Post Medical Job

Do you have a permanent (full-time or part-time) opening for a high-quality medical specialist? Click Here to post More »

Post Your Resume Here

Are you a healthcare professional working long 12 -14 hour days, too many weekends and holidays, or traveling too far from home? Are you not home for dinner usually or not able to spend enough quality time with your family More »

About US

NSI Healthcare Recruiters is one of the most trusted and reliable recruitment and placement services available to medical professionals in the USA. NSI has been in business for over 29 years and has assisted many healthcare providers in locating and hiring qualified medical professionals. More »

Contact Us

Candidates: Because our posted healthcare jobs are filled quickly we ask that you contact us for the latest updates. Employers: Please post your job here for affordable placement service. More »

Health-Care-Recruiter.com

We at Health-Care-Recruiter.com pride ourselves on the highest quality, personalized-service that medical facilities and medical job applicants alike have come to expect from us. pride ourselves on the highest quality, personalized-service that medical facilities and medical job applicants alike have come to expect from us. More »

 

Daily Archives: July 20, 2016

Study: Medicare Beneficiaries May Face ‘Treatment Gap’ For Painkiller Abuse, Misuse

When most people think of the victims of the nation’s opioid abuse epidemic, they seldom picture members of the Medicare set.

But a research letter published Wednesday in JAMA Psychiatry found Medicare beneficiaries had the highest and most rapidly growing rate of “opioid use disorder.” Six of every 1,000 recipients struggle with the condition, compared with one out of every 1,000 patients covered through commercial insurance plans.

The letter also concluded that Medicare beneficiaries may face a treatment gap. In 2013, doctors prescribed a high number of opioid prescription painkillers for this population — which put patients at risk for addiction — but far fewer prescriptions for buprenorphine-naloxone, the only effective drug therapy for opioid use disorder covered by Medicare Part D.

“The take home message is we have very effective treatments,” said Anna Lembke, one of the research letter’s authors and assistant professor at the Stanford University School of Medicine. “But they’re not widely accessible.”

Researchers analyzed 2013 Medicare Part D claims to count the number of prescriptions for Schedule II opioids and buprenorphine-naloxone. The latter drug curbs addiction by partially stimulating the same brain receptors as a stronger opioid, but with a lower risk of overdose.

Use Our Content
This KHN story can be republished for free (details).

The data showed the number of doctors who prescribed buprenorphine-naloxone equaled less than 2 percent of the 381,575 prescribers responsible for 56,516,854 Schedule II opioid claims. For instance, the researchers found that for every 40 family physicians prescribing pain killers, only one family physician prescribed the addiction management drug.

The letter also found states in the northeast, including Maine, Massachusetts and Vermont, had the highest ratio of buprenorphine-naloxone claims in the country, more than Ꮼ times the national average.

In the last decade, the incidence of opioid addiction in the United States has reached crisis levels. According to the latest data from the Centers for Disease Control and Prevention, more than 19,000 Americans died from prescription opioid overdoses in 2014.

More than 300,000 Medicare recipients battle with opioid use disorder, according to the study. Among beneficiaries, hospitalizations due to complications caused by opioid abuse or misuse increased 10 percent every year from 1993 to 2012.

Lembke said part of the reason doctors do not prescribe more addiction management medications is because they view the problem as one of medicine’s lost causes.

“Doctors feel helpless and hopeless when it comes to addiction,” she said. “They feel that nothing can be done for them.”

And Medicare patients face additional obstacles when it comes to addiction treatment. First, Part D, Medicare’s prescription drug program, only covers buprenorphine-naloxone. Other effective treatments such as methodone are not covered, posing a barrier to access, said Lembke.

Buprenorphine-naloxone also usually requires prior authorization before a patient can receive the treatment. In addition, in order to prescribe it, physicians must take an 8-hour class, apply for a waiver and receive a special Drug Enforcement Administration number in addition to his or her regular DEA registration number. It becomes a hassle many medical professionals do not feel is worth the time, said Dr. Jonathan Chen, co-author of the study and instructor at Stanford.

“Why is it hard to [prescribe buprenorphine-naxolone], yet so easy for me to hand out things that get people dependent in the first place?” he said.

A different JAMA study found only 2 percent of doctors nationwide had obtained the authorization needed to prescribe the medication in 2014. And over half of the nation’s counties did not have a health provider with the ability to prescribe the medication.

But the letter’s authors note that physicians who prescribe opioid painkillers have in place a relationship with their patients that makes them well-positioned — with some additional training — to take steps to intervene when opioids are being misused.

“The bottom line is it’s a heck of a lot more work to get patients off of opioids than to get them on opioids,” said Lembke.

KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

For Surgeons, Talking About Adverse Events Can Be Difficult: Study

Dr. Thomas Gallagher has been through many tough conversations with patients. He remembers once standing in front of a patient and the patient’s family, preparing to tell them about a mistake that had occurred.

