Consumers Uncertain About Their Medical Diagnosis and Treatment

  • Author: Health Informer
  • Filed under: Health News
  • Date: Dec 3,2008

Clinical Case Reviews Reveal Deficiencies in Care for Individuals across the Country

Members who recently sought expert medical consultations from Best Doctors, Inc., expressed deep uncertainty about their initial diagnosis or course of treatment, according to data released today.

The findings are based on clinical reviews of cases of Best Doctors members. Best Doctors is a unique health benefit that calls upon top medical specialists to help members navigate critical decisions about their care.

More than 500 members in the United States voluntarily called Best Doctors for help during the second quarter of 2008. Of those:

  • 25 percent said they needed help choosing among treatment options;
  • 23 percent questioned whether they needed surgery;
  • 16 percent were skeptical of their doctor;
  • 15 percent didn’t understand their diagnosis;
  • 14 percent felt their symptoms were not improving; and,
  • 7 percent had no firm diagnosis to guide their treatment.

“There is tremendous uncertainty among consumers about whether they are getting the right diagnosis and treatment,” said Evan J. Falchuk, president and chief operating officer of Best Doctors. “Consumers face hard decisions that impact their lives, as well as the bottom line of employers who pay for their care. Certainty is the one thing people want most when they make tough medical decisions, but it’s harder and harder to attain.”

Members had legitimate reasons to be anxious about the quality of their care, according to Best Doctors, which offers its service through public and private employers.

The initial diagnosis and treatment received by members was incorrect or inadequately supported in more than two-thirds of the cases. Diagnosis and treatment plans changed after Best Doctors expert clinical case reviews uncovered:

  • Insufficient work-ups in 31 percent of cases;
  • A more effective treatment strategy in 25 percent of cases;
  • Incorrect interpretations of pathology or diagnostic tests in 12 percent of cases; and,
  • The treatment was causing patient symptoms in 5 percent of cases.

Falchuk said the complexity of medicine, easy access to conflicting medical information and advice, and the increasing workload of physicians all play a role in fueling consumer uncertainty around diagnosis and treatment, as well as in missteps that lead to incorrect clinical recommendations.

“Our track record shows that the initial diagnosis needs to be changed for one in five members and that treatment needs to be altered for three in five,” Falchuk said. “Providing expert medical consultation creates certainty that has a direct and immediate impact on the quality and cost of care. It puts members on a path to better health and it saves money for their employers.”

Conditions involving cardiovascular and pulmonary diseases accounted for 19 percent of the cases handled by Best Doctors during the second quarter; followed by oncology, neurology and orthopedics and trauma at 16 percent each; rare genetic diseases, immunology and infectious diseases, and skin, eye, ear, nose and throat conditions at 9 percent each; and, nephrology and endocrinology at 6 percent each.

Source: Best Doctors, Inc.


British Medical Journal study finds natural, less expensive treatments are effective for Irritable Bowel Syndrome Sufferers

With its feasts, travel and family gatherings, the holiday season is, for most, anticipated with excitement. But for the estimated 60 million Americans who suffer from Irritable Bowel Syndrome (IBS), the holidays can be fraught with the fear of sudden embarrassing and debilitating gastrointestinal attacks, often triggered by food or stress.

IBS is the most common chronic health disorder in the U.S. with symptoms that include abdominal pain, cramping, bloating, gas, diarrhea, and/or constipation. IBS has no known cure and expensive prescription drugs have disappointed millions with life threatening side effects and recalls.

In new analysis appearing in the British Medical Journal in November, researchers reexamined relatively inexpensive, safe, and readily available therapies as treatments for IBS. The article reviewed 38 studies involving more than 2,500 volunteers and found three treatments — peppermint oil, antispasmodic drugs and soluble fiber — to be effective. The study also indicated that significantly more people obtained some relief from peppermint oil (the most effective remedy in the analysis) than from fiber, the most common doctor-recommended remedy.

The new report is reawakening interest in natural, less expensive and side effect-free treatments for IBS like IBSuppress(R) Stabilizing Tablets, which can help manage and limit the condition’s impact on quality of life. Designed for sufferers who are prone to urgency-related symptoms and diarrhea, IBSuppress(R) contains a proprietary blend of natural ingredients including peppermint oil, ginger and fennel – which are all antispasmodic herbs.

“Research shows that these herbs fight spasms, relieve pain, reduce gas and aid digestion,” says IBSuppress(R) director of marketing Jamie Miller. “Our goal is to help IBS sufferers manage their condition and improve their quality of life, especially when they are away from home.”

