504HealthNet in the News

Some had no place to go or no wheels to take them. The sick and the elderly waited helplessly. Thousands stayed for their pets or figured they’d just ride it out as they had before. In a pinch, there was always the Superdome.

Roxy Wright was too connected to get stuck like that.

Wright counts prominent musicians, judges and politicians in her orbit of family and friends, and for a time she attended Mass with former Gov. Kathleen Blanco. She was Blanco’s New Orleans office director when she tuned in to watch her boss stand before the TV cameras on Aug. 28, 2005, ghostly white, and plead for rapid flight.

Read the full story here.

504HealthNet in the News

Access Health Louisiana (AHL) is marking National Health Center Week 2015 (NHCW) with a special Voter Registration Drive as well as a Coloring Contest for Children in all its Community Health Centers in seven parishes in south Louisiana.

This is part of a weeklong campaign (Aug. 9-15) to raise awareness about the mission and accomplishments of America’s Health Centers – the largest and most successful system of primary healthcare.One of the bright spots in America’s health care system, health centers started 50 years ago as a pilot project during President Lyndon Johnson’s War on Poverty.

Read the full story here.

504HealthNet in the News

By the time patients arrive at Dr. Monir Shalaby’s office at the EXCELth clinic in New Orleans, they have run out of options: Most have little or no income, no health insurance and, usually, a heap of health issues.

Ten years ago, their options shrunk to nothing when Hurricane Katrina’s storm surge breached the levees, swamping homes and businesses. With many of the city’s charitable hospitals closed due to storm damage and two of EXCELth’s clinics flooded, patients came to the third from all over the city, standing in blocks-long lines to replace lost prescriptions and seek health care.

Read the full story here.

504HealthNet in the News

504HealthNet and Flip the Clinic Take the Stage at the White House Champions of Change for Precision Medicine Event

NEW ORLEANS—504HealthNet is pleased to announce participation in Flip the Clinic, a project of the Robert Wood Johnson Foundation, which will encourage the use of electronic medical records to empower patients to take charge of their health.

Today, 504HealthNet and Flip the Clinic will join the White House for their Champions of Change for Precision Medicine Event. Flip the Clinic’s program director Whitney Bowman-Zatzkin will share the news of a transformational idea that has been picked up by over a dozen health systems, organizations, and clinics across the country. Right now, the solution—what Flip the Clinic calls “Flip 55”—is set to reach 20 million patients and 160 thousand clinicians, and interest is only growing.

“This is an exciting opportunity for 504HealthNet members to participate in an innovative initiative aimed at increasing patients’ engagement with their health,” said Susan Todd, Executive Director of 504HealthNet. “By participating in this project, we are supporting improvements in the way people access their health information that can help inform their healthcare decisions.”

Flip 55 is an elegant yet practical solution that helps health systems encourage patients to access their electronic medical records. It also directly supports patients as they request their electronic health data from clinics, hospitals, and labs. Starting today, Flip the Clinic is offering a toolkit to accompany Flip 55 aimed at helping health systems get the word out to patients and helping patients navigate their electronic health record requests. Flip the Clinic will also offer targeted support to electronic health record providers, hospitals, clinics, and patients.

The idea for Flip 55 came about this Spring, after a recent U.S. Department of Health and Human Services report cited that an impressive ninety-two percent of hospitals have a system in place to provide patients with timely access to an electronic copy of their health record. Yet, the number of patients requesting a digital copy of their health record in a year was one or none. The survey hints at a striking disconnect between what’s technically available and a patient’s understanding of what they’re able to access. Just 38 percent of patients with an electronic health record-enabled provider reported being offered a copy by a clinician or insurer.

Because of Flip the Clinic’s focus on open experimentation and its view that patients and clinicians are equal participants in making the health care experience better, Bowman-Zatzkin realized that Flip the Clinic was uniquely suited to help. “For both patients and health systems, pushing for patients to access and use electronic medical records is a massive cultural shift,” explains Bowman-Zatzkin. “At a very basic level, it’s not unlike our cultural shift around online banking. At first, both banks and customers were skeptical, but eventually we changed to a more proactive way of managing our money. A patient’s ability to view, share, and use their electronic health records or lab results is a really great thing. We’re just starting to understand the opportunities for patients to connect their data in meaningful ways that match their health goals.”

