Wednesday, October 19, 2016

On Call by Casey Ross

Good morning and welcome back. Lots of ideas are flowing into the On Call inbox and I appreciate it. Please enjoy today's reading. Don't forget to follow me on Twitter: @byCaseyRoss. Follow STAT, too: @statnews.

Today's agenda: A push to tackle health woes in rural America

It is one of modern medicine’s most intractable problems: How to get effective care to people who live nowhere near it. Federal regulators will tackle the issue today at a rural health solutions summit in Baltimore.

I got an early look at some of the problems they'll discuss from Dr. Kathleen Schmeler, who told me she sees a steady stream of patients from the Rio Grande Valley with advanced cervical cancer. Rates in the region can run 30 percent higher than in the rest of the US. That's comparable to what you'd see in some parts of Africa and Central America.

“It’s heartbreaking,” said Schmeler, who practices at MD Anderson Cancer Center in Houston.

“It’s a completely preventable disease, and it’s not being prevented because of education and access," she said. "This is really health disparity at its worst."

Schmeler and her colleagues use Project ECHO, a videoconferencing tool, to prod local clinicians to vaccinate for HPV, the most common cause of cervical cancer, and to teach them to respond early and effectively to abnormal pap test results. Such use of telemedicine will be a hot topic at today's summit.

Have you seen other innovative projects to expand care to rural residents? Drop me a note about what's worked (and what hasn't).

A medical bill you can understand

you don't have to squint, or call an accountant, to understand what you owe. (Department of health and human services)

I know. What a ridiculous notion.

But a design challenge run by Health and Human Services yielded some solid ideas. And now health systems nationwide are beginning to try them out.

The MetroHealth System of Cleveland is testing elements of the bill pictured above, which came from RadNet, a Los Angeles radiology company. (The judges deemed it “the easiest to understand.”) Particularly appealing to the folks at MetroHealth: The use of visuals and color coding to aid patients with low literacy, said Dr. Sara Laskey, an emergency medicine physician.

Laskey helped judge the contest and said the best part was seeing where the entries came from — doctors, frustrated patients, researchers, high-tech firms, and even college kids.

“It was great to see how many people got creative with this,” she said. “It also tells you that it’s something that touches all ages, genders, colors — people all over the country.”    

One big reason it's so hard to get a handle on the opioid crisis


That’s how White House drug czar Michael Botticelli describes the lack of physicians to treat an epidemic of opioid addiction that is killing 20,000 Americans a year.

Less than 1 percent of primary care doctors are now certified to treat addiction disorders, according to the American Society of Addiction Medicine. And there are few incentives to get trained, especially in the many states where Medicaid systems don't reimburse physicians for addiction treatment.

“A lot of people want to malign primary-care doctors for not owning their share of the problem, but it’s just not that simple,” said Dr. R. Corey Waller, who leads the advocacy division of ASAM. “We’ve set them up for failure.”

STAT reporter Bob Tedeschi took a close look at the problem in Espanola, N.M., which has been ravaged by opioid addiction.

Read more.

A trick to beat burnout

For nurses, beating burnout might be as simple as believing you can do your job despite all the bull you have to put up with.

That’s the conclusion of a study out today that examined how 596 Canadian nurses dealt with workplace incivility and emotional exhaustion. (Full disclosure: They got a $2 coffee voucher as an inducement to fill out the survey.) 

Essentially, the study, published in the journal Health Care Management Review, revealed a self-fulfilling prophecy. Nurses who believed they could block out workplace baloney tended to notice it less, and avoid burnout.

Or, in the jargon of academia: “The results of this study demonstrate promising support for the notion that relational occupational self-efficacy plays a protective role against workplace incivility, burnout, and their detrimental outcomes.”

And if you want to bolster that "occupational self-efficacy?" Here's a link to a story I wrote a few months ago exploring five ways hospitals are trying to reduce stress in the workplace.


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Stay well, and come back tomorrow.


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