THE COST OF PRIVATIZED HEALTHCARE Tens of thousands of women turn to the ER for fibroid symptoms

Study suggests that many women using emergency care for fibroids may be better served in alternative health care settings

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

Research News 

IMAGE: STUDY SUGGESTS THAT MANY WOMEN USING EMERGENCY CARE FOR FIBROIDS MAY BE BETTER SERVED IN ALTERNATIVE HEALTH CARE SETTINGS. view more 

CREDIT: MICHIGAN MEDICINE

ANN ARBOR, Mich. - Fibroid symptoms, such as heavy menstrual bleeding and abdominal pain, are increasingly driving women to the emergency room.

In fact, tens of thousands of women were seen annually in the emergency department for the condition, which involves benign growths in the uterus, over a 12-year period.

But only 1 in 10 of these visits led to a hospital admission, suggesting that many cases may have been managed in an alternative, non-urgent health setting, according to recent Michigan Medicine research.

"Fibroids are often a chronic disease, so we have opportunities to treat this through established care with a trusted health provider. Yet, we've seen a big increase in women using the emergency room for fibroid care," says senior author Erica E. Marsh, M.D., chief of the division of reproductive endocrinology and infertility at the Center for Reproductive Medicine at Michigan Medicine Von Voigtlander Women's Hospital.

"Our study suggests that patients are potentially using the emergency department for care that could and should be obtained in a long-standing trusted environment with a healthcare provider."

Researchers analyzed more than 487 million emergency visits by women ages 18-55 between 2006 and 2017. The number of ED visits for fibroids among this age group more than doubled during the study period, up from 28,732 to 65,685 visits.

Meanwhile, hospital admissions for these types of visits decreased from about 24% to 11%, according to the study in Obstetrics & Gynecology "The Green Journal."

Study findings also reinforced that fibroid care is among the costliest types of ED care, which has been estimated to be generally twice as expensive as other visits among similarly aged women. This is likely to due to imaging studies and other tests to address bleeding.

Over the study period, median ED visit charges for fibroids more than doubled, with the average charge more than $6,000 per visit and a total of $500 million during 2017.

Many of these patients were likely appropriate candidates for outpatient imaging, which potentially could have saved significant costs and resources, Marsh says.

"We should be focused on interventions that improve access to outpatient care for this group of women in order to help mitigate unnecessary, costly ED utilization," Marsh says.

Emergency department visits for fibroids were highest among women who were aged 36-45 years (about 45%) and with lower incomes. Women who came to the ED for bleeding related issues were also 15 times more likely to be admitted.

Marsh notes that while bleeding symptoms should be addressed right away, there are several interventions that can help manage bleeding through regular office visits. Hospital admission was least likely for uninsured patients who came to the ED with fibroid symptoms.

"The apparent disparity in likelihood of admission based on insurance type is concerning and certainly warrants further study," Marsh says.

"We must constantly call out and investigate disparities in care."

Improving equitable fibroid care

Uterine fibroids are the most common benign gynecologic condition in the U.S., affecting up to 70% of all women by age 50 and a disproportionate number of African Americans. Although the majority of fibroids are asymptomatic, between a quarter and half of patients will experience symptoms, most commonly heavy menstrual bleeding and pelvic pain or pressure that can be disruptive to daily life.

Fibroids are also the leading cause of hysterectomies, which is the surgical procedure involving removal of the uterus.

Many potential factors may help explain the ED trends highlighted in the new study, Marsh says. It could be that patients are using the ED because they don't have a primary healthcare home or trusted relationship with an outpatient provider for their gynecological care.

Many women may also delay treatment for uterine fibroids because they think their symptoms are "normal" or are unaware of what types of non-surgical treatments are available.

Insurance gaps and access barriers may also be issues.

"We need to better understand gaps in fibroid care and why so many patients are turning to the ED to receive care for a condition that could be managed in the outpatient setting," Marsh says.

"We have a diverse team looking at these data to identify opportunities to re-envision care for women with fibroids and barriers we can reduce to improve their care in the outpatient setting.

