Preventative care

[major]

Does anyone feel like they actually get to practice good preventative medicine? If so, where are you working? 

[Mayamom]

the only time i felt i was making a difference with preventative medicine was pediatrics and adolescent medicine.   by the time they reach adulthood it becomes much more difficult (myself included)

[ventana]

Vaccines

colon ca screen 

mammo

paps 

 

 

that’s about all for preventative care in older population pcp 

[kettle]

I work EM and recommend a lot of things. Help establish PCP, tell people for their 45th birthday they get a colonoscopy etc. Being in my 30s I really push men in their 30s and 40s to get yearly physicals, if time allows talk about family history. For those who drink and smoke heavily I realize it's a loosing battle and ask them to use half as much.

[CAAdmission]

I'm still stuck trying to figure out if it supposed to be "preventative" or "preventive?"

[sas5814]

We, supposedly, have a strong focus on preventative medicine that is "alerts" in the EHR. However, there are so many that they take up a huge part of the time allotted for a visit they have actually become a drain on actual care. A typical new patient visit has 29 alerts between me and the nurse that have to be done. We live and die by metrics and check boxes.

[rev ronin]

2 hours ago, Hemmingway said:

We, supposedly, have a strong focus on preventative medicine that is "alerts" in the EHR. However, there are so many that they take up a huge part of the time allotted for a visit they have actually become a drain on actual care. A typical new patient visit has 29 alerts between me and the nurse that have to be done. We live and die by metrics and check boxes.

I mentioned one of my Bulimia patients self-harmed after a new NP showed her the computer screen with her weight, then ran through the diet-and-exercise recommendation bit, presumably based on EHR BMI trigger, despite her having disclosed current eating disorders treatment?

https://journals.lww.com/jaapa/Fulltext/2021/11000/Meaningful_use.13.aspx

[Reality Check 2]

The United States historically has never focused on prevention.

Only the privileged have insurance. They only use insurance seemingly if something goes wrong.

Our approach is all ass backwards.

Countries that have NHS (yes, another discussion) have preventative care requirements and overall better numbers for outcomes on some diseases - there is also a great cultural contribution to lifestyle and approach to health.

Many Americans cannot afford the copays or deductibles or coinsurance associated with any coverage they have so they decline to see a provider for anything preventative and thus practice crisis medicine.

Most of America is crisis medicine. Only treat something when it rears its ugly head and then a pill should fix everything.

A paradigm shift has to occur - where to break the cycle? What about for profit commercial insurance? They are not likely to participate as long as their CEOs are going home with 6-7 digit bonuses - often associated with denial of care and "saving money".

I am open to ideas. I do personally support a NHS where everyone has coverage universally. 

 

[sas5814]

1 hour ago, Reality Check 2 said:

The United States historically has never focused on prevention.

Only the privileged have insurance. They only use insurance seemingly if something goes wrong.

Our approach is all ass backwards.

Countries that have NHS (yes, another discussion) have preventative care requirements and overall better numbers for outcomes on some diseases - there is also a great cultural contribution to lifestyle and approach to health.

Many Americans cannot afford the copays or deductibles or coinsurance associated with any coverage they have so they decline to see a provider for anything preventative and thus practice crisis medicine.

Most of America is crisis medicine. Only treat something when it rears its ugly head and then a pill should fix everything.

A paradigm shift has to occur - where to break the cycle? What about for profit commercial insurance? They are not likely to participate as long as their CEOs are going home with 6-7 digit bonuses - often associated with denial of care and "saving money".

I am open to ideas. I do personally support a NHS where everyone has coverage universally. 

 

I saw the shift to preventative care and screening over the last 20 years or so. However, it did what most things do when there is money or the government involved..... it swung way too far and now people are absolutely drowning in recommendations for screening tests. It becomes too much white noise and, when everything is important, nothing is important.

I can't even count how many people I walked through the importance of a AAA screen (with 50% mortality if it blows) who agreed and later cancelled or declined to schedule. If a possible 50% chance of dropping dead won't motivate people why would they care about their cholesterol or blood sugars?

