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Health Sense: Group tries to reduce hospital readmissions

Group tries to reduce hospital readmissions

MADISON.com: Under the Affordable Care Act, Medicare penalizes hospitals that have too many readmissions, or admissions within 30 days of discharges, for patients with pneumonia, heart attack and heart failure.

But hospitals aren’t the only places that influence whether patients return. Nursing homes, home health agencies, home care agencies, aging agencies, hospices, pharmacies, ambulance services and others have an impact.

That’s a key motivation for the Dane County Community Transitions Coalition. Started in 2012, the group includes representatives from about 30 facilities or agencies that care for the elderly or chronically ill. The coalition meets monthly in an effort to improve transitions of care and keep readmissions down.

“We’re sending these people home and often they’re falling off the radar,” said Maria Brenny-Fitzpatrick, transitional care program director at UW Health and a co-leader of the coalition.

Preventing patients from returning to the hospital isn’t only about avoiding Medicare penalties. It’s also better for patients, Brenny-Fitzpatrick said. “Readmissions, on the patients, are very traumatic and very difficult,” she said.

One tool the coalition developed is an emergency medical information form that patients or loved ones can keep at home and give to paramedics and emergency room staff when needed.

The form includes major diagnoses, a list of medications and contact information for a care coordinator. It says whether the patient needs glasses or hearing aids to communicate or a cane or walker to walk.

Another information sheet, explaining supportive home care services, was developed by six agencies that provide such care in the county: BrightStar, ComForcare, Comfort Keepers, Home Instead, Midwest Home Care and Senior Helpers.

Other handouts focus on heart failure, when the heart doesn’t pump enough blood. One includes warning signs that should prompt patients to call a doctor or nurse, such as trouble sleeping or shortness of breath with regular activity. The handout also includes “red zone” symptoms requiring a 911 call, such as chest pain or a fainting spell.

In a related effort, Safe Communities of Dane County and the Wisconsin Institute for Healthy Aging plan to offer a Living Well workshop next spring focusing on heart failure.

Living Well workshops “build participants’ confidence in their ability to manage their health condition to maintain active and fulfilling lives,” according to the institute’s website. For more information about the workshops, contact Lynne Robertson, Safe Communities’ outreach specialist, at 608-836-9810 or lynnerob@charter.net.

Dane County’s readmission rate, of about 37 per 1,000 Medicare beneficiaries, hasn’t changed much in recent years. It’s lower than the state and national averages but higher than two-thirds of counties in Wisconsin.

Alzheimer’s research

I wrote an article in November about a study at UW Hospital of whether an experimental drug can protect healthy seniors whose brain scans show signs of risk for Alzheimer’s disease.

Now UW Hospital is part of a different study to see if another drug might slow the progression of the disease in people with mild to moderate Alzheimer’s. Patients who are ages 55 to 85 and have been taking the drug Aricept for at least six months might be eligible.

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Home Care in Switzerland

Home care continues its negative showing due to maturity and pressure from private label

Sales of home care registered retail value declines across many categories in 2013, in part due to the maturity of a number of categories, such as laundry care, and the pressure from private label on value sales. While private final consumption grew at a fairly healthy level in 2013, consumers continued to display a strong preference for value-for-money home care. A further obstacle to growth was the strength of the Swiss Franc, which continued to provide a strong incentive for cross-border sales.

Home care continued to be heavily impacted by declining unit prices across virtually all categories as competition from private label and between branded manufacturers remained fierce. The strength of retail giant Migros’ private label continued to be detrimental to unit prices, given the fact that the retailer offers a large and popular range of value-for-money home care. Another source of pressure was the higher inflow of cheaper imports from the EU/EEA following the opening of the Swiss market in July 2012. In the face of growing competition from private label and cheaper imports, branded manufacturers responded with more frequent price promotions, thereby adding further downward pressure on unit prices.