"Ultimately, we want to ensure patient centered and equitable care for all individuals with this chronic condition."

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Paper Cited: "Trends in Emergency Department Utilization Among Women With Leiomyomas in the United States," Obstetrics & Gynecology. DOI: 10.1097/AOG.0000000000004333

 

Improved detection of atrial fibrillation could prevent disabling strokes

Results from clinical trial expected to significantly change how clinicians monitor for atrial fibrillation in Alberta stroke patients

UNIVERSITY OF ALBERTA FACULTY OF MEDICINE & DENTISTRY

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IMAGE: AN IMPLANTABLE DEVICE THAT MONITORS FOR ATRIAL FIBRILLATION OVER 12 MONTHS IS MORE THAN THREE TIMES MORE EFFECTIVE AT DETECTING THE CONDITION THAN STANDARD CARE, AND COULD HELP PREVENT DISABLING... view more 

CREDIT: SUPPLIED

A clinical trial examining the efficacy of two devices to monitor and detect atrial fibrillation (AF), or an irregular heartbeat, in ischemic stroke patients--one an implantable device that monitors over 12 months, the other an external device that monitors over a 30-day period--found the implantable device is more than three times more effective in detecting AF, and both are a significant improvement over the current standard of care in Alberta, Canada.

The Post-Embolic Rhythm Detection With Implantable Versus External Monitoring (PER DIEM) study, led jointly by University of Alberta and University of Calgary researchers, was published today in the journal JAMA. The findings are expected to significantly change practice in how clinicians look for AF in Albertan patients following ischemic stroke.

"We know that (the current method of monitoring) isn't as effective as it could be in picking up atrial fibrillation from this study because regardless of which arm of the study patients went into, we were picking up anywhere from five to 15 per cent extra atrial fibrillation," said Brian Buck, a stroke neurologist and associate professor of medicine at the U of A. "We found in the study there were a lot of patients with undetected atrial fibrillation, even after they received the standard cardiac monitoring."

Atrial fibrillation causes about one in four strokes in Alberta. Detecting it early is key to preventing further disabling strokes in patients who have already experienced ischemic stroke, a type of stroke caused by a blockage in an artery that supplies blood to the brain. If atrial fibrillation is detected, clinicians have treatments--mainly blood thinners--that can reduce the risk of stroke by almost 70 per cent.

The standard test in Alberta for AF is a 24-hour electrocardiogram monitor. In the PER DIEM trial, 300 Albertan patients who had suffered a stroke were randomized to one of two new devices that can monitor for AF for longer durations. The study showed that the implantable device picked up three times more new AF than the 30-day monitor (15 per cent versus five per cent). All of the patients in the clinical trial with new AF were started on blood thinners.

"We didn't expect that we would get such a dramatic increase with the longer recording, even though it intuitively makes sense," said study co-author Michael Hill, professor of neurology at the University of Calgary and senior medical director for stroke with Alberta Health Services' Cardiovascular and Stroke Strategic Clinical Network. "Most people suspected that detection rates apply to only certain subtypes of ischemic stroke. This study showed that theory is not correct."

"We believe that those patients that were identified with atrial fibrillation are now, for the rest of their lives, going to have a much lower risk of having a stroke in the future," added Buck, who is also a member of the U of A's Neuroscience and Mental Health Institute.

One of the patients who took part in the trial was Norman Mayer, the sitting mayor of the central Alberta community of Camrose for the past 32 years. Mayer recalls being admitted to the emergency department about five years ago after not feeling well and experiencing sudden pain. After examination, the clinicians on duty informed him that he had likely experienced a minor stroke.

After being stabilized, Mayer was informed of the clinical trial and given the option of participating. After giving his consent, he was randomly assigned to the group of patients who were given the implantable monitoring device.

"It was the luck of the draw, and the advantage of it was that it's inconspicuous and wearing (an external device) would not have been very appealing to me," said Mayer. "So I had (the implantable device) tucked into my chest. It's there and nobody knows about it except for me and my doctor.

"It gives you a bit of a comfort level, I guess. It's not bothering you. It's just there and a part of life," he added. "It gives you the feeling that if something was to go wrong, somebody's going to be in touch to let you know (what steps need to be taken)."

