California program is a good step toward coordinating care for high-needs patients, study finds

An evaluation by UCLA researchers has found that a California program launched in 2016 has been a positive step toward providing better-coordinated health care for people insured by Medicaid.

Initial findings from the ongoing analysis were published today by the UCLA Center for Health Policy Research. The researchers report that the state’s Whole Person Care program has been successful on several fronts so far, including the sharing of patients’ medical, behavioral health and social services data, which should enable providers to better collaborate to treat so-called “high-needs” patients.

That development is important in light of growing evidence that collaboration among medical, behavioral and social service providers can improve the health and well-being of people who frequently use health services—particularly those who are homeless or have mental health conditions. Nadereh Pourat, who led the evaluation and is the center’s associate director, said the lack of coordination among doctors, social workers and other health providers has been one of the system’s persistent and longstanding challenges.

Whole Person Care launched with 25 test programs covering 26 California counties; it is part of a California Department of Health Care Services effort to provide quality comprehensive care for people enrolled in Medicaid.

Among the researchers’ key findings:

  • All 26 locations provided “active referrals” to medical care, behavioral health care and social services (meaning that workers made and attended appointments, and provided transportation assistance and follow-up).
  • There were notable improvements in coordination and continuity of care because of the program.
  • Data sharing capabilities improved. Seventeen centers (65 percent) had access to patients’ medical, behavioral health and social service data, and 15 of them (58 percent) had data-sharing agreements with all key partners. Also, 21 centers (81 percent) had access to patient data for frontline staff.
  • Communication between the centers and patients was strong, with 23 centers (88 percent) reporting frequent, ongoing communication with enrollees.

However, the analysis found that the program, which is scheduled to continue through 2020, still needs to enhance data sharing across sectors, increase outreach to improve engagement with patients with complex needs, and make some other improvements to program infrastructure.

The authors assessed the extent to which the program met criteria that they developed for evaluating the successful coordination of medical and behavioral health care.

“The program addresses challenges such as providing transportation to appointments or translation services for patients with complex needs, which can require organizations to work together in new ways,” said Emmeline Chuang, lead author of the paper and an associate professor at the UCLA Fielding School of Public Health. “We’ve identified elements of a framework that other organizations can use in considering how to successfully create their own programs and ultimately could influence policymakers and insurers to invest in the WPC approach to improve care for patients in California and beyond.”

Source: Read Full Article

Research shows that weight stigma toward pregnant women is widespread and damaging

Family and friends are often the first people with whom women share the news of a pregnancy, and who get a first peek at a newborn fresh from the hospital.

But, when a woman discovers that friends and family are often the most likely to dish out jabs about her weight, her new bundle of joy can morph into a new bundle of stress.

Building upon her research on weight stigma, Angela Incollingo Rodriguez, assistant professor of psychology at WPI, recently published two articles on the topic. The first, in the journal Stigma and Health, reports nearly two-thirds of pregnant and postpartum women experience weight stigma, and that those instances of weight stigma come from friends, family, and even healthcare providers. The second, in the journal Social Science & Medicine, reveals that when pregnant and postpartum women experience weight stigma, they are at risk for depressive symptoms, unhealthy eating behaviors, and stress.

Incollingo Rodriguez’s study included 501 women, 143 of whom were in their second or third trimester of pregnancy and 358 who had given birth within 12 months prior to participating in the study. All the women were surveyed about their experiences with weight stigma—whether they had spoken with anyone who made them feel bad about their weight, how frequently they experienced weight stigma, and even how frequently depressive symptoms occurred after hearing instances of weight stigma, such as, “I have been so unhappy that I have been crying.”

The results showed that about 65 percent of women experienced weight stigma from at least one source. Participants reported that the top offenders of weight stigma included …

  • society in general (33.9 percent)
  • the media (24.6 percent)
  • strangers (21.2 percent)
  • immediate family (21 percent)
  • healthcare providers (18.4 percent)
  • friends (14 percent)

Examples included well-intentioned but misdirected comments from family members, like “You shouldn’t be trying to get pregnant because you’re too heavy,” or invasions of privacy by strangers who offer unsolicited comments, such as “You should put your baby up for adoption because you’re going to make it fat.”

Similar to her original study linking weight stigma and postpartum and maternal mental health, published in Health Psychology, Incollingo Rodriguez found that these instances of weight stigma, regardless of where they came from, instigated in participants more depressive symptoms, maladaptive dieting behavior, emotional eating (particularly among pregnant women), and higher stress.

“This is a huge problem because these symptoms can not only affect the mother or mother-to-be, but also the child,” Incollingo Rodriguez said. “Studies have shown that stress in pregnancy can lead to cognitive and learning disabilities, impaired health, even behavioral issues in the child. It can also affect the mother-child relationship, making it more difficult for mothers to breastfeed, and impair mother-infant bonding.”

Incollingo Rodriguez found that weight stigma comes from both individual sources, such as a family member, and general sources, such as the media, and recommended action be taken in all areas to minimize the risk of weight stigma. An important intervention direction here, she said, is for potential weight stigma offenders to be trained in acceptance.

“Family and friends can make an effort to be accepting of all shapes and sizes, and to shift the prevailing social messaging that associates weight with negative qualities,” she said.

Similarly, healthcare providers, especially physicians, might consider integrating “new school” training to their education to sensitively address weight gain guidelines with their patients regardless of their size, and recognize that discussions of weight can be received as criticism.

