Healthcare Archive

Research we're watching

Doctors have been overprescribing opioids for chronic musculoskeletal pain, according to a December 2019 study in The Journal of Pain. Researchers looking at data from a survey conducted between 2007 and 2015 found that doctors more often prescribed pills, either non-opioid or opioid, rather than physical therapy, counseling, or other nondrug interventions — a practice that is directly at odds with what experts now recommend, including those in the CDC Guideline for Prescribing Opioids for Chronic Pain. At their first visit with the doctor, people were most often prescribed non-opioid painkillers (40.2%) or opioids (21.5%), followed by counseling, nonpharmacological treatments, and physical therapy. Study authors say this shows there is room for improvement through education. However, it's worth noting that the time period studied (2007 through 2015) preceded much of the recent work and advocacy aimed at reducing prescriptions of opioids.

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Do a thorough assessment to make sure equipment is safe.

Your doctor or an occupational therapist may recommend that you use some kind of medical equipment, such as a walker, electric scooter, cane, lift chair, or shower chair. Such equipment can help you maintain your independence or continue living at home. But what if your insurance won't pay for an item or if you need a spare? For many people, the solution is gently used equipment.

Bargain hunting

You'll find used medical equipment in consignment shops and thrift stores, and through online classified ad sites (such as Craigslist). The deals are substantial: you may find a used electric wheelchair (that retails for $2,500 new) for a few hundred dollars, or a used power lift chair ($500 new) for just $75.

Talking about sexuality with a doctor can be uncomfortable. If you identify as LGBTQ+, it's important to find a doctor who is attuned to the specific needs of the LGBTQ+ community. This can make getting proper care easier.

What if someone you love doesn't have an advance directive? That's common, although the underlying reasons may differ. Basic barriers include thinking that an advance directive isn't needed, not wanting to think about death or serious illness, not wanting to burden people, not knowing enough about advance directives and health care choices, needing help to fill out the forms, and lack of time with the doctor to discuss the matter. A person's ethnic or cultural background can also be a barrier: minorities tend to be more suspicious of health care providers and resistant to talking about or completing advance directives. According to AARP, African Americans in home health care and nursing homes are half as likely as whites to have advance directives.

To deal with this situation, try asking your loved one two simple questions, even if you think you know the answers.

Although it can be difficult to have hard conversations regarding advance care planning, most people find it a relief to know they have voiced their preferences and laid the groundwork for decision making once it is complete. Coming up with an advanced care plan can be overwhelming, but it is important to take it step by step.

The first step is simply gaining a realistic understanding of your current health status. You may be in generally good health, despite having several medical conditions such as high blood pressure or osteoarthritis. You may be doing well now but have a chronic, progressive, ultimately fatal illness such as Alzheimer's disease or metastatic colon cancer. You may be frail because of multiple interacting chronic conditions or one disease that has widespread effects on your daily activities and health. Or you may have a serious advanced illness, such as end-stage heart failure.

The old-fashioned house call is back in a big way. Here's how it works.

It's hard to get to the doctor when you don't drive anymore or you're struggling with several chronic medical conditions. The result may be missed appointments and a lack of needed care.

But a growing trend makes it far easier for older adults to get medical attention, bringing routine exams and diagnostic tests to the patient's doorstep. It's called home-based medical care — when doctors, nurse practitioners, physician assistants, or other providers visit and treat older adults right in their homes.

News briefs

As we've reported before, free medically tailored meals are making a big difference for older adults who have chronic illness or are recovering from a hospital stay. The meals are provided by nonprofit agencies and are customized to your dietary needs — like a potassium-controlled diet if you have kidney disease, or a diet low in vitamin K if you're taking a blood thinner. Now an observational study published online April 22, 2019, by JAMA Network Open suggests that taking part in a free medically tailored meal program is linked to fewer admissions to hospitals and nursing homes, as well as lower medical costs. Researchers looked at about 1,000 adults with health problems such as cancer or diabetes. Half took part in a free medically tailored meal program for about a year; the other half did not. During a two-year follow-up, people who received medically tailored meals had 49% fewer hospital admissions and 72% fewer nursing home admissions than those who did not receive meals. Getting the meals was also tied to a 16% reduction in medical costs each month. To find a program near you, check out the partner section of the Food Is Medicine Coalition (www.fimcoalition.org/partners).

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The FDA may require mammography facilities to notify patients about this breast cancer risk factor, but women don't know what to do with this information.

Do you know how dense your breasts are? If you don't, a new proposal by the FDA may mean you will soon find out.

The agency proposed a change that, if approved, will require mammography facilities to send letters informing women about their breast density — a measure of the proportion of active tissue versus fat in their breasts (see "The FDA proposal").

Drug recalls don't necessarily affect every batch of a pill or potion. You'll need to do a little homework before you stop taking your medication.

We take prescription and over-the-counter medications to get better or avoid getting sick. We know drug side effects can make us feel ill. But we don't imagine that medications can contain toxic impurities. Yet, it happens. Recently, for example, dozens of prescription blood pressure pills (angiotensin-receptor blockers, or ARBs) containing trace amounts of potentially cancer-causing compounds were recalled.

Recalls happen frequently. Sometimes, the FDA finds the manufacturing process to be defective. Other times, a dangerous side effect that was initially not apparent becomes clear later. "Some medication recalls are for problems that are not very serious, but the products have to be recalled nonetheless," says Joanne Doyle Petrongolo, a pharmacist with Harvard-affiliated Massachusetts General Hospital.

Many people understandably want to keep their living will and health care power of attorney forms in a secure place. But if these documents are locked away in a safe deposit box, they won't be much help if you're unexpectedly hospitalized. Here are some people who should have copies of your advance directives and some other places where they should be filed.

• Your health care agent and any alternative agents. All should have a copy of your health care power of attorney (and your living will, if you have one). In an emergency, your agent may need to fax the documents to doctors or a hospital.

• Your doctor. A copy of your advance directives should be in your file and medical record.

• Your hospital chart. If you are in the hospital, ask to have a copy of your advance directives put in your chart. (Your health care agent or a family member should do so if you are unable to do it.)

• A safe spot in your home. File the original documents in a secure place in your home — and tell your agent, family, and friends where you put them. Hospitals may request an original, so it's important that someone can find the documents when necessary. The National Hospice and Palliative Care Organization suggests noting on all copies of the documents where the originals are stored.

• Carry it with you. Put a card with your health care agent's name and contact information in your wallet or purse. Also note on the card where you keep the original and additional copies of your directives.

If you have a do not resuscitate order (DNR), remember that you or your health care agent may be required to produce a signed form, or you may have to wear a special bracelet identifying that decision. If a lawyer drew up your advance directives, ask whether he or she will keep a copy, and for how long.