Health for life

Months ago, the caffeine-addled Disease Management Care Blog reviewed with the spouse how to pre-set the kitchen coffee brewer for a pot of fresh coffee for the next morning. After listening politely to its earnest instructions, the DMCB spouse rarely set up the brewer.

Which is why the DMCB wasnt surprised by an Iowa Chronic Care Consortium (ICCC) study of how its newly minted medical home coach trainees were being deployed in the real world. The ICCC is a not-for profit organization that was founded in 2002 and offers a training program that prepares health professionals to be members of a medical home team.
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The Consortium surveyed 318 graduates from their program. Of that number, there were 164 responses, yielding a 54% response rate. 83% of the respondents were nurses, while the remainder were medical or office assistants, diabetes educators, dietitians, social workers, physicians, pharmacists or administrators.
 
The good news is that care-management caffeine was available. The majority of respondents reported that they were using their skills to coach patients for self management, care coordination, planning visits and supporting registry use.  The majority also found their work professionally rewarding.

The bad news is that these professionals were not being supported for maximum effect:

55% were still "building support for the position."

48% reported that "office work" was given a "higher priority," often due to physician and administrator resistance.

73% reported that their coaching duties were part time and was in addition to their more traditional roles.

Only 8% were involved in office "change management."

Only 11% enjoyed a pay differential that rewarded their coaching skills.

The Consortiums paper concludes - paralleling the DMCBs coffee-making travails - that a good idea accompanied by well-meaning training is not enough to overcome established clinic routines, business roles and local culture.  The authors recommend that provider payments "change," coaching functions be "operationalized," training programs be "advanced," outcomes be "demonstrated" and that roles be "clarified."

While the DMCB ponders coffee change, operations, advances, demonstrations and clarifications, the DMCB has a far more more fundamental concern for the medical home:

With friends like this, the fledgling medical home movement doesnt need any enemies.

If the clinics that took the time and the money to train these individuals are unable to leverage their skills, disappointing outcomes could end up snatching usual care from the jaws of primary care clinic transformation.

The DMCB has three recommendations:

History Repeats: Years ago, established "disease management" companies had to go on record and oppose start-ups that were offering "faux" telephonic patient counseling programs. The medical home and population health management community, including the PCPCC, likewise cant afford to have clinics going to market with diluted medical home programs that deliver empty process instead of hard outcomes.  All health care is local, and much of the buy-in for the medical home will ultimately be won or lost at that level.  Speak up!
 
Buyer Beware: Payers and insurers need to be wise to the possibility that having a trained health coach on staff with credentials is not the same as having a health coach on line with the patients. On site credentialing may be in necessary that includes review of policies, job descriptions, pay scales and staff interviews.

Build or buy: Primary care clinics need to know that when they buy patient counseling services from a population health management vendor, you get full time on a plug and play basis. That may be a better option for a clinic that is not prepared to both train and fully use an on-site health coach.

We know olive oil is good for the heart. Its monounsaturated fats have a reputation for lowering LDL (bad cholesterol) and raising HDL (good cholesterol).

Now, researchers have found another benefit of olive oil - the ability to reduce pain and inflammation, much like non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil® or Motrin® can.

This time the benefit is not due to olive oils monounsaturated fats, but to a newly discovered chemical the researchers named oleocanthal. It was found occurring naturally in the extra-virgin type of olive oil.

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For a summary of the researchers findings:
Olive Oil Contains Natural Anti-inflammatory Agent

The article appears in the September 1 issue of the journal Nature (editors summary only, subscription required for full article.):
Phytochemistry: Ibuprofen-like Activity in Extra-virgin Olive Oil

People with diabetes are more vulnerable to pollution from traffic and coal-burning power plants than are people without diabetes. Compounds in polluted air impair the function of their blood vessels, increasing their risk for heart attack, stroke, and other cardiovascular problems.

These are the findings of researchers who studied the blood vessel function of 270 Boston-area residents exposed to various levels of pollutants in their surrounding air. They also found cardiovascular risk was greater in people with type 2 diabetes than people with type 1.

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For a summary of the study:
People with Diabetes More Sensitive to Cardiovascular Effects from Air Pollution

For the study itself (abstract only, subscription required for full article):
Diabetes Enhances Vulnerability to Particulate Air Pollution–Associated Impairment in Vascular Reactivity and Endothelial Function