Hospital readmissions on the rise

Word on Health was shocked to learn that 1 in 10 adult Medicaid patients who were hospitalized in 2007 for a medical condition, other than childbirth, had to be readmitted at least once within 30 days of their initial hospital stay.

The Agency for Healthcare Research and Quality also reported that Medicaid patients are 70% more likely to be readmitted compared with their privately insured counterparts.

The number of underlying health problems appears to correlate with the frequency of readmission. For example, 14% of Medicaid patients with 3 or more underlying health problems were readmitted compared with 10% of those who had no other health problems.

These high hospital readmission rates have been drawing increasing attention from policymakers because they have a significant impact on health care costs. Additionally, they may reflect issues with the standards of health care provided in hospitals as well as a lack of discharge planning and outpatient follow-up.

SRxA has developed a number of innovative disease education and patient management programs specifically designed to:

• improve health
• increase adherence and compliance to medical advice and medications
• decrease the health care burden to society.

Contact us today for further information.

Depression – an Inflammatory Disease?

SRxA’s Word on Health brings you a chicken and egg type conundrum to start your day.

Up to 40% of people who are chronically ill get depressed.  Depressed people are prone to a variety of medical illnesses including diabetes and coronary heart disease.

So which comes first?

A new meta-analysis from researchers at the University of Toronto, published last month in Biological Psychiatry, may provide the answer.

To determine whether pro-inflammatory cytokines play a role in the overlap between depression and inflammation-associated medical disorders, the Toronto group conducted a meta-analysis of 24 studies of cytokine levels in 438 unmedicated subjects with major depression and 350 medically and psychiatrically healthy controls.

They found that concentrations of two cytokines: tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6 were significantly higher in depressed patients than in controls. The groups showed no significant differences in other interleukin levels.

IL-6 stimulates differentiation and proliferation of antibody secreting white blood cells while TNF-α  stimulates the release of other pro-inflammatory cytokines and inflammatory prostaglandins. In the brain, these substances result in increased cortisol production; and increased production of a substance that accelerates cell death.  This reduces the resilience of the brain and may contribute to the stress response that is characteristic of depression.

High levels of IL-6 and TNF-α  have also been correlated with depression in patients with cancer, end stage kidney disease, Parkinson’s disease, stroke and a host of other non-infectious conditions.

The results of this study provide further evidence that depression is accompanied by activation of the inflammatory response system and contributes to the development and progression of physical illness.

Which begs the question – will anti-inflammatory drugs prove helpful in managing depression?

Although corticosteroids, used to treat inflammatory conditions, have an initial ‘pick me up’ effect in some patients, over time, the same drugs can provoke depression. Non-steroidal anti-inflammatory drugs (NSAIDs) could be another option, but they may also cause depressing side-effects such as  nausea, vomiting, diarrhea, constipation, headache, and drowsiness.

Word on Health suggests more studies are needed before we start popping more pills!

You Can Control Your Asthma

To mark World Asthma Day, SRxA’s Word on Health spoke exclusively to four of the world’s leading asthma specialists.

In keeping with the “You Can Control Your Asthma” theme of World Asthma Day 2010, we asked these Top Docs to share their #1 piece of advice for people with asthma.

Allan Luskin MD, Chair of the National Asthma Education and Prevention Program is adamant “Asthma can be controlled -accept nothing less.”

The Madison, WI allergist and immunologist continued “Better isn’t good enough.  Patients should try for “normal’ and for many people that’s achievable.  Normal means they sleep through the night, wake up with a clear chest in the morning, hardly ever need a rescue inhaler, are fully active including whatever exercise they want to do, and are able to get a cold without needing an urgent visit to the office or ER and using medication with no significant side effects.”

Bill Storms MD, Clinical Professor at the University of Colorado Health Sciences Center and Director of the Research Center at the William Storms Allergy Clinic in Colorado Springs, CO says succinctly “Take your meds on a preventative basis, not as needed.”

World Asthma Day is organized by the Global Initiative for Asthma (GINA) in collaboration with health care groups and asthma educators to raise awareness about asthma and improve asthma care throughout the world.  The first World Asthma Day, in 1998, was celebrated in more than 35 countries. Participation has increased with each World Asthma Day held since then, and the day has become one of the world’s most important asthma awareness and education events.

Michael Kaliner MD, Founder and Director of the Institute for Asthma and Allergy, Wheaton, MD advises, “Most asthma is due to allergies. Having an allergy assessment by a certified allergist can lead to advice about allergy avoidance and consideration for allergy injection therapy. Allergy injections are the only treatment of any kind that can reduce asthma at its root cause.”

Brad Chipps MD, Director of the Capital Allergy and Respiratory Disease Center, Sacramento, CA adds “The most important advice to maintain asthma control is a thorough understanding of what constitutes good asthma control both in impairment (day to day symptoms) and risk (exacerbations) domains. This should be integral of the treatment plan provided to each patient.”

Four excellent pieces of advice, from four outstanding clinicians.

To learn more about how SRxA can help you to educate patients, physicians or allied health professionals on asthma control and management contact us today.

No No Nitro!

Doctors in the United States wrote more than four million prescriptions for nitroglycerin tablets last year.  Commonly referred to as nitro, these under-the-tongue pills are used to relieve chest pain associated with heart disease (angina) or to stop a heart attack (myocardial infarction).

However, the doctors who prescribed these drugs and the patients who took them have just learned that about 80% of the drugs dispensed had not been approved by the Food and Drug Administration (FDA).

Worse still doctors have no way of knowing whether patients may have suffered unnecessarily as a result.

“If it’s not approved and no one has tested it, we can’t be sure that it’s safe and effective,” warned Dr. Harry M. Lever, a cardiologist at the Cleveland Clinic.

The FDA sent warning letters in late March to suppliers of the unapproved tablets giving them 90 days to stop making the drugs and 180 days to stop shipping them.

The FDA said that it had not examined the quality of the products it was ordering off the market but that it had recorded problems with other unapproved nitroglycerin products in the past. The agency advised people who take unapproved nitroglycerin to continue taking their tablets but to consult their doctors about replacement prescriptions.

The two companies involved: Konec Inc. and Glenmark Generics Inc. said they would comply with the order, but declared that their tablets were safe.

Only one brand of nitroglycerin pills is FDA approved: Pfizer’s Nitrostat.    Pfizer says it has stepped up production of the drug and expects to be able to meet the entire US market demand.