In a post on The Health Care Blog, Stephen Soumerai, ScD, Professor of Population Medicine and Director of the Drug Policy Research Group, discusses how high out-of-pocket health care costs for seniors can be tragic because people will opt to go without essential medical care. The “inflation adjustment” recently proposed by the federal government is supposed to decrease the Social Security beneficiary’s income by a few hundred dollars a year. But, in reality, the reduction will amount to $1,600 in cases where the beneficiary is older, poorer, and sicker – punishing those who already have difficulty paying for life’s necessities.
Studies conducted through the Department of Population Medicine have shown that a 50% reduction in drug benefits in New Hampshire for low income, chronically ill seniors backfired. Another study demonstrated that about 30% of disabled Medicare recipients in poor health skip or split pills to make them last longer because they cannot afford prescription drugs which has been shown, by other researchers, to increase hospitalization of heart disease patients by 21%.
Dr. Soumerai further cites financial estimates regarding average retirement savings and estimated average cost of retirees’ out-of-pocket medical expenses from several data sources to make the point that this Social Security cost-of-living adjustment is both flawed and morally unacceptable.
Lead author Larissa Nekhlyudov, MD, MPH, of the HPHC Institute, and her colleagues from other institutions conducted a national survey of over 2200 oncologists and primary care physicians and asked them to select the long-term effects (LEs) they had either observed or had seen reported for five chemotherapy agents used to treat breast and colon cancer.
Differences between clinicians in awareness of specific LEs was described and predictors of physicians’ awareness of LEs associated with the chemotherapy agents was determined using multivariate logistic regression models.
The five long-term effects of specific interest included cardiac dysfunction, premature menopause, secondary malignancies, pulmonary fibrosis, and peripheral neuropathy.
For chemotherapy agent doxorubicin, 55% of PCPs and 95% of oncologists stated they had observed or seen reported cardiac dysfunction as an associated LE. For agent cyclophosphamide, 15% of PCPs and 71% of oncologists identified premature menopause as an LE, and 17% and 62% identified secondary malignancies, respectively. Peripheral neuropathy was identified as an associated LE for paclitaxel by 27% of PCPs and 97% of oncologists and for oxaliplatin, by 22% of PCPs and 97% of oncologists.
The study points out that there is a need for ongoing education about LEs of cancer treatment among all physicians who care for cancer survivors. Since PCPs don’t usually encounter chemotherapy agents and LEs in their clinical practices, oncologists need to communicate information about them.
Emily Oken MD, MPH, Dennis Ross-Degnan ScD, and Jennifer Thompson, along with other team members, developed a Community Wellness Map – an interactive, web-based tool to help residents be more active, eat better, and live a healthier lifestyle. The map provides wellness resources for five towns served by Cambridge Health Alliance (CHA): Cambridge, Somerville, Malden, Everett and Revere. It features a comprehensive list of physical activity, nutrition, and weight management programs, and includes important program details, such as cost, contact information, and eligibility criteria.
The development of this tool was part of a larger effort to improve diabetes prevention for CHA patients and individuals living in the neighboring areas. Other institutions involved in the production of the interactive map were The Harvard Center for Geographical Analysis and the Dana Farber Cancer Institute Health Communication Core.
This project demonstrates it is possible to create mapped community program guides and suggests that such programs have the potential to improve population health management.
The Community Wellness Map is available online for all users. The Welcome Page provides instructions on how to use the program guide and also provides tips for healthy living, including suggestions for activities that can be done within publicly accessible outdoor and indoor public spaces. To access the Community Wellness Map, click here.
Researchers from Harvard Pilgrim Health Care Institute and other institutions found that asthma patients who are started on statins experience fewer asthma-related emergency department visits and decreased oral corticosteroid use. The study will be published Nov. 1 in American Journal of Respiratory and Critical Care Medicine.
The research was based on a large population-based cohort of subjects with asthma drawn from the data of five health plans, including Harvard Pilgrim Health Care. Statin users were matched with non-statin users using characteristics such as age, baseline asthma therapy, site of enrollment, season of enrollment and propensity score. Statin exposure and asthma exacerbations were assessed over a 24-month observation period. The results found significantly decreased odds of asthma-related ED visits and use of oral corticosteroids for statin users compared to non-statin users.
“This study used a large sample to test the effect of statins on asthma symptoms,” said senior author Ann Wu, MD, MPH, of Harvard Pilgrim Health Care Institute at Harvard Medical School. “While other studies on statins and asthma have had mixed results, most were limited by small sample sizes and short treatment periods. These results may be encouraging for the more than 300 million people around the world with asthma, but additional randomized controlled trials are needed to confirm these findings.”