Now that Health reform is frequently the biggest topic in the news I found some wonderful websites that can be used as resources for anyone interested in what is being discussed, debated and critiqued. These were found in the Austin American Statesman on August 30, 2009. Just note if you type in the URL it is cAse SEnSitIvE so be careful when you transcribe it.
Interactive tools that show outcomes of different policy options (I found this to be quite interesting) http://bit.ly/ayVfn
Compare how competing proposals deal with key issues http://bit.ly/1jmVR
Washington Post's indepth coverage of the debate and the issues http://bit.ly/mdCHa
Glossary of health care terms and phrases http://bit.ly/L15cE
Do prominent voices in the debate have their facts straight? http://bit.ly/415OC
http://bit.ly/IJTG5
Obama administration's Web site http://bit.ly/1BOvjg
Full text of House bills http://bit.ly/ldzqU
http://bit.ly/tqQ3Z
Long-term study of wasteful medical spending in Texas and other states http://bit.ly/3GsgNx
Congressional Budget Office information http://bit.ly/1BOvjg
I hope these sites provide some good information and education for everyone interested in healthcare and the health of our nation!!
What exactly is health reform? This is a very big question requiring a broad response.
The first issue that needs to change is how people use the healthcare system. After years of working in numerous emergency departments (ED) I saw lines of patients coming in all hours of the day for colds, chronic headache conditions, mild rashes, sore throat, ear pain... you get the picture. These conditions could and should have be handled by a primary care provider (PCP) - i.e. your family Doctor (MD), Nurse Practitioner (NP) or Physician Assistant (PA) and not in the ED. Ok, I know - if it is after 5pm and your provider is closed then where do you go? Now there are numerous Retail Clinics located in drugstores, grocery stores, big discount stores and in some malls that can be utilized. Some common names are MinuteClinic, Take Care, RediClinic, The Little Clinic and many more. Visit http://www.ccaclinics.org/ to learn more about the retail clinics. Most are open during the evening hours and on weekends and charge much less than an ED. We don't need to use up precious space and skills in the ED for a cold! It would cost 8-10 times more to see someone in the ED than their PCP or a retail clinic.
How about taking something to relieve the symptoms? If a person has a cold (stuffy/runny nose, fever up to 102, headache, sore throat, tired, achy) then take a fever reducer/pain reliever such as tylenol or ibuprofen - depending on your health history and allergies. Maybe using a saline nasal wash to clear up the nasal passage and stop the runny nose and dripping. More on the saline rinse in my blog on sinus infections. Rest is always a good idea. Good hand washing skills and using a tissue to cough or sneeze and throw it away immediately can help prevent the spread of most colds and the flu. Most importantly - stay home when you have a fever, a cold or have been diagnosed with the Flu, this is the best way to prevent spreading your illness to others.
You get the idea - retraining people to not run the the ED or their PCP at the first sneeze or cough will help keep costs down. Next we need to make sure our providers (MD, NP, PA) are using the latest guidelines and evidence based medicine when treating their patients. This means not prescribing antibiotics for colds or stuffy heads or sore throats without any evidence the patient has a bacterial infection. Many times the patient will drive how the PCP practices because they come into the office and state "I know I have a sinus infection and I need an antibiotic" - the provider is the one who needs to perform an exam, run any pertinent tests i.e. rapid Strep A or Flu test, sinus or chest X-ray, before they prescribe an antibiotic or antiviral. I know sometimes it is just quicker and easier to not argue with the patient and write the prescription and go on to the next patient, but is this the best evidence-based practice? I recently read that Physician prescribing of antibiotics for Acute Respiratory Illnesses is down http://firstwatch.jwatch.org/cgi/content/full/2009/819/3 but the use of stronger antibiotics is up, which is not without it's risks. I am hopeful the trend to not prescribe antibiotics for a virus will continue to go down. We don't need to give any unecessary medication that can cause more problems than good.
If the providers will stand up to their patients and take a few minutes to educate them on their symptoms and what the patient can do to feel better before prescribing an antibiotic they will probably have healther patients who won't come in for every sniffle or cough. I can't tell you the number of people who have told me they have gotten over an illness without an antibiotic and simply used an over-the-counter (OTC) saline nose spray and drank plenty of water and rested.
If people are more educated on common illnesses, what they can safely take for their different symptoms, and when to seek medical care then we will have more health-smart patients that will save the insurance companies money.
One idea I have is for a provider to develop a list of common OTC medications, what they are used for, and when to take them/stop them. Then when their patients come in for a physical or illness then the PCP can hand them the list with the appropriate OTC's checked off that the patient can safely take considering their medical history. For instance the list could contain Ibuprofen, acetaminophen, pseudoephedrine, diphenhydramine, guiafenisen, dextromethorphan, saline nasal wash, loratadine, cetirizine, etc... next to each item is a description of what the medication is used for, what it will do for the patient and any pertinent side effects plus how much to take and how often. Then when a patient comes in and has a stuffy and runny nose, sneezing and headache but no fever or cough and it is determined the patient has a cold (upper respiratory illness) - the PCP can check off saline nasal wash, and any other products they feel will help and write how each should be used and how often. Another example would be to hand this sheet to your healthy patient and mark the medications they can safely take and how each is used for the next time they come down with any symptoms. The sheets would need to be specific for each patient according to their medical history.
Another point I would like to mention in health reform is what a patient needs to have ready when they have a visit with their PCP or any medical provider. This website has a nice list - http://www.abms.org/who_we_help/consumers/educate.aspx. This basically tells the patient how to have a smart visit with their PCP such as be ready to list your current and past illnesses, have a list of your current medications (including OTC, vitamins, herbals and Rx), pertient family history, why specifically you are there to see the provider. The last part seems to be hard for some people because they don't go to their provider very often and aren't sure what information is important and what isn't. Basically the provider wants to know:
1) When did your current problem start
2) What was your first symptom (i.e. headache, fever, body aches, pain in my stomach etc.)
3) What happened next and what did you take for your symptoms
4) did the medication you took help your symptoms
5) What makes it worse or better
6) Have you had the symptoms before and if so what was your diagnosis if there was one
7) Do you have any idea what caused it? (such as your daughter was diagnosed with strep last week and now you have a sore throat and fever, or several people in your office have the Flu, or I was working in the garden and when I got up my lower back started to hurt and spasm).
This small amount of information will help the provider narrow down what they will focus on and they won't have to play detective and dig for the information needed.
Now that Health reform is frequently the biggest topic in the news I found some wonderful websites that can be used as resources for anyone interested in what is being discussed, debated and critiqued. These were found in the Austin American Statesman on August 30, 2009. Just note if you type in the URL it is cAse SEnSitIvE so be careful when you transcribe it.
Interactive tools that show outcomes of different policy options (I found this to be quite interesting) http://bit.ly/ayVfn
Compare how competing proposals deal with key issues http://bit.ly/1jmVR
Washington Post's indepth coverage of the debate and the issues http://bit.ly/mdCHa
Glossary of health care terms and phrases http://bit.ly/L15cE
Do prominent voices in the debate have their facts straight? http://bit.ly/415OC
http://bit.ly/IJTG5
Obama administration's Web site http://bit.ly/1BOvjg
Full text of House bills http://bit.ly/ldzqU
http://bit.ly/tqQ3Z
Long-term study of wasteful medical spending in Texas and other states http://bit.ly/3GsgNx
Congressional Budget Office information http://bit.ly/1BOvjg
I hope these sites provide some good information and education for everyone interested in healthcare and the health of our nation!!
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