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Implanted Defibrillators: New Recommendations For Drivers With ICDs
Patients with an Implantable Cardioverter Defibrillator (ICD) have an ongoing risk of sudden incapacitation that might cause harm to others while driving a car. Driving restrictions are imposed making these recommendations an important guideline for patients.

American Diabetes Association Related To Studies Published In Diabetelogia Suggesting Possible Link Between Insulin Glargine And Cancer
Diabetelogia, the journal of the European Association for the Study of Diabetes (EASD), published a series of research papers today examining a possible link between insulin glargine (brand name, Lantus) and cancer. Findings from these research papers are conflicting and inconclusive, and the American Diabetes Association cautions against over-reaction until more information is available.
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Blogs Comment On Sotomayor Confirmation Hearings, Health Reform, Other Topics
The following summarizes selected women"s health-related blog entries.~ "Judge Sotomayor Provides Important Testimony on the Constitutional Right to Privacy and Its Application to Reproductive Rights," Marcia Greenberger, Womenstake: "One major line of questions, asked repeatedly throughout the hearings" for President Obama"s Supreme Court nominee Sonia Sotomayor was her "views on the constitutional right to privacy," Greenberger writes, adding, "Given that this right is central to women"s lives, protecting" such "decisions involving whether to bear children ... and having consensual adult sexual relations, it is important to analyze Judge Sotomayor"s answers carefully." According to Greenberger, because Sotomayor "had not ruled directly on the right to privacy as a federal judge, her testimony in this area warrants particular attention." Following questions from senators such as Herb Kohl (D-Wis.), Orrin Hatch (R-Utah) and Dianne Feinstein (D-Calif.), Sotomayor portrayed a "clear agreement with the right to privacy and strong description of the court"s current precedents regarding Roe and women"s health," which "lend[s] further support to the view from her legal record that she would not undermine Roe v. Wade if confirmed to the Supreme Court" (Greenberger, Womenstake, 7/16). ~ "Major Steps Forward for Health Care Reform," Thao Nguyen, Womenstake: Nguyen, outreach manager for the National Women"s Law Center, reports that the health care reform legislation passed by the Senate Health, Education, Labor and Pensions Committee is "particularly important for women because of the critical headway it makes towards women"s ability to secure access to quality, affordable health care throughout their lives." The bill "works towards confronting many of the particular obstacles faced by women in our current health care system," such as banning the "discriminatory" practice of basing insurance premiums on gender, even when maternity benefits are excluded, Nguyen writes. The bill also bans insurance companies from rejecting patients based on medical history, which has prevented many domestic violence survivors and women who have had caesarean sections from obtaining coverage. Nguyen concludes that "the momentum for health care reform could not have come at a more needed time" because women and their families "need quality, affordable and comprehensive health more than ever" (Nguyen, Womenstake, 7/15).~ "Democrats for Life of America Ousts Member Who Supports Contraception," Feministing: Feministing reports that Democrats for Life of America removed Rep. Tim Ryan (D-Ohio) from its advisory board because he supports efforts to improve access to contraception. According to Ryan, he was dismissed from the board after four years after attempting to persuade the group to support contraceptive use as a way to avoid unintended pregnancies. According to the blog, "This is why we call anti-choicers "anti-choice": because they"re not just about making abortion illegal." It adds, "They don"t want women to have access to contraception either -- something that 98% of American women will use at some point in their lives" (Feministing, 7/15). ~ "Umpires, Perspective and the Supreme Court," Jim Wallis, Sojourners" "God"s Politics": "During his opening remarks for his own confirmation hearing in 2005, Chief Justice [John] Roberts made" an analogy between judges and umpires "that has gotten a lot of play in the media and has already been used quite a few times during" Sotomayor"s confirmation hearing, Wallis writes. He adds that "nothing in the world would frustrate me more than an umpire who would call the game differently based upon the color of the jersey that" players were wearing. "But I haven"t seen that happen," Wallis writes, adding, "In fact, the biggest problem we face isn"t an umpire that has favored one team over the other, but umpires who make mistakes in their rulings and judgment because of their lack of perspective." He adds that Sen. Jeff Sessions (R-Ala.) and "others w
Mental Health

