Anticipatory Guidance From Primary Care Physicians Could Prevent Falls Among Seniors

We hear about stories like this all time. An elderly person falls and breaks something…a hip, a wrist or an arm. Soon, what once was a healthy, independent senior begins an inexorable down hill slide. Such is the case of my 89-year old mother who fell recently and broke her wrist.

Turns out that 30% of people >65 years fall each year. Predictably seniors with the following risk factors are more prone to falls:

• Using Sedatives
• Cognitive Impairment
• Problems Walking
• Urinary Tract Infection
• Eye Problems
• Balance Issues

Similarly, when a person does fall, a cascading series of predictable clinical events occurs. It even has a name “post fall syndrome.” This syndrome is characterized by things like fear of falling again, increased immobility, loss of muscle and control, lack of sleep, nutritional deficits, and so on. Seniors susceptible to falls also have higher rates of hospitalization and institutionalization.

What strikes me about falls among the elderly is that they are seemingly predictable events. And once a fall does occur, the consequences seem pretty predictable as well, e.g., post fall syndrome. So if falls and their consequences are so predictable, why aren’t primary care physicians more proactive it terms of:

1. Preventing falls
2. Treating post fall syndrome patients

In the case of my mother, her primary care physician and orthopedist were both very diligent at treating her episodic needs, i.e., her pain and broken bones.  But little attention if any was given to assessing her her long term needs, i.e., nutrition, inability to do anything with her left hand (she’s left-handed), sensitivity to new medications (she never took drugs because they make her loopy), gait analysis, or depression counseling.

I know, I know, doctors can not be expected to do everything in the confines of a 7-15 minute office visit. Yes I know that doctors aren’t paid what they deserve.  I am also aware that many physicians just don’t like treating geriatric patients.  But hey… this is my mother!

Pediatrics coined a term awhile back called “anticipatory care.” It refers to the act of helping children and parents anticipate and deal with predictable developmental and health issues associated with childhood.

It seems to me that primary care physicians and insurance companies need to get together with respect to providing anticipatory guidance for aging as well. Not only would it improve seniors’ quality of life, it would also prevent unnecessary hospitalizations and institutionalizations.

Besides…wouldn’t you want that for your mother or father?

Looking For A Way To Engage Patients In Behavior Change? Try “Storytelling”

My wife had just finished meeting with her medical oncologist for her bi-annual check-up at MD Anderson’s Thoracic Clinic.   We were sitting in an area called “the Park” rehashing what her doctor had said when a mother and her daughter sat down at our table.   There were lots of empty seats in area but for some reason they decided to sit with us.  Call it serendipity.   It turned out that both my wife and Megan (the daughter) had just gotten “good news” from their respective oncologists.

We ended up talking with our new friends for one and a half hours – my wife and the daughter about the travails of cancer (hair loss, uncertainty, and so on) – the mother and I about care giver stuff (insurance authorization, navigating the health system, etc.).  My wife and I always feel so energized after “talking story” with other dealing with the same issues.   You see these “chance meeting” always happen to us….and a lot of other patients as well I suspect.

Talking Story Hawaiian Style

I have always supposed that there was some “therapeutic benefit” to these chance meetings with other cancer patients.    Turns out I was right according to a recent study of hypertensive patients in the Annals of Internal Medicine.

The study explored the use of culturally-appropriate “storytelling” among a population of inner-city African-Americans (71% women) diagnosed with hypertension.   In the study, an experimental group of patients received a DVD showing “people just like them” talking about their experiences living with high blood pressure.  For example, lessons learned about how to best interact with their physicians, and strategies to increase medication adherence.   A control group received a general introductory DVD on hypertension without the “storytelling.”

The study found that that patients diagnosed with uncontrolled hypertension benefited the most from receiving culturally sensitive “storytelling” messages promoting hypertension control.  People in the experimental group (at 3 months post baseline) had an 11mm Hg greater reduction in systolic blood pressure than the control group.  Smaller reductions (6mm) were also found for diastolic blood pressure among the experimental group.  No change in systolic or diastolic blood pressure was found among patients in the experimental group diagnosed with controlled hypertension.   Blood pressure reduction in these patients from baseline to 6 to 9 months also favored the intervention group for systolic and diastolic blood pressures.

