Bluetooth protocol also has the ability to connect easily to other health and medical devices, e.g., blood pressure cuff, glucometer, and a weight scale.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

March 25, 2019

Trends Archives

The month of March 2019 was characterized by a considerable amount of activity on Capitol Hill and by the Trump Administration involving the topic of higher education. Regarding the latter, mention was made on page three of this issue of the newsletter about President Trump’s introduction of a federal budget proposal for FY 2020, which begins on October 1 of this year. Apart from proposed spending reductions in key health programs and activities, his budget includes a cut for the Department of Education, a stream-lined repayment process for student loans, and the elimination of the Public Service Loan Forgiveness program. The Department’s reduction would be about $8.5 billion or 12%, including a cancellation of surplus funds in the Pell Grant program. Whether any of these proposed changes ever see the light of day will require the approval of Congress, which does not seem highly likely.

The Congressional arena had its own highlights with hearings on reauthorizing the Higher Education Act (HEA). Last renewed in 2008, this legislation authorizes various programs within the Department of Education, including the federal aid programs that support students wanting to pursue a postsecondary education. The House Committee on Education and Labor conducted the first of five scheduled bipartisan HEA hearings on the topic, “The Cost of College: Student Centered Reforms To Bring Higher Education Within Reach” and the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on “Reauthorizing The Higher Education Act: Simplifying The FAFSA And Reducing The Burden Of Verification.” Both events were covered thoroughly by ASAHP staff. Comprehensive summaries were placed on the Association’s NEWSWIRE on March 12 (Senate Hearing) and March 14 (House Hearing). These items then were distributed to the membership on March 15.

Meanwhile, a set of proposals from the White House was released on how to reform the HEA through legislation and revise higher education regulations. The list calls for the accreditation process to focus on student outcomes, asserting that current compliance-focused federal requirements inhibit innovation and that accrediting organizations need to return to the primary purpose of ensuring educational quality. Congress is requested to streamline the 10 federal recognition standards to focus on educational quality and student learning. The proposals also call for defining accrediting organizations by the mission of their institutions, rather then geographically, as regional accreditors currently are structured.

Department Of Education Negotiated Rulemaking

The Department of Education (USDE) held the second of four sessions of its negotiated rulemaking (a process to reach agreement on the terms of a proposed administrative rule or regulatory change) on accreditation and other topics on February 19-22, 2019 in Washington, DC. The first session was on January 14-16, 2019, the third one is scheduled for March 25-28, 2019, and the fourth on April 1-3, 2019. A main committee focuses on accreditation while three subcommittees address distance learning and educational innovation, faith-based entities’ participation in Title IV programs, and TEACH Grants. At the February session, the committee received reports from the subcommittees, responded to questions posed by the Department, and addressed several proposed regulations, including: permitting accrediting organizations to waive certain criteria for institutions to encourage innovation, transferring credit among institutions, and limiting the number of states in which a regional accrediting organization could operate.

Borrower Defense to Repayment Regulations

On November 1, 2016, the Department of Education published final regulations concerning borrower defense to repayment and other related matters in the Federal Register. The original effective date (July 1, 2017) of these regulations was delayed by the Department, but by order of the U.S. District Court for the District of Columbia, the 2016 final regulations from the Obama Administration must take effect. They govern loan forgiveness for defrauded borrowers, ban some types of mandatory arbitration agreements, give federal officials new tools to go after troubled colleges, and require for-profit colleges to warn students if alumni have low loan repayment rates. The current Administration now must implement them.

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HEALTH REFORM DEVELOPMENTS

John Colbert

March 25, 2019

Trends Archives

The 1st Session of the 116th Congress featured the introduction of the Medicare For All Act Of 2019 (H.R. 1384) in the House of Representatives by Pramila Jayapal (D-WA). The bill had 107 Democrat co-sponsors. It calls for transforming the Medicare program into a single payer system that would be implemented over a two-year period beginning after the bill is signed into law. Beneficiaries could keep their current health insurance coverage during the two-year transition period, but would lose it once the Medicare plan began. Individuals automatically would be enrolled in the program at the time of birth in the U.S. Coverage would include inpatient and outpatient hospital care; ambulatory services; primary and preventive care (also chronic care); prescription drugs; biologics; medical devices; mental health and substance abuse treatment services; laboratory and diagnostic services; maternity care; dental and vision care; and long-term care. Health plans and employers still could provide additional benefits not covered by the Act. No co-payments, premiums, deductibles, or similar charges would be imposed.

It cannot be expected that a piece of legislation this broad will be passed and enacted anytime soon. Many vested interests stand to be affected quite dramatically. They include: providers, insurance companies, pharmaceutical firms, medical device manufacturers, and individuals who are satisfied with their present coverage. Figuring out how to pay for benefits is another challenging aspect that has serious ramifications for the nation’s tax structure.