Private label and large multinationals compete vigorously

Although there is a fairly large number of players present in Swiss home care, the majority of sales remained in the hands of private label and a small number of leading global players. The most significant player remained Swiss retail chain, Migros, with its private label range of home care accounting for the largest value share in 2013, and resulting in overall private label being ahead of branded products. After private label, the three leading global players, Unilever, Procter & Gamble and Henkel, took the leading positions, relying on their well-known global brands.

Discounters continues to gain but supermarkets remains the strongest channel

In line with the growing demand for private label home care, discounters registered the fastest growth in value sales in 2013. This was particularly detrimental to the value share of health and beauty specialist retailers and traditional grocery retailers, but also supermarkets and hypermarkets felt the pinch. The growing strength of discounters was further underpinned by the fierce outlet expansion pursued by German discounter chains, Lidl and Aldi, which in turn also put pressure on domestic discounter chain, Denner. However, in absolute terms, supermarkets remained the most important channel in home care in 2013, supported by the strong performance of the private label ranges of leading supermarket chain, Migros.

Lack of demand for premium products expected to hamper future sales of home care

Sales of home care are expected to register a stagnant performance in constant value terms at 2013 prices over the forecast period. While demand will remain positive across most categories, consumers are expected to grow increasingly reluctant to spend on premium products, especially in view of the growing availability of higher-quality private label alternatives. The uncertain outlook for Switzerland’s economic performance is further expected to impact consumers’ spending decisions to the detriment of home care. In addition, growing price competition between manufacturers, retailers and private label, especially following the recent opening of the Swiss market to cheaper imports from the EU and EEA, will result in unit price declines across virtually all categories, thus adding further pressure on value sales.

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Reality check-up for health care in Canada

Reality check-up for health care in Canada

Canada’s health care system has had an unhealthy cough for years and it’s not getting better on its own.

According to the Fraser Institute the median wait time for treatment after seeing a doctor is now 18.2 weeks. So, on Jan. 1, your doctor tells you that discomfort on your backside might be a disorder that causes you to grow a tail. He refers you to a specialist who confirms the diagnosis. Alarming news for sure.

You could try to manage your condition but you’ve noticed that your golden retriever is forever coming home with twigs and brambles in his tail, which would be embarrassing in an office setting. So, you opt for the surgery. Then your specialist delivers the bombshell. You can’t get in until May.

You briefly consider going to a veterinarian before accepting that you have to live with the pain and embarrassment. You will need to get your pants altered.

Now, please understand that the situation I have described is not based on an actual case. I use it only to illustrate the seriousness of the situation in Canada. In 1993 the same process would have taken 9.3 weeks, or about half as long as it does today. Doctors tells us the median time between seeing a specialist and getting treatment is three weeks longer than is “clinically reasonable.” This is health care in Canada.

Note too that spending on health care is rising. Depending on the province it may now consume as much as half of all provincial spending. The polls tell us that timely access to health care is always the public’s first or second priority. And yet after 20 years, many great speeches and campaign promises and trillions of dollars in government spending, the time it takes to access treatment has essentially doubled.

Let’s get specific and look at one medical condition and one province. Consider lung cancer treatment in Alberta.

On Dec. 15, 2011, Alberta Health Services announced “the Expedited Management of Lung Cancer Program aims to ensure that, by March 2013, 75% of patients will wait no longer than 30 days from the time of referral from their primary care physician to when a treatment decision is made, and 60 days from the time of referral from their primary care physician to surgery.” They proclaimed it a “top priority” and allocated $15 million to make it happen.

But on March 27, 2014, the Canadian Institute for Health Information announced that the average wait time in Alberta between a specialist booking a date and the actual surgery was 85 days vs. 49 days, the national average. An epic fail.

I am not picking on Alberta. If the average wait times in Canada have doubled over the last 20 years then Alberta is clearly not alone. Canada’s health care system does not provide timely care and it’s not financially sustainable. Baby boomers are retiring in huge numbers. We are losing them as big taxpayers and gaining them as big patients.