With better monitoring, clinicians may be able to diagnose much more AF after stroke and dramatically reduce the risk of future disabling stroke. According to the Canadian Coordinating Office for Health Technology Assessment (CADTH), the external device costs about $1,000 per patient to administer, while the implantable device typically costs over $5,000 per patient. The implantable device had the added advantage of remote monitoring, reducing the need for trips to the hospital--an important consideration for rural Albertans. The team says an in-depth cost-benefit analysis is needed to determine the best approach to providing superior care while also providing savings for the health-care system.

"The biggest problem with stroke is that it dramatically impacts people's lives. So you take a healthy, independent person with a big disabling stroke, and they often end up being dependent on others for help with care. So that's terrible for patients and it's very expensive for the system. If you can prevent even a few of those big disabling strokes per year, it helps the person and reduces the burden on the health system," said Buck.

"This new evidence will help guide selection of what strategy is best going forward," added Hill. "We need to go beyond (24-hour monitoring) for Albertan patients. But if the system is going to pay for this technology, we need to know more definitively that patients are going to end up with lower stroke rates in the future."

The researchers say studies to this point have shown a trend in that direction, but more work is needed to prove it definitively. They hope to address those questions in future research.

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The PER DIEM study was conducted as one part of the overarching Performance Evaluation & Rhythm Follow-up Optimization with Remote Monitoring (PERFORM) project led by the University of Calgary's Derek Exner with the Libin Cardiovascular Institute. The research was funded through Alberta Innovates' Partnership for Research and Innovation in the Health System (PRIHS) program and in part through the Alberta Innovates CRIO grant program (QuICR Alberta Stroke Program). Industry partner Medtronic also gave in-kind support to the 

Canadian prescription opioids users experience gaps in access to care

Study suggests people treated for opioid use disorder may face difficulties finding new providers

PLOS

Research News

 

Stigma and high care needs can present barriers to the provision of high-quality primary care for people with opioid use disorder (OUD) and those prescribed opioids for chronic pain. A study published in PLOS Medicine by Tara Gomes at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada and colleagues suggests that people treated for an opioid use disorder were less likely to find a new primary care provider (PCP) within one year of termination of enrolment with the previous physician.

People with substance use disorders often have complex medical needs, requiring regular access to primary care physicians. However, some physicians may be less willing to treat these patients due to stigma, high health care needs, or discomfort prescribing opioids. To assess differences in access to primary care, researchers conducted a retrospective cohort study, analysing records of 154,790 Ontario residents who lost their enrolment with a primary care physician between 2016 and 2017. They assigned individuals to one of three groups based on their history of opioid use: no opioid use, opioid pain therapy, and opioid agonist therapy (for OUD). The authors then analyzed the number of people from each group who had found a primary care provider within a year.

The researchers found that people receiving opioid agonist therapy were 45% less likely to secure another primary care physician in the next year compared to opioid unexposed individuals. The study was limited in that the authors were unable to identify people with OUD if they were not in treatment and could not identify people who received care from walk-in clinics. However, the research is an important step in identifying inequities in access to primary care and management of complex chronic conditions.

According to the authors "Ongoing efforts are needed to address stigma and discrimination faced by people who use opioids within the health care system, and to facilitate access to high quality, consistent primary care services for chronic pain patients and those with OUD".

Dr. Gomes also notes, "There are considerable barriers to accessing primary care among people who use opioids, and this is most apparent among people who are being treated for an opioid use disorder. This highlights how financial disincentives within the healthcare system, and stigma and discrimination against people who use drugs introduce barriers to high quality care".