“This is a topic I think about all the time and it was still very nerve-racking and embarrassing,” said Gallagher, an internist and a professor at the University of Washington’s medical school specializing in quality and patient safety issues. The patient had been sent to another clinic an hour away to get an MRI, but because of a miscommunication, the MRI was done in the wrong area of the body and would have to be repeated.

“The patient was disgusted,” Gallagher recalled about the event that occurred before he came to Washington. “His family was furious … that after all the patient had gone through to get this test … we still couldn’t even figure out something this basic.”

Use Our Content
This KHN story can be republished for free (details).

Medical mistakes often happen. National guidelines call for doctors to provide full disclosure about adverse events, and studies have shown that those discussions benefit patients. But new research finds that the act of disclosure, combined with stress from the procedure gone wrong, can be an anxious experience for some doctors — and more training is needed to help them engage in these difficult conversations.

The study, published in JAMA Surgery Wednesday, examines what surgeons tell patients and what effect those discussion can have on the doctor.

“For a long time in the field, people thought that the primary reason that physicians have trouble reporting adverse events is that they were worried about being sued, but there are other barriers that are more important,” said Gallagher, one of the authors of the study. “This paper helps highlight how embarrassing and upsetting these events are for clinicians … (and) makes it difficult for the physician to admit to the patient, ‘Here is exactly what happened.’”

Friendly female doctor hands holding patient hand lying in bed for encouragement, empathy, cheering and support while medical examination. Bad news lessening, compassion, trust and ethics concept

The researchers used surveys of surgeons who reported adverse events at three Veterans Affairs medical centers. They found that about 90 percent of the surveys showed that doctors said they had disclosed the event to patients or their families within 24 hours, expressed concern for the patient’s welfare, explained why the event happened, expressed regret and discussed with patients steps to treat subsequent problems.

But only about half showed the doctors discussed whether the event was preventable and a third reported they talked about how it could be avoided in the future. Just over half apologized to the patient.

The study also reported that those surgeons who find an event very or extremely serious and who had difficulty discussing that event are more likely to suffer anxiety over the experience. That was also true of surgeons who feared negative reaction from patients, an impact on their reputations, bad publicity or a malpractice suit.

“These surgeons who have volunteered to participate probably feel very comfortable talking to patients compared to those who didn’t participate, and even among these surgeons there was a lot of anxiety,” said A. Rani Elwy, an associate professor at Boston University and an investigator and researcher at the VA Boston Healthcare System who was the lead author of the study. “I can only imagine it is much more accentuated among the bigger population.”

Initial questionnaires were administered to 67 surgeons between January 2011 and December 2013. Of those doctors, 35 contacted the researchers during the study period to report adverse events and filled out 62 individual surveys on those events. Surgeons could complete up to three surveys for the study.

Elwy said that the VA surgeons who participated in the study had not been taught how to deal with patients on these situations and the study called for more training to create a “culture of professionalism” that will help surgeons better handle patients’ needs and allow for “self-care following disclosures [that] may also increase surgeons’ well-being.”

“Lots of clinicians don’t feel comfortable about these conversations, and doctors say they don’t know what to say, they don’t know how to say it,” Gallagher said. “I’ve had no training on having these conversations in medical school or residency.”

That’s also a concern of Dr. Marjorie Stiegler, an associate professor of anesthesiology at University of North Carolina at Chapel Hill who was not associated with the study.

“Every physician, perhaps every clinician, at some point will have some kind of adverse event,” she said, adding, “It’s never easy to break bad news to a family member of a loved one.”

She wrote an article in JAMA in 2015 arguing for more awareness of physicians’ well-being when faced with clinical adverse events. She noted a study that found physicians were twice as likely to commit suicide than the general population and a survey documenting post-traumatic stress disorder symptoms among anesthesiologists involved in surgical deaths.

Gallagher said that in the case of the botched MRI he apologized to the patient and tried to help the family figure out the next steps.

“At the end of the conversation, while they were unhappy, they felt like they were getting care at an organization that would tell them if there was a problem,” he said.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Viewpoints: Obamacare Court Challenges Continue; Examining The GOP Platform

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Perspectives On Drugs Costs: A Misunderstanding About ‘Sunk Costs’; Insurers’ Role In Pricing

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

How Much More Do Americans Pay For A Drug Than Others Around Globe? Report Quantifies Gap

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

State Highlights: Midwives Seek Licenses To Practice In More States; Minn. Reports Whooping Cough Rise

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

HIPPA Hasn’t Kept Up With Apps And Wearable Fitness Trackers, Report Finds

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Maryland Changes Preferred Opioid Treatment But Critics Say New Drug Is Less Effective

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

30 Years Of Emphasizing Low-Fat Diets May Have Backfired, Study Finds

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

James Watson: Cancer Moonshot Is ‘Same Old People Getting Together … And It’s All Crap’

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS