This is the second (and final) part of the findings reported in the 2005 survey of adults with health problems in the eighth annual series of cross-national surveys conducted by Harris Interactive. The information provides not merely a salutory reminder that individuals must learn to take more responsibility for their own health and wellbeing, it also enables health services managers and health professional practitioners to focus efforts to improve on areas of greatest need.
Patients with chronic diseases in all of the countries often did not receive the care recommended to manage their condition. At best, about half of diabetics reported receiving all of the four recommended screening exams to manage their condition. Patients who had supports such as a self management plan or a nurse included as part of their care management team were significantly more likely to have received recommended care.
The U.S. was an outlier for its financial burdens on patients: Half (51%) of the U.S. adults reported they had gone without care because of costs in the past year. In contrast, just thirteen percent of U.K. adults reported not getting needed care because of cost. One-third (34%) of U.S. patients reported out-of-pocket expenses over $1,000 in the past year. U.K. patients were the most protected from high cost burdens, with two-thirds (65%) having no out-of-pocket expenses. The variations were notable given the study design focus on sicker adults with recent intensive use of medical care.
Access, including after-hours access, and waiting times to see a doctor when sick differed markedly across the countries. Canadian and U.S. adults who needed medical care were the least likely to report fast access (same day) to doctors (30% or less of U.S. or Canadian patients). In contrast, majorities of patients in New Zealand (58%) and Germany (56%) reported they were able to get same-day appointments, as did nearly half of patients in Australia (49%) and the U.K. (45%).
Majorities of patients in Germany (72%), New Zealand (70%), and the U.K. (57%) also reported that after-hours (nights, weekends, or holidays) access to a doctor was easy. In contrast, majorities of patients in the U.S. (60%), Australia (58%), and Canada (53%) said it was very or somewhat difficult to get after-hours care.
The four countries with comparatively more rapid access to physicians – Australia, Germany, New Zealand, and the U.K. – also had significantly lower rates of emergency room use, with Germany having the lowest rates. One-fifth of Canadians and one-fourth of U.S. patients who reported going to the ER said it was for a condition that could have been treated by their regular doctor if available.
The findings highlight the need for improved access as well as coordination of care. The authors conclude that "These findings suggest that many of the problems with which policy leaders are grappling transcend specific payment or delivery systems and will require more fundamental transformation."
How was the study performed? The survey screened initial random samples of adults age eighteen or older to identify those who met at least one of four criteria: rated their health as fair or poor; reported that they had a serious illness, injury, or disability that required intense medical care in the past two years; or reported that in the past two years they had major surgery or had been hospitalized for something other than a normal pregnancy. The final study includes 700-750 adults in Australia, Canada and New Zealand and 1,500 or more in the U.K., U.S. and Germany.
The Commonwealth Fund funded the core study and partnered with the Health Foundation to expand the United Kingdom sample. The German Institute for Quality and Economic Efficiency in Health Care funded the German sample. The questionnaire was designed by researchers at The Commonwealth Fund and Harris Interactive, with advice of experts in each country. Interviews were conducted by telephone between March 17 and May 9, 2005 in the five English speaking countries and May 9 to June 12, 2005 in Germany. The survey was conducted in German in Germany and English in the five other countries, with an option for French in Canada and Spanish in the United States. The margin of sample error for country averages are approximately: +/- 4% for Australia, Canada and New Zealand, +/- 3% Germany and U.S., and +/-2% for U.K. at the 95 percent confidence level.
There is great value in the findings of this quite professional research. One can only hope that it is put to good use by those with policy and practice roles withing the health systems of every surveyed country. Again I say, the findings should also serve to motivate individuals to take more responsibility for staying well and for managing their own health care needs.
Consider the following findings of some quite professional and significant research. The findings aren’t good by any means, but try to think of what can be done to improve the situation as you note the main issues in this first of two related posts.
One-third of patients with health problems in the U.S. report experiencing medical, medication, or test errors, the highest rate of any nation in a new Commonwealth Fund international survey. Assessing health care access, safety, and care coordination in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States, the survey found that while no one nation was best or worst overall, the U.S. stood out for high error rates, inefficient coordination of care, and high out-of-pocket costs leading to barriers to access to care.
The 2005 survey of adults with health problems is the eighth in an annual series of cross-national surveys conducted by Harris Interactive for the Fund.
One third (34%) of U.S. survey participants reported at least one of four types of errors: they believed they experienced a medical mistake in treatment or care, were given the wrong medication or dose, given incorrect results for a test, or experienced delays in being notified about abnormal test results. Three of ten (30%) Canadian respondents reported at least one of these errors, as did one-fifth or more of patients in Australia (27%), New Zealand (25%), Germany (23%) and the United Kingdom (22%).
U.S. patients who saw four or more doctors in the past two years were especially vulnerable, with about half (48%) reporting at least one of these errors, pointing to lapses in communication during transitions.
Although attention to patient safety has focused chiefly on care in hospitals, a majority of patients (60% or more) in each country who reported medical mistakes or medical errors said these errors occurred outside the hospital, highlighting the need for policies to improve patient safety in ambulatory care.
In all six countries, one-third or more of recently hospitalized patients reported failures to coordinate care during hospital discharge. Germany had the highest rate of patients reporting lack of follow-up care, with three fifths (60%) saying the hospital did not make arrangements for follow-up visits with a doctor or other health professional or otherwise give instructions about post hospital care, such as symptoms to watch for and when to seek further care.
The U.S. had the highest rate of patients reporting coordination of care problems that reflected inefficient care during doctor visits. One-third (33%) of U.S. respondents said that within the past two years, either their test results or records were not available at the time of a doctor’s appointment, or that a doctor had ordered a test that had already been done. Rates of care coordination problems in the U.S. were significantly higher than those in the other five countries, which ranged between about one-fifth to one-quarter reporting coordination problems.
It is clear that the health system, like any large and complex system, has many areas in need of improvement. The major issue with problems in the health system, especially the medical and hospital subsystems, is that the results tend to be significant cost overruns on the good side and increased suffering and death on the bad side.
Come to think of it, there really is no good side. More details will follow later.
Do you take aspirin? This is a trade name for the drug acetylsalicylic acid. Many people take aspirin for aches and pains occasionally. Some people troubled by regular or frequent pains, such as headaches, may take aspirin quite often. Of course acetylsalicylic acid has a few clinical applications since it functions as an analgesic (pain remover), an antipyretic (lowers temperature of fever) and an anticoagulant (reduces blood clotting).
Interestingly, acetylsalicylic acid may be purchased over the counter without need for a prescription, usually in tablet form. This is common knowledge so why is this interesting?
I consider it interesting since acetylsalicylic acid (most commonly purchased as Aspirin) is actually quite dangerous. A fairly common class of allergens is known as the salicylates. Aspirin, being acetylsalicylic acid, is a salicylate and for those who are sensitive enough, it can cause very serious allergic reactions, even life threatening and fatal ones.
Additionally, acetylsalicylic acid is quite irritating to the gastric mucosa (lining of the stomach). It can quite easily erode the lining resulting in ulceration and gastric bleeding, which again, can be serious, even fatal. This is a very high risk for anyone who accidentally or deliberately takes an overdose of the drug.
So clearly, many adverse drug reactions (ADRs) are caused directly by taking this drug. Yet many people take the view that unless one has an obvious reaction, it is clearly safe since very large numbers of people are told to take it every day to prevent complications from heart disease. This is a dangerous error.
One serious but hidden problem that is commonly overlooked is that of drug-induced nutritional deficiencies. Aspirin is a glaring example of this problem. It is an antinutrient. Marketed and prescribed for daily use to prevent heart attack, aspirin depletes the body of the life-saving nutrient folic acid (as well as iron, potassium, sodium, and vitamin C). Symptoms of folic acid depletion include anemia, birth defects, elevated homocysteine (itself a significant risk factor for heart disease), headache, fatigue, hair loss, insomnia, diarrhea, and increased infection.
This should be taken as a warning about this drug and it should not be taken lightly. Studies show that the side effects of aspirin are so severe they can increase the risk of death in people who take it regularly.
Increasingly even orthodox doctors are recognizing the need for dietary supplements for people to achieve required and optimum nutrition. They seem even to be learning that effective nutrition is essential for health! Most of them don’t quite understand much of the details, but at least many of them seem to learn fast.
Even if you eat a healthy diet, don’t be surprised if your regular doctor recommends a multivitamin and mineral supplement. Years ago, that idea would have been medical heresy. Today, even among the sceptics and less-well informed, it is considered a wise form of insurance.
Not so long a go it seemed that all doctors thought that people could get all the necessary vitamins and minerals by eating a wide variety of foods, including lots of vegetables and fresh fruit. Now the medical dogma has changed, for several reasons.