The Medical Device Tax As A Means Of Offsetting Health Care Costs

When the Patient Protection and Affordable Care Act (ACA) became law nine years ago this month, it was anticipated that new taxes would help to offset some of its costs. One example is a medical device tax. This 2.3% federal excise levy on the medical device industry has been suspended and delayed since the law was enacted. More recently, the tax was delayed retroactively and will not go into effect until January 1, 2020. Senators Pat Toomey (R-PA) and Amy Klobuchar (D-MN) have introduced legislation (S. 692) to repeal this tax permanently. The bill currently has 25 bipartisan cosponsors.

A Bipartisan Approach To Reducing Health Care Cost Growth

Barring any overnight developments that produce cures for major causes of mortality, such as heart disease and cancer, due to a steady growth in the overall population of the U.S. and accelerating increases in the number and proportion of the aged, health care costs will continue to increase. Recent years have witnessed considerable amounts of dissention and polarization in the political arena. Thus, it always is refreshing whenever spurts of bipartisanship occur. On March 1, eight prominent health economists from the Brookings Institution and the American Enterprise Institute, organizations seldom aligned ideologically, sent Lamar Alexander (R-TN), Chairman of the Senate Committee on Health, Education, Labor, and Pensions (HELP), a list of 13 recommendations for the government to reduce the growth in health care costs. Recommendations include: passing legislation to expand mandatory bundled-payment programs and to end surprise out-of-network billing; and increasing Medicare payments for primary-care services and reducing them for other services.

Curtailing Fraud In Government Health Programs

Every year, billions of dollars in outlays and government program complexity combine to result in a susceptibility to improper payments, including fraud. Although there are no reliable estimates of fraud in Medicare, in fiscal year 2017 improper payments were estimated at about $52 billion, according to the Government Accountability Office (GAO). On February 25 of this year, the House passed H.R. 525, the Health Care Fraud Prevention Task Force Act, by voice vote. The bill would create the Health Care Fraud Prevention Task Force, a public-private partnership that would identify nationwide health care waste, fraud, and abuse and would supersede the Health Care Fraud Prevention Partnership (HFPP), which currently is operated by the Centers for Medicare & Medicaid Services (CMS). The newly established task force would contract with a third party to detect and prevent health care fraud through information sharing; streamline analytical tools and data; and provide a forum for government and industry experts to exchange successful anti-fraud practices. The task force also would be required to submit a report every two years to Congress showing any progress and cost savings attributable to the partnership.

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FEDERAL BUDGET RELEASE AND PROPOSED LEGISLATION

John Colbert

March 25, 2019

Trends Archives

The Trump Administration released its FY 2020 Federal Budget proposal on March 11. During the week of March 17, additional materials were released, including an appendix, analytical perspectives, and a Major Savings And Reforms Document that contains detailed information for use by the Appropriations Committees. An overall view reveals proposed savings of $48.4 billion in discretionary programs, including $25.8 billion in program eliminations and $22.6 billion in reductions. If history is any guide, legislators are unlikely to accept what the Administration has offered and will weigh in regarding what they consider to be more alternative ways of allocating federal dollars.

Immediate Congressional criticism of the Administration budget has focused on spending reductions on health programs that are considered too harsh. For example, the President’s proposal would cut hundreds of billions of dollars from Medicare. The budget also would slash funds for the National Institutes of Health by $5.5 billion in 2020, including a $897 million reduction in the National Cancer Institute's budget. The Administration also wants to provide $256 million to consolidate the Agency for Healthcare Research and Quality's work into the National Institute for Research in Safety and Quality, which is part of an attempt to streamline federal research.

Prior to taking action to pass 12 annual appropriations bills, lawmakers first will have to reach an agreement to raise spending caps under the Budget Control Act (BCA) so that appropriators have top-line spending limits with which to work. Absent a new agreement, discretionary spending caps will be cut to the levels outlined in the BCA for FY 2020, approximately $126 billion less than FY 2019.

Regarding other legislation, Senators Ron Wyden (D-OR), Marco Rubio (R-FL), and Mark Warner (D-VA) on March 6, 2019 reintroduced the Student Right to Know Before You Go Act (S. 681) to provide information through the U.S. Department of Education (USDE) on the costs and outcomes associated with higher education. Data focusing on graduation rates, debt levels, and earnings would be generated based on student information from institutions, along with loan and income information from USDE and the Internal Revenue Service. Versions of this bill have been introduced in every Congress since 2012. A companion bill (H.R. 1565) was introduced in the House by Duncan Hunter (R-CA).

Senators Bill Cassidy (R-LA), Elizabeth Warren (D-MA), and 13 other Republicans and Democrats reintroduced the College Transparency Act (S. 800) on March 14, 2018. Initially introduced in the previous Congress, the bill would change the way the USDE collects information on postsecondary institutions, modifying the college reporting system to include student outcomes information, such as completion and post-college employment. Institutions would provide data for USDE to generate post-college outcome reports to be presented on a user-friendly Website. Currently, the Higher Education Act (HEA) prohibits a student unit record system. A companion bill (H.R. 1766) was introduced in the House by Mitchell Paul (R-MI).