Flip 55 has drawn monumental interest in an extremely short amount of time. Twenty million patients are currently within reach of its message. Thanks to the White House’s support for Flip the Clinic, Flip 55 is on track to benefit even more patients. “The President’s Precision Medicine Initiative starts with connecting more patients to their digital health records through support and encouragement from clinicians across the United States,” says Bowman-Zatzkin. “This is just the first step.”

Flip the Clinic is thrilled that the following organizations have committed to promoting awareness of a patient’s ability to receive their electronic health data by piloting Flip 55: 504HealthNet in New Orleans, Allergy & Asthma Care Centers in Virginia, Almost Family in Kentucky, The Austin Diagnostic Clinic in Texas, Children’s Integrated Center for Success in Pennsylvania, Inova Health in Virginia, Johns Hopkins Sibley Memorial Hospital in Washington, D.C., LIVESTRONG Foundation, National Association for Trusted Exchange, Palo Alto Medical Foundation in California, text4baby, Trinity Health in Michigan, Trinity Health in Michigan, UMKC Health Care in Missouri, UNC Health Care in North Carolina, and Epic.

Join Flip the Clinic at the White House Champions of Change for Precision Medicine by watching the live event at whitehouse.gov/live. You can encourage easy and regular access to digital health records by joining the Flip 55 team. Pilot this Flip in your community or practice promoting patient access to electronic health records. Make the commitment here: fliptheclinic.org/flips/AccessOurData.

ABOUT 504HEALTHNET
504HealthNet is a non-profit organization comprised of 22 community health service providers representing the primary care and behavioral health safety net for Orleans, Jefferson, St. Bernard, and Plaquemines Parishes. Together, 504HealthNet is working collaboratively to better meet the primary care and behavioral health needs of low-income, uninsured, and underinsured residents in the Greater New Orleans area.

ABOUT FLIP THE CLINIC
Flip the Clinic, a project of the Robert Wood Johnson Foundation, brings together patients and health practitioners, both online and in person, to design new tools and share existing strategies aimed at getting more out of the health care interaction. For more information, go to FlipTheClinic.org. Follow Flip the Clinic on Twitter @FlipTheClinic.

Budget Passed, Includes Funding for GNOCHC

Greater New Orleans Community Health Connection Program funded with $8 million

New Orleans, LA (6/22/15) — On Friday, June 19th, Governor Jindal signed the 2015 budget into law which included $8 million for the Greater New Orleans Community Health Connection (GNOCHC), a program that provides primary care and behavioral health coverage for 59,000 people in the Greater New Orleans Region. GNOCHC participants are adults under 105 percent of the federal poverty level, who are uninsured and not eligible for regular Medicaid, and who live in Jefferson, Orleans, St. Bernard, and Plaquemines parishes.

“We are thrilled that this important program will continue. This program has made a huge impact in the four parish area,” said Susan Todd, executive director of 504HealthNet. “It gives people who are otherwise uninsured access to a primary care doctor to take care of important health issues like diabetes and high blood pressure. This program covers the people who can’t get health care coverage through their employer, or through any other program, and allows them to address their basic healthcare needs.”

This funding will maintain access to preventative healthcare and behavioral health services for 59,000 GNO residents in our community. It also means more than 300 people in health centers across the metro area will keep their jobs, and Louisiana will continue to save money as people are able to access care in the lower cost setting of a community health center instead of the emergency room, which is more costly.

“We are thankful to all of the Legislators representing this region who has been very supportive of GNOCHC. Representatives Moreno and Montoucet stepped up to support this important program by submitting an amendment to include funding for it in the state budget. This critical program continues to make a significant impact on the lives of patients,” Todd said. “Continuing to fund this program means so much for patients who are looking to stay healthy in our community.”
By providing $8 million in funding from the current state’s budget, GNOCHC will draw down an additional $13 million in federal funding. If this program had been cut, we would have experienced a devastating blow to prevention and building a healthy community, as the GNO region would have lost $21 million to deliver care to low-income residents.