Many people, for instance, simply don’t eat that wide variety of foods, and don’t get the necessary vitamins and minerals. The U.S. Federal Government’s "Dietary Guidelines for Americans 2005" expressed concern that children and teenagers don’t get enough calcium, potassium, magnesium and vitamin E. Adults, it said, often don’t get enough calcium, potassium, magnesium, and vitamins A, C and E.
Scientists also have found that older people can eat all the right foods, but their bodies don’t absorb enough vitamins. For example, up to one-third of people older than just age 50 can no longer absorb enough natural vitamin B12 from their food. Dietary Guidelines, issued by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture, cite dietary supplements as a good source of vitamin B12.
The report also recommends more vitamin D, from fortified foods or vitamin and mineral supplements, for several groups of people. These include older people, individuals with dark skin, and those who don’t get enough sunlight directly on their skin (which the body needs to make vitamin D).
Research also has uncovered new reasons why vitamins are important. During the last few years, for instance, studies have shown that women need enough folic acid (a B group vitamin also called folate) in their bodies immediately after a pregnancy begins. Without it, they face a higher risk of a baby with serious birth defects. Many doctors and nutritionists recommend that women who may become pregnant get enough folic acid from fortified foods or vitamin supplements.
Some people may benefit from combining a daily multivitamin-mineral with separate supplements containing extra calcium or other supplements like Omega 3 fatty acids (which help prevent heart disease and other conditions). One excellent source I have verified as having simply brilliantly formulated nutritional supplements can be accessed via our HealthProductsSite.
Remember that if you are ill or taking medications it is important to let your doctor know about intentions to use supplements since some drugs do interact unfavorably with various nutrients.
It may be interesting to learn that about 1 in 3 people in the United States now take supplements, and they spend more than $3 billion a year. Come to think of it, I suppose there’s no wonder orthodox doctors are catching on, since so many consumers now know the benefits of improved nutrition.
Are you a pessimist? Is your glass half-empty rather than half-full? Do you recognize or do people tell that you have a negative outlook on life? If so, you may actually be doing long term damage to your brain.
People with a particularly pessimistic outlook are often socially isolated to some degree simply because others don’t enjoy their company. Offered the choice of associating with a positive person or a negative person, few choose the latter.
If you are a pessimist who can live with that fact and your attitude is "so what?", you may want to reconsider. A Mayo Clinic study revealed that people who had a high score on the pessimism scale of a personality test were much more likely to develop dementia and its array of symptoms that impact intellectual and behavioral function, including Alzheimer’s disease.
Now we aren’t talking about dementia bringing about personality changes such as pessimism. This study actually identified pessimism as a risk factor, not an early manifestation of disease. Back in the 1960’s, the researchers first conducted personality tests covering thoughts, feelings, attitudes, physical and emotional symptoms and life experiences on 3,500 people ages 20 to 69. Then, in 2004, the researchers followed up with interviews of the same individuals or the relatives of those who were impaired or deceased to determine the impact of personality characteristics on development of dementia later in life. They discovered that pessimists had a 30% increased risk for dementia, and that for those who scored high on anxiety as well as pessimism, the increased risk rose to 40%.
What of the risk that pessimists will turn the findings into self-fulfilling prophecy? It’s possible, but no one has to be stuck in pessimism, says Chris Peterson, PhD, professor of psychology at the University of Michigan and expert in how personality relates to health and longevity. Dr. Peterson says that, fortunately, some aspects of personality are contagious and that positive and negative outlooks are in that category.
So pessimists who want to substantially reduce their risk of developing Alzheimer’s Disease and other dementias can turn themselves around. The first step is to evaluate the types of people in your life. Surround yourself with the ones who are upbeat and cheerful, and you will find yourself moving in that direction as well.
Next, according to Dr. Peterson, when faced with decisions, instead of asking yourself the despairing "Why?" turn it around and replace it with "Why not?" The third step is to enjoy and savor your successes. Excessive modesty robs you of your good feelings about yourself and life. You might even want to write down your successes, big and small, as you go along and refer to them when you’re feeling bleak.
Finally, rather than assume that situations will have negative outcomes, step back, look at the evidence and make realistic determinations. Include in that a realistic assessment of your personal setbacks. Mostly you’ll find that the evidence shows most are nothing but minor bumps on the road of life.
So there you have it. The ways in which the brain (organic matter) and the mind actually work are fascinating. Whether your aim is to dramatically reduce your risk of dementia or not, eliminating pessimism and negative thinking by replacing it with optimism and positive thinking will be very good for your wellbeing and thoroughly life enhancing. It’s your life, you can do it.