Researchers theorized that narratives or “storytelling” can break down cognitive resistance people may have to behavior change by helping listeners:

• make meaning of their lives
• actively engage them in their care
• influence  their health behavior
• get them to imagine picture themselves taking part in the same behavior/action

So What Does This Mean For You?

Storytelling may well turn out to be an effective, inexpensive, and highly appealing strategy for engaging patients with all kinds of conditions in behavior change.  Primary Care Medical Groups, Accountable Care Organizations, Health Plans, Population Health Management and Disease Management Vendors should explore ways of “pairing up” culturally-like patients…say with uncontrolled hypertensive patients with culturally similar patients who have successfully gotten their condition under control. Same thing diabetes, asthma and other conditions. Social media, e-mail and the telephone are ways that patients can begin sharing their stories…and improving health outcomes.

If you would like more information on “storytelling” and how it might work for your organization, feel free to contact me by leaving a comment below.

Sources:

Houston, T. et. al.  Culturally Appropriate Storytelling to Improve Blood Pressure A Randomized Trial.  Annals of Internal Medicine. 2011;154:77-84.

When A Major Healthcare Brand Fails To Deliver On Its Promise – The Case of MD Anderson Cancer Center

Let me start by saying I really like MD Anderson Cancer Center. There is a lot to like. Take their tag line for example, “making cancer history.” If anyone finds a cure for this cancer or that cancer…MD Anderson will have a hand in it I am sure. Hospitals could also learn a thing or two about the meaning of comprehensive care, clinical integration, and customer service from MD Anderson is well.

I have another reason why I like MD Anderson so well.

They saved my wife’s life. You see she was diagnosed back in November of 2004 with Stage 4 non-small cell lung cancer (NSCLC). As anyone familiar with lung care knows, lung cancer is a very tough adversary.

It’s an even tougher adversary when your insurance company insists that your local community hospital and oncologists are “just as good” as MD Anderson’s in terms of quality and outcomes.

You guessed it. In 2004, my wife and I had to fight long and hard to get our insurance carrier to authorize my wife care at MD Anderson…an out of network provider. I am happy to say we won that fight back in 2004 and again just last week when my wife’s employer’s new insurance carrier refused to authorize her continued care at MD Anderson. You see her new carrier wanted to rehash the whole medical necessity thing all over again.

Now you would think that a world class organization like MD Anderson would do everything possible to help prospective patients deal with these kinds of insurance issues. After all, they seem to do everything for you once care is authorized. But you would be wrong.

The business office staff at MD Anderson did little to help us get “authorization” in 2004 or 2011. This time, we got the proverbial run around from every member of the business office staff we talked to. Most recently I had 3 different staff members contact my wife’s carrier. Each person failed to get authorization giving us three different explanations. One person even told me that my wife could not be authorized for a PET-CT exam because she was disease free at her last visit. Evidently she had to have active disease before she could qualify for preventive screening exam. I even asked the business office coordinator if she reminded the insurance carrier that MD Anderson was the #1 Cancer Hospital in the U.S. I don’t think she thought to mention it.

Not to worry. In 2011, as in 2004, I, with the help of my wife’s clinicians, was able to demonstrate the “medical necessity” of her being treated at MD Anderson. No thanks to the hospitals business service however.

What’s the Point?

The point is that the wonderful brand experience my wife associate with the clinical side of MD Anderson does not extend to MD Anderson’s business services, e.g., pre-authorization, etc. In fact I will go so far as to say that I do not trust anything that comes out of the mouths of that department.

How could such world class organization make such a first class blunder with something as important as obtaining helping patients obtain “authorization for care?” More importantly, how many cancer patients get sub-optimal treatment because they aren’t as adept as I am at navigating my way through the health care system?

I honestly don’t know. But if MD Anderson wants to hire me to come in and help them fix the problem my phone number and email are here below.

Business: 408-448-1537 (PST)
swilkins@smarthealthmessaging.com