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Research Article

Peer reviewed; Observational; Humans

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003631

Funding: This study was funded by grants from the Ontario MOHLTC Health System Research Fund (grant # 06673) and the Canadian Institutes of Health Research (grant #153070). It was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). RG is supported as a Clinician Scientist in Family and Community Medicine at St. Michael's Hospital and the University of Toronto. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests to report: TG and RG have received grant funding from the Ontario Ministry of Health and CIHR. RG serves as a CIHR Scientific Director. DNJ is an unpaid member of Physicians for Responsible Opioid Prescribing (PROP). He is also a member of the American College of Medical Toxicology. Both groups have publicly available positions on this issue. He has received payment for lectures and medicolegal opinions regarding the safety and effectiveness of analgesics, including opioids. MMM has received honoraria for attending Advisory Board meetings for NovoNordisk and Neurocrine Biosciences.

Citation: Gomes T, Campbell TJ, Martins D, Paterson JM, Robertson L, Juurlink DN, et al. (2021) Inequities in access to primary care among opioid recipients in Ontario, Canada: A population-based cohort study. PLoS Med 18(6): e1003631. https://doi.org/10.1371/journal.pmed.1003631

CANCEL HER FINE

Grand Slam leaders pledge to address Naomi Osaka's concerns

Shawna Chen


Photo: TPN/Contributor via Getty Images

Leaders of the four Grand Slam tournaments on Tuesday pledged to address players' concerns about mental health after Naomi Osaka withdrew from the French Open.

Driving the news: Osaka, a four-time major champion and No. 2-ranked player, pulled out of the French Open on Monday amid controversy over her decision to not attend press conferences at the tournament. She wrote in a statement that she experiences "huge waves of anxiety" before meeting with reporters and has "suffered long bouts of depression."

"I'm gonna take some time away from the court now, but when the time is right I really want to work with the Tour to discuss ways we can make things better for the players, press and fans," she added.

What they're saying: "On behalf of the Grand Slams, we wish to offer Naomi Osaka our support and assistance in any way possible as she takes time away from the court. She is an exceptional athlete and we look forward to her return as soon as she deems appropriate," said Tuesday’s joint statement from leaders of the French Open, Wimbledon, U.S. Open and Australian Open.

"Mental health is a very challenging issue, which deserves our utmost attention. It is both complex and personal, as what affects one individual does not necessarily affect another," the statement added.

"We commend Naomi for sharing in her own words the pressures and anxieties she is feeling and we empathize with the unique pressures tennis players may face."

In a separate statement to the AP, International Tennis Federation official Heather Bowler said the sport will "review what needs to evolve" after Osaka "shone a light on mental health issues."

Between the lines: The same four administrators who threatened disqualification or suspension for Osaka all signed on to Tuesday's joint statement, per AP.

The 23-year-old player of Haitian and Japanese descent was fined $15,000 on Sunday after not attending a mandatory press conference.

Go deeper: What to know about Naomi Osaka's French Open withdrawal

ALASKA

Interior Dept. suspends oil and gas leases in Arctic National Wildlife Refuge

Shawna Chen AXIOS JUNE 1,2021

Photo: Sylvain Cordier/Gamma-Rapho via Getty Images

The Interior Department suspended nearly a dozen oil and gas leases in the Arctic National Wildlife Refuge on Tuesday, the agency announced.

Why it matters: The move, which will require a new environmental analysis, will undo former President Trump's most significant environmental actions in his final days in office.

Worth noting: The new analysis could be time consuming and its results may spark a court battle.

Our thought bubble, via Axios' Andrew Freedman: Environmentalists have spent decades trying to protect this area of largely untouched wilderness that's home to thousands of caribou and a key population of polar bears. It's therefore not surprising the Biden administration would move to reverse this action, but it could spark a lengthy court battle.

What they're saying: “Today marks an important step forward fulfilling President Biden’s promise to protect the Arctic National Wildlife Refuge," White House national climate adviser Gina McCarthy said Tuesday.

• "President Biden believes America’s national treasures are cultural and economic cornerstones of our country and he is grateful for the prompt action by the Department of the Interior to suspend all leasing pending a review of decisions made in the last administration’s final days that could have [changed] the character of this special place forever.”

Flashback: Two weeks before President Biden took office, the Trump administration auctioned off the right to drill in the refuge's coastal plain, an expanse in Alaska that has been subject to political dispute for decades.

• Native Americans and environmentalists had opposed the sale.
• No major oil companies participated in the auction. All but one went to an agency of the state of Alaska.