Successful Disease Management Programs Can Play Role In Health Care Reform

A study of the award-winning Behavioral Pharmacy Management Program (BPM) shows the private-public Medicaid partnership program has helped improve patient care while saving eight states almost $95 million in behavioral health pharmaceutical costs. Lilly funds the program, which is designed and run by research firm Comprehensive NeuroScience, Inc. (CNS) at the sole direction and guidance of state Medicaid departments. The BPM, which has been executed in more than half of the states, has won a variety of national awards, including the Substance Abuse and Mental Health Services Administration Science and Service Award, URAC Silver Award for Best Practices in Consumer Empowerment and Protection, American Psychiatric Association Bronze Achievement Award and Disease Management Association of America Gold Award. Missouri, one of the states included in the study, has seen significant improvements in patient care, as well as Medicaid cost savings. "We need to make sure we take the very best care of the Medicaid patients we serve and help them understand how to take the very best care of themselves. With the BPM, we have the opportunity to do that by simply targeting best practices and making educational information available to physicians, so they understand the best practice alternatives. We believe that, if you do the right things, the cost will follow and it has," said George Oestreich, deputy division director, Clinical Services, MO HealthNet Division. "Controlling health care costs and improving quality is a big, complicated issue. These kinds of partnerships, which pursue quality as a way to contain costs, are really going to be the solution to a lot of the health care problems that America faces," said Dr. Joseph Parks, chief clinical officer and division director, Comprehensive Psychiatric Services, Missouri Department of Mental Health. How the Program Works The BPM reviews Medicaid prescription patterns for more than 400 mental health medications. Then, it compares them to national best practice guidelines, which are compiled by each state Medicaid department and CNS. These guidelines are based on the latest medical research, including studies published in peer-reviewed medical journals. When there is an inconsistency with what is considered best prescribing practice, the BPM sends an educational mailing to the physician, so they can consider the information for the next visit with the patient. Some of the inconsistent patterns the program has identified include: duplicative prescribing of a medication by different doctors for the same patient; prescribing above or below recommended dosing levels; and prescribing multiple medications from the same therapeutic class. "Physicians will change their prescribing practice patterns to be in keeping with best practice, when they know what the best practice is. They use the educational information from the program"s mailing, and, when they do, the overall care of the patient is improved, and we see overall reduction in health care costs," said Carol D. Clayton, Ph.D., vice president, account management services, CNS. The BPM also informs physicians when their patient has not refilled their prescription. This is a health care concern because poor compliance or non-compliance with medication treatment is strongly is linked to relapse, rehospitalization, poor outcomes, and high economic costs. In addition, physicians receive regular information bulletins about special topics related to mental health medications, such as tips for addressing and discussing treatment adherence with patients. Eight-State Study Cost Savings Results The study, conducted by CNS, evaluated eight representative state BPMs to determine behavioral pharmacy costs for Medicaid patients whose physicians received an educational mailing compared to costs for a similar group of patients who had not yet been a subject of a mailing. On average, the program helped states avoid almost $800 in behavioral health pharmaceutical costs each year, per patient, or a total of $94.5 million since the programs began for the eight states studied. "These data document that it is possible to improve the care of people with psychiatric illness in a cost-efficient manner. The treatment of mental illness has advanced remarkably in recent years, but those advances are generally only slowly translated into better clinical practice. The BPM puts evidence-based best practice guidelines into clinicians" hands on a fast track," said Jack Gorman, MD, SVP and chief scientific officer, CNS. "The Behavioral Pharmacy Management Program is an excellent example of evidence-based interventions that increase access to quality mental health care while reducing costs. Community behavioral health providers across the nation are committed to replicating such science to service initiatives to provide outcomes that benefit individual patients," said Linda Rosenberg, MSW, president and CEO, National Council for Community Behavioral Healthcare. Patient Care Improvement Results In addition to saving Medicaid costs, the BPM has resulted in more than 2 million patient care improvements nationwide. For example, an analysis of the first year of Missouri"s BPM found a: - 98 percent decrease in the number of patients who are prescribed the same mental health medications from multiple doctors; - 64 percent decrease in the number of patients who are on two or more mental health medications of the same type; and - 40 percent decrease in the number of patients receiving an unusually high dosage of medication. A separate study of Missouri Medicaid patients found a 43 percent decrease in hospital admissions for those whose physicians received an educational mailing versus a 1 percent decrease in those from a similar comparison group who did not yet receive a mailing.6 For other state examples of patient care improvements and cost savings, visit http://www.lillyforbetterhealth.com. The program has run in 26 states, including Oklahoma, which began its BPM in 2004. "We call our BPM "SoonerPSYCH" which stands for Prescription Solutions for Your Cognitive Health. Through the program, our partnership with Lilly and CNS has allowed us to target physicians with patient-specific information and education in the most efficient and effective manner. Physicians are able to know whether their patients are filling the prescriptions on time or not at all, and to see if other physicians are prescribing similar medications for the same patient. Having the information in hand provides an opportunity for the physician to educate the patient about the chronic nature of their condition and the importance of persistence, compliance and adherence to their prescribed medication regimen," said Nancy Nesser, J.D., Pharm. D. pharmacy director for the Oklahoma Health Care Authority"s state SoonerCare program. Evidence suggests that 96 cents of every Medicare dollar and 83 cents of every Medicaid dollar are used to treat chronic diseases.7 Disease management programs help patients with chronic diseases manage their condition and get the care they need. For more than seven years, Lilly has funded disease management programs in partnership with state Medicaid departments. "Just like cancer or diabetes, mental illness is a devastating disease that impacts millions. We believe disease management and coordination of care programs that leverage health care information, technology and education are a viable option to manage rising health care costs rather than limiting patients" access to vital medications and treatments," said Alex M. Azar II, vice president of business-to-business, LillyUSA Lilly provides financial support for the initiative, with the operation and implementation of the program being done solely by the states and CNS. If the state decides to share data with Lilly, the data is blinded and aggregated and does not contain information about individual patients or providers. In addition, Lilly has sought approval and received support from the Centers for Medicare & Medicaid Services for these initiatives. The BPM is entirely voluntary for physicians. All decisions regarding treatment and medications are made privately between the physician and the patient and are completely individualized. Eli Lilly and Company


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