A Medicare For All Act also was introduced in this session of Congress and will be discussed on the next page of the current newsletter.

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PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

March 25, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 11th of many profiles and the third in 2019 is presented as follows:

Name and Title: Curt Lox, Dean, Brooks College of Health

Place of birth: Harbor City, CA

University: University of North Florida

How long have you been in your position? Almost two years

What’s the value of a university education? Socioeconomic mobility, psychosocial development

What is the value of ASAHP? ASAHP brings together dedicated individuals who are all focused on health, broadly defined. Whenever a group of passionate, educated professionals congregate, great things can happen.

Your philosophy on education in seven words: Engaging, expanding, and challenging young minds (OK, that is only six words but perhaps I can get extra credit for efficiency?)

If I could teach in another field, which one and why? I enjoy talking about leadership so that would probably be my choice though I have no formal training in this area.

Before I retire I want to: See my unit become a nationally-recognized College of Health

What music is playing in my car/office? I will forever be a big fan of music from the 80’s.

The last book I read for fun was: The latest Lee Child (Jack Reacher) novel

My favorite trip was: Mediterranean cruise

If I could travel anywhere it would be: Australia/New Zealand

Four people I’d take to coffee or have a glass of wine with: There is much more I wish I knew about my family history so my first two selections would be my grandfather and grandmother (both deceased). As a Beatles fan, I’d love to visit with Paul McCartney. As a sports fan and student of leadership, I would have welcomed the opportunity to pick John Wooden’s brain if he were still with us.

The best advice I ever received was: From my dad. He said that it was critical to work hard in school so that I could find a job that I loved because it would occupy a large portion of my life. I’m glad I took his advice because I love what I do.

My hobby is: Outdoor activities and travel

My passion is: People (we’re social beings!)

A perfect day is: Exploring a geographical region I’ve never been before with family and/or friends.

Cats or dogs? Definitely dogs

E-book or hardback? Hardback

Beach or mountains? I love them both but given that I live three miles from the beach, I’d have to say the former.

I wish I could: Play a musical instrument

My favorite saying is: From former Notre Dame football coach Lou Holtz: “The only things that are going to change you from where you are today to where you are going to be five years from now are the people you meet and the books you read.”

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COSTS ASSOCIATED WITH NONADHERENCE

John Colbert

March 25, 2019

Trends Archives

Patients with physical and mental health ailments seek relief through interactions with a wide range of health care practitioners. Assuming that accurate diagnoses are made and effective forms of affordable treatment are available, then prescribing remedial and curative interventions should produce desired outcomes. A major problem is that some patients fail to adhere to recommendations and the result is the occurrence of highly significant kinds of costs that affect not only them as individuals, but also their caregivers and society as a whole.

An ongoing concern is the high cost of health care and what can be done to pay for it. According to the March 2019 issue of the journal Medical Care, medication nonadherence for diabetes, heart failure, hyperlipidemia, and hypertension resulted in billions of Medicare fee-for-service expenditures, millions in hospital days, and thousands of emergency department visits that could have been avoided. If the 25% of beneficiaries with hypertension who were nonadherent became adherent, it is estimated Medicare could save $13.7 billion annually, with over 100,000 emergency department visits and seven million inpatient hospital days averted.

Patients and health professionals enter into a transaction at the point of care in which both sides are in a position to gain or lose in various ways. Clinicians benefit from the opportunity to practice their knowledge and skills while simultaneously being able to obtain a livelihood through payment for services rendered. The health status of recipients of care may improve by symptom reduction, pain relief, and contributions to enhancing overall wellbeing.

Both sides of the equation must function in responsible ways for outcomes to be of optimal worth. Caregivers need to go beyond the provision of hands-on care by educating patients about the purpose of an intervention and ascertaining that these individuals fully understand their personal roles in taking medications properly, following dietary recommendations, and achieving satisfactory levels of physical fitness. Many aspects of care are volitional on the part of patients. Whereas being treated with hot packs or receiving a massage tend not to require much active patient involvement, a considerable amount of health care entails patient consent from the perspective of their needing to know why certain procedures are warranted. These individuals also must demonstrate both resilience and a willingness to cooperate in what is being furnished.

Some patients may lack adherence because of the unaffordability of medications, but other factors, such as low health literacy may be more pertinent. It is common today for patients to receive telephone and text messages reminding them of an upcoming appointment with a health professional, but less seldom are messages aimed at determining follow-up levels of patient understanding and adherence to recommended protocols. Although it is relatively easy and comforting for practitioners to assume that adherence occurs, the truth may be otherwise. As a potential downside, it is worth noting that a failure by nonadherent patients to show improvement can result in increased dissatisfaction on the part of caregivers that possibly contributes to feelings of burnout, a major issue in health care today.

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More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

BIPARTISAN HEALTH LEGISLATION

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

VALIDATION OF DIGITAL HEALTH SOLUTIONS

More Articles from TRENDS May 2019