IBSuppress(R) Stabilizing Tablets are sold by DWD Consumer Products, Inc. and are available in boxes of 30 chewable tablets. They can be purchased on the company’s website www.ibsuppress.com for $7.99, and at select retailers. Tablets can be taken anytime, anywhere to help maintain normal bowel function or at the first sign of an unsettled system. Sufferers are advised to consult with their physician before taking any medication, supplement or medical food.

Source: DWD Consumer Products, Inc.


Study: Patient Harm More Common with Patient-Controlled Pain Medication

  • Author: Health Informer
  • Filed under: Health News
  • Date: Dec 2,2008

Intravenous patient-controlled analgesia (PCA) allows patients to control their own pain medication, but a new study published in the December 2008 issue of The Joint Commission Journal on Quality and Patient Safety shows that errors related to this practice are four times more likely to result in patient harm than errors that occur with other medications.

The study of more than 9,500 PCA errors over a five-year period in the United States showed that patient harm occurred in 6.5 percent of incidents, compared to 1.5 percent for general medication errors. The PCA errors examined also were more severe — harming patients and requiring clinical interventions in response to the error — than other types of medication errors. Most errors involved either the wrong dosage or the wrong drug caused by human factors, equipment or communication breakdowns. For example, one case involved a patient who received several 10 mg doses instead of 1 mg medication doses after surgery because of an incorrectly programmed dispensing pump. The PCA errors examined also were more severe — harming patients and requiring clinical interventions in response to the error — than other types of medication errors.

“The entire PCA process is highly complex,” says the study’s lead author Rodney W. Hicks, Ph.D., M.S.N., M.P.A., UMC Health System Endowed Chair for Patient Safety and Professor, Anita Thigpen Perry School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas. “PCA orders must be written, reviewed and then accurately programmed into sophisticated delivery devices for patients to be pain free. Such complexity makes PCA an error prone process. Health care organizations should now plan to make the process safer.”

Through this method, a patient can administer doses of pain medication with the push of a button. A computerized pump that contains a syringe of doctor-prescribed pain medication is connected directly to a patient’s intravenous (IV) line. PCA can be used to relieve pain after surgery or for other chronic pain conditions. Harm associated with PCA errors can include respiration suppression, inadequate pain relief and patient death.

Data for the study came from voluntary reports to the United States Pharmacopeia (USP)’s MEDMARX Program, and shows that more than 60 percent of the hospitals anonymously reporting medication errors through MEDMARX had at least one PCA error. The study — “Medication Errors Involving Patient-Controlled Analgesia” — is important because preventing PCA errors “would yield substantial gains in patient safety,” the authors conclude.

To reduce PCA errors, Dr. Hicks and the co-authors recommend three strategies:

  • Simplify the technical equipment used in PCA. The study shows that the PCA process is heavily dependent on the ability of caregivers to execute sequential tasks successfully, so easy-to-follow setup instructions for equipment could reduce errors. The study urges PCA vendors to look for ways to make it less likely that programming errors will lead to a wrong dose.
  • Use bar codes and an electronic medication administration record to reduce errors that involve the wrong medication. Independent double-checks of the PCA orders, the product and the PCA device settings should be standard practice, the study advises.
  • Ask pharmacists to design easily understood and standardized forms for PCA, and ensure that prescribers use only these standardized forms. These actions would address communication problems that lead to errors and bring regional standardization to the PCA process.

In 2004 The Joint Commission issued a Sentinel Event Alert (www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_33.htm) that identified root causes of patient-controlled analgesia errors and contained recommendations for reducing errors.

The Joint Commission Journal on Quality and Patient Safety, published monthly by Joint Commission Resources, features peer-reviewed research and case studies on improving quality and safety in health care organizations. Click here to order this article in the December 2008 issue: http://www.ingentaconnect.com/content/jcaho/jcjqs

To subscribe to The Joint Commission Journal on Quality and Patient Safety, please call JCR Customer Service toll-free at 800-746-6578, or visit www.jcrinc.com.

Joint Commission Resources, Inc. (JCR), a not-for-profit affiliate of The Joint Commission, has been designated by The Joint Commission to publish publications and multimedia products. JCR reproduces and distributes these materials under license from The Joint Commission. JCR educational programs and publications support the accreditation activities of The Joint Commission, but are separate functions. Attendees at JCR educational programs and purchasers of JCR publications receive no special consideration or treatment in, or confidential information about, the accreditation process. Learn more about Joint Commission Resources at www.jcrinc.com.


