One in Four Americans Lacks Timely Access to Optimal Care

One in Four Americans Lacks Timely Access to Optimal Care

Hospitals that treat a higher volume of patients tend to have more resources and better outcomes.
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Although most Americans live close to some type of emergency room, as many as one in four Americans are more than an hour away from the type of hospital that’s most prepared to save their life during a time-sensitive medical emergency, according to a new University of Pennsylvania School of Medicine study published in the Annals of Emergency Medicine. Since little is known about which U.S. hospitals are best equipped and staffed to tackle emergent illnesses like stroke, cardiac arrest, heart attack and the severe bloodstream infection sepsis, many more Americans may be in peril because no system exists to transport them to the right hospital at the right time.

“Whether you are bleeding to death from an injury, having a heart attack, or having a stroke, the common denominator is time. In those life-threatening emergencies, we must blindly rely upon the system to rapidly deliver us to the care that we need,” lead author Brendan Carr, MD, MA, MS, an assistant professor of emergency medicine and epidemiology and senior fellow in Penn’s Leonard Davis Institute of Health Economics, said in a news release. “If we knew what services were provided where, we could design a system that would do that for patients everywhere in the country.”

The new study, conducted with collaborators from the Emergency Medicine Network at Massachusetts General Hospital, shows that 71% of Americans have access to an emergency department of some kind within 30 minutes, and 98% can reach one within an hour. But on a state-by-state basis, the findings suggest that many of those nearby facilities may not be able to provide care for the most emergent conditions.

Research shows that hospitals that treat a higher volume of patients tend to have more resources and ultimately, better patient outcomes. Residents of rural states appear to be much less likely to have access to those types of facilities.

The nation’s regionalized trauma care system allows for emergency medical service providers to bypass the closest hospital and bring severely injured patients to accredited facilities which meet specific care benchmarks. Carr suggests that this same model could be applied to care for other time-sensitive conditions like heart attack and stroke.

Among possibilities for boosting care quality in rural or other underserved areas, the authors suggest subsidizing rural hospitals or offering incentives for physicians to practice at those facilities, improving interhospital referral networks and identifying hospitals that can specialize in treatment of certain emergent illnesses. Carr, who serves as associate director of Penn’s division of emergency care policy and research, sees the new findings as a first step in improving the United States’ emergency care system.

Text Messaging Reminders Effective in Improving Sunscreen Use

Girl texting
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Despite dermatologists continual efforts, a disconnect persists between the public’s understanding of the harmful effects of excessive sun exposure and regular use of sunscreen as part of an overall sun protection strategy to reduce the risk of developing skin cancer. But now, the same technology that keeps people connected may help encourage them to apply sunscreen regularly via daily text messaging reminders.

At the 67th Annual Meeting of the American Academy of Dermatology, dermatologist Joseph C. Kvedar, MD, FAAD, associate professor of dermatology at Harvard University Medical School in Boston, presented findings of his study that showed text messaging reminders were effective in improving sunscreen usage.

“For most people, cell phones, e-mail and text messaging are an integral part of how they communicate with one another and an ideal channel for health care professionals to reach patients with important reminders on taking their daily medications or even applying sunscreen,” Kvedar said in a news release. “Our study was designed to determine if, in fact, daily text messaging reminders encouraging people to apply sunscreen resulted in increased sunscreen usage.”

Since few innovations exist that accurately measure adherence to products such as sunscreen and no reminder system is currently available to improve sunscreen adherence in the general population, the Center for Connected Health – a division of Partners Healthcare in Boston – developed a reminder service in which study participants were sent cell phone text messages reminding them to apply their sunscreen.

This technology was evaluated in a randomized controlled trial in the fall of 2008 to test the effect of these reminders on the frequency of sunscreen application. Seventy patients ranging in age from 18 to 72 participated in the study and were asked to apply sunscreen daily for 6 weeks. Half of the patients were randomly selected to receive text messages via cellular phones and the other half did not receive reminders. Text message reminders were sent to participants each morning around 7 a.m., which stated the weather report and a reminder to apply sunscreen.

Kvedar evaluated patients’ adherence to daily sunscreen usage with a novel electronic monitoring device, which was strapped onto the tube of sunscreen. When the cap of the sunscreen tube was removed, the device sent a text message to researchers that was then recorded as evidence of sunscreen use.

At the end of the study period, Kvedar concluded that the participants receiving text messages had a significantly improved rate of sunscreen application as compared to the control participants. Specifically, the 35 participants who received daily text message reminders to apply sunscreen had a mean daily adherence rate of 56% compared to a mean daily adherence rate of only 30% by the 35 subjects who did not receive reminders.

Among the patients in the reminder group, 68.6% reported that they would keep using the text message reminders after the study and 88.6% reported that they would recommend the text messaging reminder system to others.

Low Fruit, Vegetable Intake is a Worldwide Problem

Overall, 77.6% of men and 78.4% of women consumed less than the suggested five daily servings of produce.
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A new study that looks at the fruit and vegetable consumption of nearly 200,000 people in developing countries finds that the prevalence of inadequate diet is “remarkably high” across the globe.

Overall, 77.6% of men and 78.4% of women consumed less than the suggested five daily servings of produce.

“Low fruit and vegetable consumption is a risk factor for overweight and obesity, and adequate consumption decreases risk for developing several chronic diseases,” lead author Spencer Moore, assistant professor in the school of kinesiology and health studies at Queen’s University in Ontario, said in a news release. “The release of the 2002-2003 World Health Survey data provided a unique opportunity to examine global differences in low fruit and vegetable consumption in a way that has until now simply not been possible.”

Moore and his colleagues looked at data from 196,373 adults in 52 mainly low- and middle-income countries. The study appears in the American Journal of Preventive Medicine.

There were wide variations among nations, ranging from 37% of men in Ghana who did not meet that standard — to 99% of Pakistani men. The researchers saw similar findings in women with the same two countries at the high and low ends of the spectrum.

The prevalence of low fruit and vegetable intake increased with age and decreased with income. These results surprised Moore, as surveys from the United States and other developed countries consistently show that fruit and vegetable intake increases with age.

“Most people regardless of the country that they live in simply do not meet the recommended guidelines for adequate fruit and vegetable consumption,” co-author Justin Hall, a graduate student at Queen’s University, said. “Some countries appear to be better off than others in relative terms, but the overall prevalence of low fruit and vegetable consumption is remarkably high across the globe.”

Tim Byers, MD, interim director of the University of Colorado Cancer Center at Denver, said that this study argues against the stereotype that those in tropical climates have better diets because fruits and vegetables surround them.

“Although the survey deals mainly with developing countries, their results are not substantially different from those we have seen in other surveys done in Europe or the United States,” Byers said. “This is telling us that dietary quality is a global problem.”

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