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Irene Jansen

A rampant prescription, a hidden peril - Boston.com - 0 views

articles.boston.com/...chotics-skilled-nursing-center

overutilization drugs ltc us restraints

shared by Irene Jansen on 30 Apr 12 - No Cached
  • Ledgewood is one of many nursing homes that have commonly used antipsychotic drugs to control agitation and combative behavior in residents who should not be receiving the powerful sedatives.
  • Federal data show that roughly 185,000 nursing home residents in the United States received antipsychotics in 2010 contrary to federal nursing home regulators’ recommendations
  • The drugs, which are intended to treat severe mental illness such as schizophrenia, can leave people in a stupor. The US Food and Drug Administration has issued black-box warnings - the agency’s most serious medication alert - about potentially fatal side effects when antipsychotics are taken by patients with dementia.
  • ...1 more annotation...
  • Freedom of Information Act request
  • Irene Jansen on 30 Apr 12
     
    From elsewhere in the article: more than one in five nursing homes in the United States, antipsychotics are administered to a significant percentage of residents despite the fact that they do not have a psychosis or related condition that nursing home regulators say warrants their use There is a clear link between the rate of antipsychotic use in a nursing home and its staffing level. state inspectors rarely cite homes for overprescribing antipsychotics. Until 2006, there was a specific citation for overuse of antipsychotics, but that year officials folded that citation into a more generic "unnecessary medication use'' category that pertains to all medicines.
Irene Jansen

Eliminating Waste in US Health Care - - JAMA - 1 views

jama.ama-assn.org/...jama.2012.362.full

sustainability spending us coordination overutilization

shared by Irene Jansen on 19 Mar 12 - No Cached
  • In just 6 categories of waste—overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse—the sum of the lowest available estimates exceeds 20% of total health care expenditures.
  • Obtaining savings directly—by simply lowering payments or paying for fewer services—seems the most obvious remedy.
  • Here is a better idea: cut waste.
  • ...16 more annotations...
  • The literature in this area identifies many potential sources of waste and provides a broad range of estimates of the magnitude of excess spending.
  • The Table shows estimates of the total cost of waste in each of these 6 categories both for Medicare and Medicaid and for all payers.
  • Failures of Care Delivery: the waste that comes with poor execution or lack of widespread adoption of known best care processes
  • this category represented between $102 billion and $154 billion in wasteful spending
  • Failures of Care Coordination: the waste that comes when patients fall through the slats in fragmented care.
  • represented between $25 billion and $45 billion in wasteful spending
  • Overtreatment: the waste that comes from subjecting patients to care that, according to sound science and the patients' own preferences, cannot possibly help them
  • represented between $158 billion and $226 billion in wasteful spending
  • Administrative Complexity
  • represented between $107 billion and $389 billion in wasteful spending
  • Pricing Failures: the waste that comes as prices migrate far from those expected in well-functioning markets, that is, the actual costs of production plus a fair profit.
  • US prices for diagnostic procedures such as MRI and CT scans are several times more than identical procedures in other countries.
  • represented between $84 billion and $178 billion in wasteful spending
  • Fraud and Abuse
  • represented between $82 billion and $272 billion in wasteful spending
  • Addressing the wedge designated “overtreatment,” for example, would require identifying specific clinical procedures, tests, medications, and other services that do not benefit patients and using a range of levers in policy, payment, training, and management to reduce their use in appropriate cases. The National Priorities Partnership program at the National Quality Forum has produced precisely such a list in cooperation with and with the endorsement of relevant medical specialty societies.
Irene Jansen

Is your mum on drugs? -- Moynihan 343 -- bmj.com - 0 views

www.bmj.com/...bmj.d5184.full

drugs seniors overutilization fromdelicious

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Last year the Archives of Internal Medicine published a feasibility study of drug discontinuation among elderly people in Israel,3 with extraordinary findings. Using an established tool, researchers were able to cut the average number of medications in half, from roughly eight to fewer than four per person. Just 2% of discontinued drugs were restarted; no adverse effects of discontinuation were reported; and almost 90% of people reported better health.
Irene Jansen

Three Reasons Why the Boomers Won't Bankrupt the Canadian Health Care System | Viewpoin... - 0 views

www.theepochtimes.com/...health-care-system-168461.html

overutilization

shared by Irene Jansen on 23 Jan 12 - No Cached
  • study after study in Canada over the last 30 years shows that aging exerts only a small and predictable pressure on health care spending (less than one per cent annually from 2010 to 2036).
  • increases in utilization—how many and how often Canadians use health services—are twice as important as aging in increasing costs year by year
  • people are seeing a larger number of doctors overall. In particular, they are being referred to specialists more often.
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  • increased use of diagnostic testing: people are being sent for far more lab tests, CAT scans and other imaging services. For example, about 6 percent more of the population in B.C. had lab tests in 2006 compared to 1997; that is an additional 260,000 people being referred for laboratory services—a hefty additional cost to the health system. There is no reason to think B.C. is different from other provinces in this or any other trend.
  • Do more tests keep us healthier and living longer? And are increased referrals to medical specialists necessary, or the predictable outcome of a poorly organized and overly-burdened system of care?
  • care itself comes with certain risks: all drugs have side-effects, many forms of imaging expose us to radiation, surgeries may have complications, and even the fact of being diagnosed with a chronic condition can have a negative effect on people’s outlook on life
  • more use of specialist services, tests and imaging do not necessarily create better outcomes
Irene Jansen

Hip implant lawsuits pile up - Health - CBC News - 0 views

www.cbc.ca/...ts-lawsuits-chasing-cures.html

technology overutilization

shared by Irene Jansen on 23 Jan 12 - No Cached
  • at least four class action lawsuits have been launched against different hip implant manufacturers
  • Regina-based class action lawyer Tony Merchant says he has hundreds of clients suing manufacturers, primarily over new versions of hip implants.
  • there were effective products on the market that were working for decades before these new products came out
  • ...3 more annotations...
  • Health Canada said of the 33 manufacturers with active licences, 12 have conducted recalls related to hip replacements in the past five years.
  • Regulators such as Health Canada and the U.S. Food and Drug Administration require fairly rudimentary, small studies on devices over a short period of time without a control group
  • like to see a mandatory system to track implant failures and to contact patients
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