May 13, 2011

Are You Ready for An Emergency?

In an email I received this week, the American Diabetes Association had a short list (too short for me) of diabetes supplies that you should have available in case of an emergency. Yes, those of us especially in the US, with the problems across the south with tornadoes and along the flooding Mississippi and other rivers need to take heed and be prepared. Other disasters can happen as well.

On August 27, 2010, I wrote about disaster preparedness and it is always good to review your plan. What bothers me about most plans, is the lack of cautions when they say to have the supplies where they can be gotten to in an emergency. For those of us on insulin, no caution or warning is made to make sure to keep the insulin refrigerated, or if not, that the insulin vials be rotated out and used before they can go bad. Insulin vials can be kept unrefrigerated for up to 28 days. Even if they are kept in the refrigerator, once the plastic cap is removed, the shelf life is 28 days.

This means that you must be able to use the vial before the end of 28 days. I normally use a vial in 7 to 10 days of one type and about 14 days of the other type. You will have to know your own usage rate to be able to rotate and use before they expire. The same would apply for other medications you inject. Normally 28 days is the unrefrigerated life for these unless clearly stated otherwise on the package. If not stated, ask your pharmacist about the unrefrigerated shelf life.

The ADA advice is still good for emergency preparedness. They suggest that a three day supply of diabetes supplies be kept in a clearly marked, and convenient, container to be carried with you when going to a shelter or evacuation. The ADA list which, depending on how you take care of your diabetes, could include oral medication, insulin, insulin delivery supplies, lancets, test strips, extra batteries for your meter, and a quick-acting source of glucose. Just don't forget to take the container with you and your meter.

The ADA did suggest something that a lot of others forget. They suggest putting a list of emergency contacts in the container and to wear a medical identification that will enable emergency medical personnel to identify and address your medical needs. They went on to say that while you are thinking about this to notify those around you about your diabetes as it could make a difference in a time of need, and how you might be treated for maintaining your good health.

To this, I would add a supply of other medications that you take, a list of each, and the purpose for taking them. Have this list in the container also. Also include a list of phone numbers for the pharmacy, doctors, and anyone else that could know where to get your supplies if the emergency extends for more than three days. A list of prescription numbers should also be considered and alternative pharmacies in the chain where you obtain your medications. Ask your pharmacist if there are other pharmacies that have access to your prescriptions within the chain of stores.

I would suggest reading my prior blog, ADA's PDF file and heeding the instructions that fit your needs. Some items can easily be overlooked, but I hope between this and my prior blog that you can put an effective and doable plan in place.
I have tried to post this the last two days, but this site has been read-only for a few days.  Apparently their maintenance took longer or did not work as planned.

May 10, 2011

Who Is Responsible for Patients' Health Literacy?

Patients health literacy is a common theme lately in releases from the various medical associations. All are directed at the patients, caregivers, and healthcare professionals and attempting to provide more information of value to all concerned. What is generating this largess of information? Has all the poor web sites, studies showing lack of reliable information in the internet, or just good public relations finally driving the different medical professional organizations to get active.

Let's hope all of the above is true. Our medical insurance industry is doing almost nothing to help doctors in educating the new patients with diabetes or other chronic diseases. This would take too much from their profits. In many of the new websites and other information, it is the big pharmaceutical companies that are stepping forward to provide assistance as cosponsors or just financial support.

Our medical insurance companies may one day come to regret their greed and refusal to help. Federal and state regulations are already under analysis to determine if the medical insurance industry is violating moral as well as legal obligations in their rejection of patients' needs. I am not sure big pharmaceutical companies are innocent of charges either, considering the Vermont case awaiting a decision by the U.S. Supreme Court later this summer.

Yes, if patients are in cities that have diabetes educators and dietitians, medical insurance will cover a few classes, and then no continuing education for a period of years. Medicare is even less helpful.

The American College of Obstetricians and Gynecologists (ACOG) now states that physicians, nurses, social workers — everyone in the health care field — must make sure that our patients fully understand their health condition and their treatment. They also emphasize the importance of patients taking their medications exactly as directed. We simply can't assume that a patient understands because she/he nods their head or because we think they seem educated.

One important point shows that that they are taking this obligation seriously. They state that asking our patients to repeat back to us what they understand is enormously helpful in making sure they really do comprehend. This can help avoid the stereotype of noncompliant being applied. They also advise using technical translators to assist when there is a language difference.

Read their article on committee opinions here.

May 8, 2011

Telemedicine Coming of Age?

This is not about diabetes, but may affect treatment of diabetes in the future. Telemedicine has been around for a few years, but with many of the advances in recent years, there is now cause to feel more confident about its use and the good that it can do to help areas without large medical centers and specifically rural areas.

Telemedicine is finally getting the light it seems to deserve. In three articles appearing on May 3, 2011, advances in telemedicine are moving forward. The Centers for Medicare and Medicaid Services (CMS) has open the door to make it easier for smaller hospitals to take advantage of doctors with specialties they can not afford. Prior to the new rules, they were required to perform medical checks on all doctors they used as if they were employing them.

Now they are required to do this only for doctors not employed by hospitals elsewhere. If the doctor is already on a hospital staff, they are deemed eligible to operate via electronic means in any hospital that needs their services and Medicare and Medicaid will cover the costs when there is a proven need. The full article covering this is here.

The more important one for me is that our veterans will now get the attention they deserve for PTSD (post-traumatic stress disorder). This will allow veterans to avoid long travel times to centers distant from where they live to get the care they need in dealing with PTSD. Previously the veteran was required to travel to major medical centers for the care they needed.

This was not conducive to many veterans because of cost, and for many the fear of traveling and going into places that may be crowded. The studies have shown that costs are less, patients are happier, and the long-term benefits have increased. Not measured is the improvement in the quality of life for the veterans receiving treatment via telemedicine. Read this article here.

The third article is from Florida and also showed improvement in patient care for trauma patients and those needing medical attention immediately. Instead of automatically transporting the patient to the local hospital to have them forward the patient on the the trauma center at a cost of approximately $10,000, telemedicine can determine with the medical personnel on the scene where to send the patient.

This saves time and some monies as if the trip to the trauma center is necessary assistance can be provided en route to the emergency personnel. The center can also assemble the team necessary to treat the patient more effectively upon arrival.

These three articles emphasize the importance and possible cost savings of telemedicine for the advantage of the patients. Expect to hear more about telemedicine during the coming year. Read the last article here.