Go deeper: How Biden could thwart Trump's Arctic push

"This was not a riot": Biden commemorates anniversary of the Tulsa Race Massacre

"[T]his was not a riot. This was a massacre — among the worst in our history, but not the only one. And for too long, forgotten by our history.

Shawna Chen  AXIOS JUNE 1,2021

•  

Tulsa Race Massacre survivors Viola Fletcher and Hughes Van Ellis watch as President Biden speaks during a commemoration of the massacre's 100th anniversary. Photo: Mandel Ngan/AFP via Getty Images

The acts of hate in Tulsa 100 years ago bear a "through line that exists today," President Biden said Tuesday, as he commemorated the anniversary of the Tulsa Race Massacre.

Why it matters: The massacre, which killed an estimated 300 people and burned multiple blocks of the Black neighborhood Greenwood, is considered one of the worst terrorist attacks in U.S. history. Survivors and their descendants have pressed for reparations for decades.

• "I still see Black men being shot, Black bodies lying in the street. I still smell smoke and see fire," Viola Fletcher, one of the last living survivors, testified before a House committee in May. "I have lived through the massacre every day. Our country may forget this history, but I cannot."

What he's saying: "For much too long, the history of what took place here was told in silence, cloaked in darkness," Biden said. "Just because history is silent, it doesn't mean that it did not take place, and while darkness can hide much, it erases nothing."

• That night, "'Mother' Fletcher says they fell asleep rich in terms of wealth, not real wealth but a different wealth, a wealth in community and heritage," Biden said. "One night changed everything."
• "[T]his was not a riot. This was a massacre — among the worst in our history, but not the only one. And for too long, forgotten by our history. As soon as it happened, there was a clear effort to erase it from our memory, our collective memory," Biden noted. "Tulsa didn't even teach the massacre" for years.
• Oklahoma governor to name stretch of state highway for Trump
• "We can't choose to just learn what we want to know and not what we should know."

In his speech, Biden unveiled a set of policies aimed at closing the wealth gap between white and Black people.

Worth noting: Some of Biden's proposals have drawn backlash from the NAACP, whose leader criticized the plan's failure to cancel student debt, the Washington Post reports.

The big picture: Biden met with survivors earlier on Tuesday after touring the Greenwood Cultural Center.

 

World anxiously waits to see where Biden will send America's vaccines

Dave Lawler

AXIOS JUNE 1, 2021

Illustration: Annelise Capossela

The U.S. is about to pivot from hoarding vaccines to sharing them globally, and countries around the world are trying to secure their places in line.

Why it matters: President Biden has promised to donate 80 million doses by the end of June. With domestic demand waning, he’ll soon be able to offer far more. But the White House hasn't said how it will distribute the initial 80 million, or when it will feel comfortable truly opening its supply to the world.

The state of play: The U.S. is currently second only to China in terms of vaccine production, but had until recently been the only major producer to keep virtually its entire supply at home.

• While more than half of all Americans have had at least one dose and dozens of rich countries aren't far behind, less than 1% of people across the world's low-income countries have been vaccinated.
• With the U.S. set to belatedly become a global vaccine powerhouse, Biden has some high-stake decisions to make.

Zoom in: Facing a fast-unraveling domestic crisis fueled in part by the pandemic, Colombian Vice President Marta Lucía Ramírez traveled to Washington last week with an urgent request: access to some of the 80 million doses.

• She’s not alone. Such requests have come in from all over the world, but countries in the Americas have been particularly frustrated with Biden's unwillingness to share up to now.
• Most have purchased doses from Russia or China and some, like Mexico, have turned to both.
• Ramírez told Axios that many of the vaccines Colombia has ordered aren’t expected until December, and the already hard-hit country is now seeing its worst spike yet.

The first decision Biden has to make is whether to send doses to individual countries, share in bulk through the WHO-backed COVAX initiative, or — as White House officials have indicated is most likely — pursue some combination of the two.