And we sometimes disincentify people who are engaged. I have lots of diabetics who want to check their sugars more often that "guidelines" say are necessary. A test strip costs 8 cents. How many strips could we buy with the cost of 1 DKA admission? None the less we (insurance and other payors) restrict how many they can have. It is penny wise and pound foolish.

The other part of the story is cultural. We, in America, don't want to work at health. We just want a pill or a shot or a surgery to make it easy.

Maybe if we started proactively paying people to achieve and maintain health and get screens done it would bump the numbers. My insurance pays $100 if I get some screening tests done annually and has offered my wife payment to get a WWE.

Imagine an entire system that pays to achieve and maintain health instead of just (reluctantly) paying after you get sick or hoping you will die before you cost too much.

[ventana]

Just clean. Up our food supply 

[rev ronin]

2 hours ago, ventana said:

Just clean. Up our food supply 

Don't forget the water supply.  Most hormonal birth control is excreted unchanged in urine, and our wastewater treatment processes DO NOT take it out. Hmm. I wonder what a wacky amount of extra hormones could do to a population?

[major]

On 5/22/2023 at 11:33 AM, Hemmingway said:

The other part of the story is cultural. We, in America, don't want to work at health. We just want a pill or a shot or a surgery to make it easy.

This is so true. I dream of a patient population that understands and desires a more natural way of healing... Wish I could prescribe diet and exercise all day and have it be meaningful. 

[CAAdmission]

On 5/22/2023 at 6:01 PM, rev ronin said:

Hmm. I wonder what a wacky amount of extra hormones could do to a population?

Can't quite put my finger on it. It might possibly cause people to desire crappy beer that tastes like bathwater?

 

[trazodone]

Low dose CT 

[Reality Check 2]

This is from 2019 - sounds good on paper but no concrete thought process on how to change an entire society and healthcare system that is based on profits.

How do you stop the machine and reset the parameters? 

Health Care Industry Insights: Why the Use of Preventive Services Is Still Low (cdc.gov)

Discussion

Industry experts participating in this stakeholder interview process made it clear that most players in the health care system are aware of recommended preventive care services and understand the benefit of preventing disease for the patient and the larger health care system. Underutilization of preventive services is largely the result of an implementation gap rather than an information gap; in other words, providers do not prioritize preventive care services although they know that preventive services can reduce the incidence and burden of chronic diseases. A major reason the implementation gap exists is that financial incentives do not align with a focus on preventing chronic diseases. Currently, most providers, including hospitals and physicians, are paid to treat rather than to prevent disease. Payers have the potential to increase utilization of preventive services with value-based payment models and contractual requirements that include reporting on preventive health quality measures.

As the participants in our study offered their perspectives on the barriers and influences surrounding the coverage and delivery of preventive care services, much of the conversation focused on the influence of financial considerations on uptake of preventive care. However, participants generally agreed that financial incentives alone are unlikely to result in positive changes in the absence of a multipronged approach to increasing preventive services among people at risk of or living with chronic diseases. A multipronged approach would include strong organizational leadership, shifts in institutional culture, team-based care, systems of care that accommodate preventive services, and willingness of patients to seek out and engage in preventive care.

[SedRate]

4 hours ago, Reality Check 2 said:

financial incentives do not align with a focus on preventing chronic diseases. Currently, most providers, including hospitals and physicians, are paid to treat rather than to prevent disease.

much of the conversation focused on the influence of financial considerations on uptake of preventive care. However, participants generally agreed that financial incentives alone are unlikely to result in positive changes in the absence of a multipronged approach to increasing preventive services among people at risk of or living with chronic diseases.

A multipronged approach would include strong organizational leadership, shifts in institutional culture, team-based care, systems of care that accommodate preventive services, and willingness of patients to seek out and engage in preventive care.

This!

This is the problem with a for-profit medical system compounded by a culture of distraction thanks to capitalism and marketing. (The nephew of Sigmund Freud was the godfather of marketing to people's emotions and insecurities.)