Supply Disruptions Hurting Home-Based Medical Care
Americans should be deeply concerned about our “sick-care” health system. The system is designed to withhold the best medicines, medical devices, and operations until their health deteriorates, and then belatedly, rescue care is offered.
It’s a penny-wise, pound-foolish approach to clinical care that puts patients at risk. There’s a far better alternative.
A truly patient-centric healthcare system would assess patients’ risk for heart attacks, diabetes, and other serious conditions, and then devote resources to preemptively reduce that risk while improving their quality of life. The current system limits access to care in the name of short-term savings, and ironically increases long-term spending.
Nowhere is this clearer than our approach to prescription drugs.
Politicians can get guaranteed applause by promising to slash the cost of medicines.
And this political drumbeat is increasingly reflected in policy efforts, whether it is the executive branch attempting to link drug prices in our country to those of other nations that employ government price controls, congressional legislation that would give the federal government greater price-controlling powers over drugs in the Medicare program, or a greater reliance on institutions like the Institute for Clinical and Economic Review (ICER) that assigns a financial value to a person’s life in determining whether to grant patients access to innovative treatments.
We need to pursue a patient-risk framework that will accelerate the delivery of breakthrough treatments to those who need them most. Healthcare providers should use data analytics and clinical assessments to score the health risk for each patient and devote the necessary medical resources to reduce that risk.
Just consider how that’d change our approach to a disease like diabetes, which is particularly prevalent in minority communities. More than 16 percent of Blacks and nearly 15 percent of Hispanics live with the condition, compared to less than 12 percent of whites.
All told, it cost our country over $237 billion in direct medical costs in 2017. Of that, about $15 billion was spent on insulin, which helps patients keep the disease under control and live relatively normal lives.
A true healthcare system would conduct regular screenings for the roughly one in three Americans who are pre-diabetic and make it easy for patients to access medications.
Instead, our current sick-care system forces diabetes patients to pay a considerable share of insulin costs out of pocket. Many can’t afford it. Over 13 percent of diabetes patients have skipped medications or not filled prescriptions due to cost concerns.
As a result, they often suffer the worst complications. Lower limb amputations, which about 70,000 Americans with uncontrolled diabetes require each year, cost about $70,000 apiece.
In other words, we spend roughly $5 billion cutting off people’s feet and toes. That doesn’t begin to count the expenses associated with other complications, from kidney disease to blindness.
The old saying, “an ounce of prevention is worth a pound of cure,” really is true. According to the CDC, “effective blood sugar management can reduce the risk of eye disease, kidney disease, and nerve disease [resulting from uncontrolled diabetes] by 40 percent.”
If we don’t do more to predict patients’ health risks and then improve outcomes, then the trillions we invest in transportation, housing, energy, education, environment, and food have limited value.
At a time when historic progress is being made in treating diseases from cancer to Alzheimer’s, it makes little sense to focus narrowly on cutting drug costs rather than viewing healthcare spending holistically.
Gary A. Puckrein is president and chief executive officer of the National Minority Quality Forum.
The benefits of travel are enumerable, and I’m seeing many social media posts from friends and family who are venturing back onto planes and trains this summer. However, as anyone who has traveled in the past 10 years knows, travel has always had its downsides, even pre-pandemic.
What increases the risk of catching a virus or infection during air and train travel?
Surprisingly, it’s not what you may think. Most people tend to focus on the air quality. While it’s true that infections can be spread through air droplets, a plane’s air is actually filtered more than a movie theater’s or sporting event venue’s.
According to a study in 2007 by Charles Gerba, professor of environment microbiology at the University of Arizona, it’s the surfaces on the airplane that create the greatest risk of picking up bacteria and viruses. The surfaces that harbor the most microbial pathogens are tray tables, bathrooms, and seats – especially arm rests.
If you could avoid contact with your face after touching the surfaces on an airplane, you could significantly reduce transmission. However, it is almost impossible not to touch your face.
In medical school, during one lab, the professor put a powder that could only be seen with UV lighting on our books. At the end of class, the professor used an ultraviolet light and confirmed that everyone had touched their face at least once – and most of us repeatedly.
Preventing viruses and infections
The most reasonable approach is to carry antimicrobial wipes to clean the surfaces of the hand rests and tray tables. Wash your hands after using the bathroom. Use hand sanitizers before you eat. You might also put a napkin over the tray table to avoid touching the surface.
Fortunately, most infections are not life-threatening, but rather a short-term inconvenience.
Deep vein thrombosis (DVT) and pulmonary embolism (PE) risks
More serious is a DVT, which is also referred to as “economy class syndrome,” because it occurs most often when sitting for long periods of time in cramped spaces. The risk of a DVT is increased by as much as two to four times on long-haul flights.
DVTs are more likely for travelers who have other risk factors, such as obesity, heart failure, cancer, increased age or recent major surgery. A 2001 New England Journal of Medicine study found that flights greater than 3600 miles cause increased risk of a DVT and PE. This limits the risk to mostly international flights and those traveling from the east coast to Hawaii. Unfortunately, DVTs and PEs can be life-threatening, if untreated.
Prevention of DVTs
When on a flight of more than five hours, make sure you walk or move around every one to two hours. Hydration is also critical to decrease clot risk. Another easy solution is below the knee compression stockings, which have been shown to decrease risk dramatically.
What about the role of stress?
Travel increases stress for many. Acute stress tends to increase the risk of hypercoagulability, or clots, and thus the risk of cardiovascular disease.
Chronic stress may also cause people to be more susceptible to infection, including the common cold.
Biofeedback, which involves deep breathing and meditation, is a great way to reduce both chronic and acute stress while traveling.
Though there are no guarantees, take these precautions to minimize the risks of infection, DVT/PE and increased stress. Also, take it to heart the next time you hear the captain and flight attendants tell you to sit back, relax and enjoy the trip.