• A European diplomat who spoke with Axios argued that the U.S. should reject “vaccine diplomacy” as practiced by Russia and China and bolster multilateralism by sharing with COVAX, which aims to provide every participating country with enough doses to cover 20% of its population this year.
• Some countries are almost entirely reliant on COVAX, but export curbs from India have left the initiative months behind and with hardly any supply in the near term.

Yes, but: Experts including Zeke Emanuel, who served on Biden’s COVID-19 advisory board during the transition, argue that vaccines should be shipped where they’re urgently needed and can be readily distributed, not through COVAX’s population-based system.

• And while Biden has said the U.S. donations will be driven by science and not geopolitics, there are clear soft power benefits to controlling distribution more directly.

What's next: In addition to the donations, producers like Pfizer and Moderna will be able to export U.S.-made doses once they've fulfilled their U.S. contracts. But many of those would be expected to go to rich countries with existing contracts.

• Biden could exercise additional purchase options — including 300 million doses each from Pfizer and Moderna — to allow the government to choose the vaccines' destinations while also hedging against the need for boosters.

The big picture: 80 million doses is only a sliver of America’s supply, and a fraction of the global need.

• “The real question is what threshold we’re going to use to start aggressively donating doses,” says Krishna Udayakumar, director of Duke University's Global Health Innovation Center.
• Rather than stockpiling on shelves or in freezers, Udayakumar argues, the U.S. should donate rapidly now, with the knowledge that more supply will be available as new domestic needs arise.
• The White House has sounded far more cautious, saying it wants to be "oversupplied and over-prepared" at home.

What to watch: Rich countries will control a huge chunk of global production even after their initial needs are met, and the U.S. has been the first to make such an ambitious pledge to share doses in the near term.

• Watch for more pledges and more coordination between developed countries, including at the G7 summit in mid-June.

 

Boy Who Sold His Pokémon Collection To Save Dog Sent Rare Cards In Appreciation

BY : EMILY BROWN ON : 31 MAY 2021 16:28

Local 12 News

A young boy who sold his Pokémon collection to save his dog’s life has been rewarded with a package of rare trading cards. 

Bryson Kliemann, of Lebanon, Virginia, made headlines earlier this month for the selfless act of selling his Pokémon card collection to save his puppy, Bruce, who had caught a highly contagious canine virus known as Parvo.

Bryson’s mother, Kimberly Woodruff, rushed the dog to Southwest Virginia Veterinary Services, but treatment was set to cost nearly $700.

Kimberly Woodruff/Facebook

Recalling the situation to Local 12 News, the eight-year-old boy said: ‘It made me kind of sad because usually my brother and sister play together and I don’t have anybody to play with. So, I usually play with (Bruce).’

Bryson’s decision to sell his Pokémon cards took Kimberly by surprise, so she shared a picture of his roadside setup online to help get the word out. The mother also made a GoFundMe page with a goal of $800, but as word about Bryson’s generosity began to spread, the donations soon exceeded $5,000.

The young boy commented: ‘I was so happy because I really wanted to get him back.’

GoFundMe

Following a week of treatment, Bruce was reunited with his adoring owners, with Kimberly explaining that the dog has more vaccine appointments lined up, but he’s ‘doing great, like amazing.’

The good news didn’t stop there, however, as when Pokémon employees based in Bellevue, Washington, caught wind of Bryson’s actions they decided to show the young boy just how much of an impact he’d had in selling his collection.

Staff decided to send the eight-year-old a package of rare Pokémon cards that are hard to find in stores, along with a letter reading: ‘Hey Bryson, we were so inspired by your story about selling your cards for your dog’s recovery, these are some cards to help you replace the ones you had to sell.’

Bryson was overjoyed with the news, according to WSLS, and said he was ‘proud’ of himself for the part he’d played in Bruce’s recovery.

He added: ‘Now my brother and sister are playing with him too, and now I’m really playing with him pretty often.’

With the GoFundMe having exceeded its goal and Bruce now back with his family, Kimberly has said the additional money will help pay for medical expenses for other sick pets in Southwest Virginia.

Hopefully Bryson will be able to build his Pokémon collection up again, but although it might take some time at least he always has Bruce by his side.