Faster, 24×7 Access to Medical Data Enables Clinicians to Deliver Better Care to Cancer Patients

EMC Corporation, the world leader in information infrastructure solutions, announced that the Cancer Treatment Centers of America (CTCA), a national network of cancer treatment hospitals and community oncology programs, has successfully implemented an EMC information infrastructure to support its comprehensive electronic health record (EHR) initiative. EHRs, digital files containing patient medical data, enable physicians to increase efficiency and better serve their patients. By implementing EMC technology to support this initiative, CTCA has achieved more responsive patient care, faster and uninterrupted access to medical data and increased operational efficiency. In addition, massive storage and server consolidation and automation of data recovery, backup and restore functions have enabled CTCA to manage its growing information infrastructure more cost-efficiently and without adding storage administrative staff.

Chad Eckes, Chief Information Officer, CTCA, said, “We’ve fully embraced the EHR because of its potential to help improve patient care and safety more than any other IT initiative. Unlike the traditional approach of incrementally adding new applications and IT components to achieve an EHR, CTCA engineered a complete transformation of our IT application architecture all at once. We now have a cohesive, centralized system that integrates every aspect of a patient’s care and delivers unprecedented information security and availability.”

“The EHR is already running in our three existing cancer hospitals, and we’ll extend the benefits even further when we open our first all-digital hospital in Phoenix in December 2008. The CTCA system will help CTCA enhance each patient’s treatment experience from the point of admission forward. Everything from viewing medical history in the operating room to submitting insurance claims to filling prescriptions will be done electronically.”

To launch the EHR project, CTCA replaced storage directly attached to its servers with a centralized EMC CLARiiON(R) storage area network (SAN). CTCA also deployed several new applications, such as Eclipsys Sunrise Clinical Manager (SCM) and Microsoft Office SharePoint Server, as well as integrated existing applications, such as Lawson enterprise resource planning software and Microsoft Exchange email, and into the new infrastructure.

“Each year, we are adding vast quantities of new medical data and clinical applications online; EMC’s SAN has enabled us to scale smoothly to storage capacities that have grown by 600% to 60 terabytes in less than two years,” said Eckes. “Even though the environment is significantly bigger and more diverse, we’ve been able to maintain our storage needs with a team of two employees who manage all of the SAN, replication and backup support on a part-time basis. With the SAN’s ease of use and simplified management, we’re able to do a lot more with the same amount of resources.”

In the latest phase of its EHR deployment, Schaumberg, Ill.-based CTCA implemented EMC RecoverPoint to replicate all of its clinical and administrative information stored on the EMC CLARiiON to another CLARiiON located at a remote datacenter 40 miles away.

Rakesh Patel, Director of Infrastructure and Security, CTCA, said, “We use EMC to replicate new data every second so our clinicians always have a current view of a patient’s status. If our datacenter failed, we would recover from clean data as opposed to data that is hours old. We also can bring up our production systems at our remote site in less than two hours compared with the three to four days a recovery used to take us.”

In addition, VMware(R) virtualization solutions have contributed to improving CTCA’s information availability. With VMware, CTCA was able to consolidate 70 percent of its physical servers as virtual machines, reducing the number of physical servers. CTCA utilizes RecoverPoint to replicate the virtual machines stored on the EMC CLARiiON and to integrate with VMware Site Recovery Manager to automate the recovery process in case of a site failure. If a virtual machine needs more resources than is being provided, CTCA uses VMware’s VMotion to move the virtual machine from one physical server to another – online, and without service interruption. In addition, if a physical server fails, VMware High Availability automatically fails over the virtual machines to operational servers.

Patel said, “That consolidation alone contributes to a more reliable environment because there is less complexity. And, using VMware and EMC recovery tools together ensures that our physical and virtualized environments can be centrally managed and well protected.”

CTCA also uses EMC NetWorker(R) software to back up its entire production environment to an EMC Disk Library 4100, which is replicated to another Disk Library. The disk backups are eventually ported to tape for longer-term storage.

Patel said, “It used to take 12 hours to back up 1.8 terabytes to tape. With NetWorker and Disk Library, we back up more than twice that much data in less than four hours. In a 24-hour operation like a hospital, it’s crucial to get the data backed up quickly so it’s not slowing down the applications.”

Source: EMC Corporation


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