504HealthNet is a non-profit organization comprised of 22 community health service providers representing the primary care and behavioral health safety net for Orleans, Jefferson, St. Bernard, and Plaquemines Parishes. Together, 504HealthNet is working collaboratively to better meet the primary care and behavioral health needs of low-income, uninsured, and underinsured residents in the Greater New Orleans area.

You can find more information about GNOCHC here.

Guidelines for the Use of Daily Aspirin for the Primary Prevention of Myocardial Infarction in Men and Cerebral Vascular Disease in Women

By Farah Kaiksow

The following information is summarized from the USPSTF March 2009 publication. Please note, the USPSTF is currently in the process of updating this publication.

  • Daily low-dose aspirin decreases the risk of myocardial infarction in men aged 45-79 years, but not in women.

  • Daily low-dose aspirin decreases the risk of ischemic cerebrovascular disease in women aged 55 to 79 years, but not in men.

  • Primary Care Physicians should recommend daily aspirin for men and women in the above age groups if their calculated risk of MI or ischemic CVD, respectively, outweighs their risk of gastrointestinal hemorrhage.

Population

Men
Age 45-79 Years

Women
Age 55-79 Years

Women
Age 55-79 Years

Women
Age 55-79 Years

Men and Women Over 80 Years

Recommendation

Encourage aspirin use when potential CVD benefit (MIs prevented) outweighs potential harm of GI hemorrhage.

Encourage aspirin use when potential CVD benefit (strokes prevented) outweighs potential harm of GI hemorrhage.

Do not encourage aspirin use for MI prevention.

Do not encourage aspirin use for stroke prevention.

No Recommendation

Grade

A

(High certainty that the net benefit is substantial.)

D

(Moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.)

I

(Insufficient Evidence)

For patients who do not take NSAIDs regularly and do not have a history of GI bleed or ulcers, the table below should be used to determine if the benefits of aspirin outweigh the risks of GI side effects.

10-year CHD risk for Men

10-year stroke risk for Women

Age 45-59 years

≥4%

Age 45-59 years

≥3%

Age 60-69 years

≥9%

Age 60-69 years

≥8%

Age 70-79 years

≥12%

Age 70-79 years

≥11%

Primary Care Physicians should use the following calculators to determine their patients’ 10-year risk of CHD or ischemic stroke:

  • Men (CHD)

  • Women (stroke)

Please note, the original stroke risk calculator (Western States Consortium) cited by the USPSTF is no longer available.

For patients who do take NSAIDs regularly or have a history of GI bleed or ulcers, Primary Care Physicians should carefully weigh the risks and benefits of daily aspirin as it more than doubles a patient’s risk of GI bleed or ulcer.

Guidelines for Diagnosis and Treatment of Diabetic Neuropathy

diabetes stock image cdc
A summary of the American Diabetes Association Standards of Medical Care in Diabetes 2015

by Sarah G. Candler, MD, MPH

The following is a summary of the American Diabetes Association Standards of Medical Care in Diabetes 2015.

Neuropathy is one of the most common complications of uncontrolled diabetes. Its incidence increases with the duration of diabetes so that by 25 years, about half of diabetic patients will develop diabetic polyneuropathy (DPN). This type of neuropathy is characterized by decreased sensation of the feet or decreased or absent ankle reflexes. Additionally, an estimated one in three diabetic patients will have painful neuropathy—with or without the loss of sensation. Diabetic patients are also at risk of cardiovascular autonomic neuropathy, which may nor may not be symptomatic, but which can be associated with significant morbidity and mortality.

It is important to screen for both sensorineural neuropathy as well as signs and symptoms of autonomic neuropathy at the time of diagnosis of Type 2 diabetes and 5 years after diagnosis of Type 1 diabetes, then annually. If patients have painful diabetic polyneuropathy (DPN), it is important to treat, as amelioration of pain has been shown to improve patients’ quality of life.

Evidence supporting pharmacologic treatment for DPN is weak, and the only medications FDA approved for this diagnosis are Pregabalin, Duloxetine, and Tapentadol. However, Venlafaxine, Gabapentin, and other medications have also been shown to assist with some DPN-related pain.

