Posted in Access to healthcare, advance-pricing, Consumer-Driven Health Care, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relationship, Economic Issues, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, out-of-pocket costs, Patient Choice, Patient Compliance, Patient Safety, Patient-centered Care, Policy Issues, primary care, The Quadruple Aim, Third-Party Free Practices, Uncategorized, Wait times to see a doctor

More Patients Turning to ‘Direct Primary Care’ | Medscape

Christine Lehmann, MA

February 11, 2020

Having quick access to a primary care doctor 24/7 is very appealing to Mick Lowderman, 56, who is married with two children, ages 10 and 8. He pays a monthly membership fee to AtlasMD, a direct primary care practice in Wichita, KS.

Primary care is built on the long-term relationship between clinicians and patients. A 10- to 15-minute patient visit doesn’t support that relationship, Sullivan says.

When Kevin Boyd, 64, fell on his stairs in Wichita and broke three ribs, he didn’t go the emergency room. Instead, he called Umbehr, who told him to come to his office. He referred Boyd nearby for an X-ray and dispensed pain medications at his office. The total cost was $70.

In contrast, the first time Boyd fell and broke his ribs, he had Blue Cross Blue Shield and drove himself to the ER, where he saw the ER doctor, a radiologist for an MRI, and got shots for his pain. The total bill was $14,000, and he paid $2,600.

“I don’t put off care the way I used to because of the money I save,” says Boyd, who joined AtlasMD in 2015.
For his monthly membership fee of $75, Boyd gets several benefits, including unlimited 24/7 access to Umbehr by text, email, or phone, extended same- or next-day office visits, and free diagnostic tests and office procedures, such as EKGs, DEXA scans, and body fat analysis. If Boyd gets really sick and needs a house call, or if he needs a phone consult when traveling, those are also included in the fee.
Posted in Disease Prevention, Nutrition, outcomes, outcomes measurement, Prevention, Uncategorized, Unsettled Science

Filter Coffee Tied to Lower Diabetes Risk in Metabolomics Study

Adults who drank two to three cups of filtered coffee a day (the highest quartile of filtered coffee–metabolite score) had a 58% lower risk of developing type 2 diabetes within 10 years than those who drank fewer than one cup of filtered coffee a day (lowest quartile) after adjusting for multiple confounders (odds ratio, 0.42; 95% confidence interval, 0.23 – 0.75).

The protective effect of drinking this high amount on the risk of developing type 2 diabetes was not seen with boiled coffee.

https://www.medscape.com/viewarticle/923238

Posted in Disease Prevention, Education, outcomes measurement, Patient Safety, Policy Issues, Uncategorized, Unsettled Science

All Young Cannabis Users Face Psychosis Risk

mscp-logo6910823767906072364RI-CLPMs use a multilevel approach to test for within-person differences that inform on the extent to which an individual’s increase in cannabis use precedes an increase in that individual’s psychosis symptoms, and vice versa.

The approach provides the most rigorous test of causal predominance between two outcomes, said Conrod.

“One of the problems in trying to assess a causal relationship between cannabis and mental health outcomes is the chicken or egg issue. Is it that people who are prone to mental health problems are more attracted to cannabis, or is it something about the onset of cannabis use that influences the acceleration of psychosis symptoms?” she said.

The study revealed statistically significant positive cross-lagged associations, at every time point, from cannabis use to psychosis symptoms reported 12 months later, over and above the random intercepts of cannabis use and psychosis symptoms (between-person differences). The statistical significances varied from P < .001 to P < .05.

Cannabis use, in any given year, predicted an increase in psychosis symptoms a year later, said Conrod.

A limitation of the study was that cannabis use and psychosis symptoms were self-reported and were not confirmed by clinicians. However, as the authors note, previous work has shown positive predictive values for such self-reports of up to 80%.

Commenting on the findings for Medscape Medical News, Robert Milin, MD, child and adolescent psychiatrist, addiction psychiatrist, and associate professor of psychiatry, University of Ottawa, said…”The study is at the forefront because it is specifically looking to measure psychosis symptoms and cannabis use in adolescents, and the model they are using strengthens the study,”

That model uses “refined measures or improved measures to look at causality, vs what we call temporal associations,” he said.

Posted in Disease Prevention, Nutrition, outcomes, outcomes measurement, Prevention, primary care, Uncategorized

Carbs May Be Intrinsically Bad, Regardless of Weight

This week , another nail in the carbohydrate coffin as a small but rigorous study appearing in JCI Insight suggests that a low-carb, high-fat diet improves the metabolic syndromeeven when weight doesn’t change.[1]

 

Source: Carbs May Be Intrinsically Bad, Regardless of Weight

Posted in Disease Prevention, FDA, Government Regulations, outcomes, Patient Safety, Policy Issues, Uncategorized, Unsettled Science

Is the Sunscreen Scare Legitimate?

