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The CMG Voice

Heart Failure Medications Under Prescribed

Posted Wednesday, September 12, 2018 by Morgan Cartwright

About 5.7 million people in the U.S. have heart failure according to a 2016 report by the American Heart Association. About half of these people have a condition called reduced ejection fraction, which is a weak heart muscle that does not eject the normal amount of blood in each heartbeat.

Heart failure results in a lower quality of life and frequent hospitalization, as well as 300,000 deaths a year. However, in some large clinical studies, certain medications have shown to help people with heart failure and reduced ejection fraction live longer and better lives. The American College of Cardiology, American Heart Association, and Heart Failure Society have put out guidelines on these medications to direct doctors.

A new study of 3,518 patients and 150 primary care and cardiology practices by UCLA looked into the patient prescriptions of three different heart failure medications. Unfortunately it was found that 27 percent to 67 percent of patients were not prescribed the recommended drugs.

Even when they were prescribed the drugs, many were given lower-than-recommended doses. Less than 25 percent of patients received all three-medication types, and only 1 percent received the target doses of all three medications.

The results suggest that use and dosing of heart failure medications has not improved over the past decade. New strategies are needed to help get patients the needed medications. This would help improve the care and outcomes for people with heart failure, leading to better quality of life.

You can read more here:

Drugs for heart failure are still under-prescribed, years after initial study

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Patients Fear Interns, Interns Fear Patients

Posted Friday, September 7, 2018 by Morgan Cartwright

In the early summer months, medical students start taking on new internships in medical centers. Interns have historically been afraid of patients because of the new situations they encounter. Without repeat experiences of these situations, the knowledge from medical school can be lost in the emergent issues of the patient.

In a recent study by Accreditation Council for Graduate Medical Education (ACGME), they examined patient’s feelings towards new interns who provided their care. The majority of patients were uneasy, which increased when the interns themselves were uneasy. To remedy the problem, patients and interns unanimously wanted a “confident, knowledgeable supervising doctor”.

This study presents an interesting problem in the medical field and patient care in general. There needs to be a balance between intern experience and doctors helping teach the interns. Without that, interns may not diagnose or treat patients correctly, which can put patients at risk.

New Report: Patients & July Interns Equally Frightened by One Another

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New online tool promises to predict heart disease risk.

Posted Tuesday, September 4, 2018 by Tyler Goldberg-Hoss

Recently, the Canadian Medical Association published the results of extensive research into the risk of heart disease: an online tool that can help you predict your 5 year risk of heart disease.

Researchers mined over 100,000 Canadian residents for demographic information such as age, smoking status, alcohol consumption, and diet. The result: the Cardiovascular Disease Population Risk Tool, or CVD-PoRT.

CVD-PoRT is intended to help direct preventative care, helping providers take a more holistic approach to counseling patients. This can include discussing possible healthy lifestyle changes that can reduce the chances of heart attack or stroke.

The insight gained from such large scale data analysis is and should in the future be used to improve other areas of medicine, including the diagnosis of serious diseases in the ER, the interpretation of radiology films, and eliminating infectious diseases in hospitals.

Perhaps the closer we make medicine to a science than an art, the safer we all will be.

You can read more about this at the Canadian Medical Association website here:

Development and validation of a cardiovascular disease risk-prediction model using population health surveys: the Cardiovascular Disease Population Risk Tool (CVDPoRT)

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OB/GYN Shortages Could Challenge Women’s Health

Posted Tuesday, July 24, 2018 by Morgan Cartwright

An OB/GYN, or obstetrician-gynecologist, is a doctor who specializes in women’s health. They provide care for women during menstruation, childbirth, menopause, and a variety of other female body experiences. From diagnosis, treatment, and care, OB-GYNs provide essential functions to ensuring women and their biological functions are healthy.

However, a recent research study has found that the nation could be reaching a severe shortage of OB-GYNs in the next couple years, especially in some of our larger metropolitan areas. The American Congress of Obstetricians and Gynecologists (ACOG) estimates a shortage of 8,800 OB-GYNs by 2020, which will increase to 22,000 by 2050.

The major contributors are that the average OB-GYN age is 51, and they have heavy workloads. Only 16% of OB-GYNs are under the age of 40. The metropolitan areas with the largest workloads also have the most uninsured or Medicaid covered women, which drives down OB-GYN compensation.

OB-GYNs are one of the top specialties and are important to women’s healthcare. This looming shortage could prove to be very problematic from a women’s health standpoint.

You can read more about this here:

Severe Ob/Gyn Shortage Looming

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Complexity in Healthcare Risky for Patients

Posted Thursday, July 19, 2018 by Morgan Cartwright

Over the years, many healthcare organizations have evolved into large and complex systems where the care of the patient is sometimes compromised precisely because of this complexity. The healthcare industry now often has so many moving parts that all of the individuals involved have to be in the same gear, otherwise the care of the patient stalls. If this happens, it can result in serious harm to the patient.

In one example, a wife of a man with dementia went to the long-term care facility that he was recently admitted to. Prior to the long-term care facility, the man was physically healthy other than his cognitive dysfunction. However, over time at the facility he developed urinary tract infections, bedsores, pneumonia, and swelling of his hands and legs. The wife tried to speak to individuals at the facility but was told, “That’s not my job, but I’ll pass this on to the nurse/doctor/supervisor.”

In another example, an intern at a hospital was given the responsibility of getting an echocardiogram scheduled, finding a cardiologist who took the patient’s insurance, getting a stress test authorized by the patient’s insurance company, and getting prescription medicine authorized by an insurance company. All of this was for a patient the intern had never even met.

Most of the time, the solution lies in safe systems promoting patient safety, and a teamwork effort that follows those safe systems in the context of so many moving parts. By failing to implement such safe systems, the healthcare organizations risk the care of the patient.

You can read more about the dangers of providing health care with too many moving parts here:

Healthcare Has Too Many Moving Parts

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