Diabetic Neuropathy Checklist
Prevent development or progression of neuropathy in ALL diabetic patients:

  • Monitor Hemoglobin A1c and promote glycemic control with goal <7%

    • If controlled: A1c at least every 6 months

    • If uncontrolled: A1c at least every 3 months

  • Recommend smoking cessation

  • Perform annual comprehensive foot exam and provide self-care education

  • Inspection, pulses, neuropathy evaluation (as below)

  • Refer to podiatry if patients smoke, have high-risk feet, or have ulcers

  • Perform annual dilated eye exam (impaired vision increases risk of foot trauma)

  • If diabetes is severe and uncontrolled, screen for cardiovascular / autonomic neuropathy (as below)

  • Treat symptoms related to painful DPN and autonomic neuropathy to improve quality of life (will not reverse the pathology)

Validated Screening Tools for the Diabetic Foot Exam
Use at least 2 methods for >87% sensitivity in detecting DPN:

  • Pinprick sensation

  • Vibration perception with 128-Hz tuning fork

  • 10-g monofilament pressure sensation at distal plantar aspect of both great toes and metatarsal joints
    assessment of ankle reflexes

Screening tests for Cardiovascular Autonomic Neuropathy: for patient with severe, uncontrolled disease

  • Resting tachycardia

  • Exercise intolerance

  • Orthostatic hypotension

  • Constipation

  • Gastroparesis

  • Erectile dysfunction

Other Causes of Neuropathy: rule these out when diagnosing DPN

  • Neurotoxic medications

  • Heavy metal poisoning

  • Alcohol abuse

  • Vitamin B12 deficiency (especially if taking Metformin)

  • Renal disease

  • Chronic inflammatory demyelinating neuropathy

  • Inherited neuropathies

  • Vasculitis or vascular insufficiency (particularly if smoker)

Recommended Treatments of Painful Diabetic Polyneuropathy (DPN)

  • FDA approved for DPN, likely effective: Pregabalin, Duloxetine, Tapentadol

  • Possibly effective but off-label use: Venlafaxine, Amitriptyline, Gabapentin, Valproate, opioids

  • N.B. Head-to-head trials are rare and evidence is poor, so management should be tailored to the patient

Screening for Hepatitis C

Test tube stock image from CDC

The following information is summarized from the article “Hepatitis C Information for Professionals” from the Center for Disease Control and Prevention 2015.

In the US there are approximately 3.2 million people with chronic Hepatitis C (HCV) infections, with a large number of patients unaware of their infected status. 60-70% of patients infected with Hepatitis C are asymptomatic or have mild illness at time of infection. It can take approximately 1-3 weeks after exposure before HCV RNA can be detected and 8-9 weeks before Hepatitis C antibody (HCV Ab) can be detected by clinical laboratory testing. 97% of patients infected with Hepatitis C will be HCV Ab+ within 6 months of exposure. Of those acutely infected with Hepatitis C, 70-85% will develop chronic HCV infections. With several new treatments for chronic Hepatitis C infections now available, there is a renewed emphasis on screening. According to CDC recommendations, Screening for Hepatitis C should start with a serum test for HCV Ab. Patients that test positive for HCV Ab should be subsequently tested for HCV RNA to differentiate between those exposed to Hepatitis C and those that are currently infected. Screening recommendations for specific populations are listed below.

Screening is Recommended

  • Adults born between 1945-1965 regardless of risk factors

  • Current IV drug users

  • Patients with history of IV drug use

  • Patients with certain medical conditions: Hemodialysis, elevated ALT of unknown origin, HIV

  • Recipients of blood transfusions or organ transplantation prior to July 1992

  • Recipients of clotting factors prior to 1987

  • Recognized Exposures: Needle sticks from HCV+ patient, Infants with HCV+ mothers. These patients with potential exposures within last 6 months, testing for HCV RNA or follow-up testing for HCV Ab >6 months after potential exposure is recommended.

Need for Screening uncertain

  • Tissue transplants (cornea, skin grafts, sperm/ova)

  • Non IV, drug users

  • Tattoos or body piercings

  • History of multiple sex partners or STDS

  • Steady sex partners of HCV+ individuals

Routine Screening Not Recommended

  • Healthcare workers without potential exposure history

  • Pregnant women

  • Non sexual household contacts of HCV+ individuals

  • General Population