But just because something gets into your body doesn’t mean it’s bad for you. I know these compounds have chemical names, but the assumption that artificial compounds are worse for you than all of the other stuff we put in our bodies is known as the “naturalistic fallacy.” By way of comparison, the average blood level of caffeine after a cup of coffee is 50 times higher than the peak concentration of oxybenzone seen in this study. But that oxybenzone level is about seven times higher than the blood nicotine level seen after smoking a cigarette.

In other words, the fact that you can measure something in the blood doesn’t tell you anything about whether it is bad for you. We simply don’t know what the risk is. And we need to find out.

Personally, I wouldn’t call for a freeze on chemical sunscreens. These drugs have been used for decades and there have been no strong epidemiologic signals of harm. Quite the opposite, they have probably prevented uncounted cases of skin cancer.

The problem with studies like these is that the fear they engender may do more harm than the good science that results from them. Nothing has changed about the harm of UV rays since the publication of this study in JAMA; you still don’t want your skin exposed to them.

https://www.medscape.com/viewarticle/913130

Posted in Education, Influence peddling, Pain, Patient Safety, Policy Issues, Quality, Rule of Law, U.S. Constitution, Uncategorized

Female Genital Mutilation: Why Are Doctors Silent?

“…we have seen a trend moving it away from villages and homes, where it has usually been done, and into hospitals, clinics, and private offices. The location change has ushered in a vocational change. Health professionals—doctors and nurses—are now frequently the ones performing this procedure on young girls.[5]

Medicalization is rapidly increasing around the world. For example, in Egypt and Sudan, where FGM/C is nearly universal, almost 80%[5] of procedures are performed by members of the health sector.”

 

 

Why are health professionals, who have sworn to do no harm, participating in a practice that is considered a human rights violation? A recent review[7] of 14 studies conducted in countries where FGM/C is common documented several ways that health professionals rationalize their participation.

https://www.medscape.com/viewarticle/907104

Posted in Access to healthcare, Doctor-Patient Relations, Government Regulations, Medical conditions and illness, outcomes, Pain, Patient Safety, Patient-centered Care, Policy Issues, primary care, Protocols, Uncategorized

The Pendulum Has Swung Too Far

“…an act, a habit, an institution, a law, gives birth not only to an effect, but to a series of effects. Of these effects, the first only is immediate; it manifests itself simultaneously with its cause—it is seen. The others unfold in succession—they are not seen: it is well for us, if they are foreseen…The one takes account of the visible effect; the other takes account both of the effects which are seen, and also of those which it is necessary to foresee. Now this difference is enormous, for it almost always happens that when the immediate consequence is favourable, the ultimate consequences are fatal, and the converse.” ~ Frederic Bastiat


Treating Pain in Primary Care

“If there is ever a case for patient-centered care, it is probably the chronic pain patient, especially the older chronic pain patient,” Vega suggests.

He recalled the case of a 72-year-old retiree with chronic degenerative disease of the spine. “She also had stage IV chronic kidney disease, hypertension, and diabetes, all fairly stable and well-controlled. It would be a huge mistake to put her on chronic anti-inflammatory drugs; acetaminophen doesn’t do enough, and she has trouble accessing physical therapy,” he explained. “What really sets her free is tramadol once a day, which she takes in the morning. And then she uses acetaminophen the rest of the day. When I last wrote her the usual prescription, the pharmacy denied it, saying she didn’t have a chronic condition and was at risk for overdose. They didn’t notify me and she went 10 days without therapy. She finally called me, asking why I had withheld her medicine, and I didn’t know what she was talking about.”

Source: The Pendulum Has Swung Too Far

Posted in outcomes, Uncategorized, Unsettled Science

Probiotics Work for Kids With AGE, Right? Not so Fast!

There was little difference in the numbers of children in each group who developed moderate to severe AGE by day 14 (11.8% of the treatment group vs 12.6% of the placebo group). Differences in the secondary outcomes were also minimal. For example, the duration of diarrhea was 54.3 hours (medium) in the treatment group vs 52.4 hours in the placebo group. The duration of vomiting was essentially 27 hours in both groups. A total of 4.8% of the treatment group vs 4.5% of the placebo group required hospitalization for their illness, and 59.2% of both groups were febrile.

Source: Probiotics Work for Kids With AGE, Right? Not so Fast!