There are a range of possible solutions. We shouldn’t shrink from discussing them just because they challenge old beliefs, many of which are crumbling under the weight of reality.

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Healthy living facts

Healthy living facts

This article is designed to give tips to readers about how they can improve or augment actions in their life to have a healthy lifestyle; it is not meant to be all inclusive but will include major components that are considered to be parts of a lifestyle that lead to good health. In addition to the tips about what people should do for healthy living, the article will mention some of the tips about avoiding actions (the don’ts) that lead to unhealthy living.

“Healthy living” to most people means both physical and mental health are in balance or functioning well together in a person. In many instances, physical and mental health are closely linked, so that a change (good or bad) in one directly affects the other. Consequently, some of the tips will include suggestions for emotional and mental “healthy living.”

Eating (diet)

All humans have to eat food for growth and maintenance of a healthy body, but we humans have different requirements as infants, children (kids), teenagers, young adults, adults, and seniors. For example, infants may require feeding every four hours until they gradually age and begin to take in more solid foods. Eventually they develop into the more normal pattern of eating three times per day as young kids. However, as most parents know, kids, teenagers, and young adults often snack between meals. Snacking is often not limited to these age groups because adults and seniors often do the same.

Tips:

  • Eat three meals a day (breakfast, lunch, and dinner); it is important to remember that dinner does not have to be the largest meal.
  • The bulk of food consumption should consist of fruits, vegetables, whole grains, and fat-free or low-fat milk products.
  • Choose lean meats, poultry, fish, beans, eggs, and nuts (with emphasis on beans and nuts).
  • Choose foods that are low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars; look at the labels because the first listed items on the labels comprise the highest concentrations of ingredients.
  • Control portion sizes; eat the smallest portion that can satisfy hunger and then stop eating.
  • Snacks are OK in moderation and should consist of items like fruit, whole grains, or nuts to satisfy hunger and not cause excessive weight gain.
  • Avoid sodas and sugar-enhanced drinks because of the excessive calories in the sodas and sugar drinks; diet drinks may not be a good choice as they make some people hungrier and increase food consumption.
  • Avoid eating a large meal before sleeping to decrease gastroesophageal reflux and weight gain.
  • If a person is angry or depressed, eating will not solve these situations and may make the underlying problems worse.
  • Avoid rewarding children with sugary snacks; such a pattern may become a lifelong habit for people.
  • Avoid heavy meals in the summer months, especially during hot days.
  • A vegetarian lifestyle has been promoted for a healthy lifestyle and weight loss; vegetarians should check with their physicians to be sure they are getting enough vitamins, minerals, and iron in their food.
  • Cooking foods (above 165 F) destroys most harmful bacteria and other pathogens; if you choose to eat uncooked foods like fruits or vegetables, they should be thoroughly washed with running treated (safe to drink) tap water right before eating.
  • Avoid eating raw or undercooked meats of any type.

Tips for special situations:

  • People with diabetes should use the above tips and monitor their glucose levels as directed; try to keep the daily blood glucose levels as close to normal as possible.
  • People with unusual work schedules (night shifts, college students, military) should try to adhere to a breakfast, lunch, and dinner routine with minimal snacking.
  • People who prepare food should avoid using grease or frying foods in grease.
  • People trying to lose weight (body fat) should avoid all fatty and sugary foods and eat mainly vegetables, fruits, and nuts and markedly reduce his/her intake of meat and dairy products.
  • Seek medical advice early if you cannot control your weight, food intake, or if you have diabetes and cannot control your blood glucose levels.

Physical activity and exercise

Physical activity and exercise is a major contributor to a healthy lifestyle; people are made to use their bodies, and disuse leads to unhealthy living. Unhealthy living may manifest itself in obesity, weakness, lack of endurance, and overall poor health that may foster disease development.

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October 10, 2015 / Posted by / Healthy living facts