Today's News and Commentary

About the public’s health

2018 Antibiotic Use Update in the United States: This CDC report updates the last one, done in 2017. Among other findings:
—At least 30% of antibiotic prescriptions are unnecessary, with large variation in prescribing by state.
— Urgent care and EDs have the greatest percent of unnecessary antibiotic use (46% and 25%, respectively).
— The one bright spot was a continuing increase in hospitals’ antibiotic stewardship programs.

Forecasted Size of Measles Outbreaks Associated With Vaccination Exemptions for Schoolchildren: As recently reported, the measles outbreak is not over; and in some areas it could even come back with increasing numbers. “This study suggests that vaccination rates in some Texas schools are currently low enough to allow large measles outbreaks. Further decreases are associated with dramatic increases in the probability of large outbreaks. Limiting vaccine exemptions could be associated with a decrease in the risk of large measles outbreaks.” Also recall lack of immunizations for illegal immigrants.

Increasing the perceived relevance of cervical screening in older women who do not plan to attend screening: Framing is very important when making recommendations to patients. This study in women ages 50-64 found that one reason for the declining rate of cervical cancer screening is their perception that the risk is low because of lack of sexual activity. Explanation of risk of cervical cancer, even years after HPV exposure increased willingness to participate in such screenings.

Poll: Nearly 1 in 5 Americans Says Pain Often Interferes With Daily Life: This NPR-IBM Watson poll found that 18% of the population says pain often interferes with their daily lives; for those older than 65 the figure is 22%, but only 9% for those under 35. Sixty percent of those in pain use over the counter medication while only 15% use prescription medications. Exercise, massage and heat/ice were also popular remedies.

Ambient Particulate Air Pollution and Daily Mortality in 652 Cities: “We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 μm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions…Our data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies.” Yes, air pollution is real and dangerous.

About health insurance

Strategies Used by Adults With Diagnosed Diabetes to Reduce Their Prescription Drug Costs, 2017–2018: Some of the findings of this study:

  • Among adults with diagnosed diabetes, women (14.9%) were more likely than men (11.6%) to not take their medication as prescribed.

  • Those under age 65 with diagnosed diabetes were more likely than those aged 65 and over to not take their medication as prescribed (17.9% and 7.2%, respectively) and to ask their doctor for a lower-cost medication (26.3% and 21.9%, respectively).

  • Among adults aged 18–64 with diagnosed diabetes, the percentage who did not take their medication as prescribed or asked their doctor for a lower-cost medication was highest among those who were uninsured.

  • Among adults aged 65 and over with diagnosed diabetes, the percentage who asked their doctor for a lower-cost medication was lowest among those with Medicare and Medicaid coverage.

    Such knowledge can, of course, help with insurance strategies to increase compliance.

Sen. Bernie Sanders changes how Medicare-for-all plan treats union contracts in face of opposition by organized labor: Starting more than a hundred years ago, labor unions used negotiation power for benefits to build membership. That is one reason unions have not backed single payer systems. Another reason is that such schemes may not have as good benefits as the ones unions have negotiated. Further, unions traded benefits for salary increases. All those advantages would go away with a single payer system such as the one Senator Sanders is advocating. Bowing to these union concerns, yesterday he slightly changed his stance, saying he “would effectively give organized labor more negotiating power than other consumers would have… by forcing employers to pay out any money they save to union members in other benefits.” Of course, this plan assumes there will be savings under a single payer system. Another question is how “savings” will be calculated, since insurance premiums will go away but taxes will be higher.

About pharma

HHS files appeal to keep plan for drug prices in TV ads alive: Recall that several months ago HHS issued regulations requiring pharma companies to advertise their prices in ads. In a decision on a lawsuit by Merck, Eli Lilly, and Amgen to block the requirement, Judge Amit Mehta, of the U.S. District Court for the District of Columbia ruled that HHS overstepped its authority. Now the government is appealing that decision.

About healthcare IT

Keeping a Pulse on Cybersecurity in Healthcare: In this Kaspersky survey of people in a variety of roles in healthcare organizations in North America the need for better cybersecurity education was dramatic:

—Nearly a third of all respondents (32%) said that they had never received cybersecurity training from their workplace but should have.

—Nearly 1 in 5 respondents (19%) said there needed to be more cybersecurity training by their organization.

—Almost a third of healthcare IT respondents (32%) said that they are aware of their organization’s cybersecurity policy and have read it only once.

—2 in 5 respondents (40%) of healthcare workers in North America are not aware of cybersecurity measures in place at their organization to protect IT devices.

There is a real business opportunity to remedy these problems.

About healthcare quality and safety

Here's what hospital groups had to say about CMS' plan to update Star Ratings: This article summarizes comments on the previously reported CMS announced revisions to the hospitals’ Star reports.