“Strictly following traditional weight rules based on body mass index (BMI) for pregnant and postpartum women can be considered old school,” Incollingo Rodriguez said. “Doctors have been educated to think like that for years. But, if doctors focused less on the numbers on a scale and more on a patient’s healthy eating and exercise habits, they could have a more positive effect on a patient’s overall health, and on their baby’s health while avoiding potentially stigmatizing their patients.”

She also said that the media has a role to play in minimizing negative portrayals of weight gain during pregnancy, such as portraying new mothers who have kept on weight postpartum as “letting themselves go,” or highlighting how quickly celebrity mothers, like supermodel Gisele Bundchen, have “lost the baby weight” postpartum. Altering its message to one that is more positive about body image, and one that raises awareness about the damaging effects weight stigma has on pregnant and postpartum women, can help spark a much-needed culture shift.

Source: Read Full Article

Ebola fears in SWEDEN as patient is rushed to hospital

Ebola fears in SWEDEN as patient is rushed to hospital with symptoms of the killer virus

  • Patient was rushed to Skane University Hospital in Lund on Monday with fever
  • Doctors say while unlikely, they can’t rule out Ebola until test results come back 
  • Comes months after death toll in the Congo rose to 2,000 amid Ebola epidemic

Medics in Sweden are scrambling to investigate a suspected case of Ebola, according to local reports. 

A patient was rushed to Skane University Hospital in Lund on Monday after suffering symptoms linked to the killer virus. 

They arrived with a high temperature and fever, prompting doctors to immediately suspect Ebola, according to Swedish newspaper Aftenbladet. 

Medics say that while Ebola is unlikely, they can’t rule out the virus until test results come back.

Medics in Sweden are investigating a suspected case of Ebola after a patient was rushed to Skane University Hospital in Lund with symptoms linked to the killer virus

‘There are confirmed cases of Ebola in the area where the person has been staying,’ Maria Josephson, director of operations at the infection clinic, said. 

‘Ebola is unlikely, but it cannot be ruled out until we have received a test response,’ she added.

The patient’s age, gender and name have not yet been released. If they do have the disease, they will be just the fifth patient to be diagnosed on European soil.  

It comes just months after an Ebola outbreak in the Congo, deemed the second biggest in history, was declared an international emergency. 

The death toll in the African nation soared past 2,000 and the number of cases has hit 3,000.

In January, another Swedish patient was feared to have been struck down with the virus.

The young man was kept in isolation at the University Hospital in Uppsala as medics scrambled to work out whether he was truly infected.  

Ebola, a haemorrhagic fever, killed at least 11,000 across the world after it decimated West Africa and spread rapidly over the space of two years. 

It was first spotted in regions close to the River Ebola in the Democratic Republic of Congo, which gave the disease its name. 

That pandemic was officially declared over back in January 2016, when Liberia was announced to be Ebola-free by the WHO. 

The Ebola death toll in the Democratic Republic of Congo tops 2,000 a year after the outbreak was declared, government data shows

The fever spread rapidly during an epidemic in 2014, with cases reported in 10 countries – including eight in the US. 

Many aid agencies volunteered to help stop it spreading, including British nurse Pauline Cafferkey, who was left critically ill by the deadly disease.

She became the first victim of the epidemic to be diagnosed on British soil and spent almost a month in an isolation unit at the Royal Free Hospital in north-west London.

Ms Cafferkey was readmitted to hospitals with Ebola complications twice in 2016.

A Spanish healthcare worker became the first person to catch Ebola outside of Africa in October 2014, after caring for a patient repatriated from Sierra Leone. She recovered after a month-long stay in hospital.

The virus was then detected on Italian soil in May, when a healthcare worker flew back to Rome after volunteering in Sierra Leone. He did not display symptoms for three days and was allowed home from hospital the following month.  

Scientists believe Ebola is most often passed to humans by fruit bats, but antelope, porcupines, gorillas and chimpanzees could also be to blame.

It can be transmitted between humans through blood, secretions and other bodily fluids of people – and surfaces – that have been infected.

WHAT IS EBOLA AND HOW DEADLY IS IT?

Ebola, a haemorrhagic fever, killed at least 11,000 across the world after it decimated West Africa and spread rapidly over the space of two years.

That pandemic was officially declared over back in January 2016, when Liberia was announced to be Ebola-free by the WHO.

The country, rocked by back-to-back civil wars that ended in 2003, was hit the hardest by the fever, with 40 per cent of the deaths having occurred there.

Sierra Leone reported the highest number of Ebola cases, with nearly of all those infected having been residents of the nation.

WHERE DID IT BEGIN?

An analysis, published in the New England Journal of Medicine, found the outbreak began in Guinea – which neighbours Liberia and Sierra Leone.

A team of international researchers were able to trace the pandemic back to a two-year-old boy in Meliandou – about 400 miles (650km) from the capital, Conakry.

Emile Ouamouno, known more commonly as Patient Zero, may have contracted the deadly virus by playing with bats in a hollow tree, a study suggested. 

An infected child is led away by a nurse at the Medecins Sans Frontiers centre in Monrovia, Liberia in 2014

Figures show nearly 29,000 people were infected from Ebola – meaning the virus killed around 40 per cent of those it struck.

Cases and deaths were also reported in Nigeria, Mali and the US – but on a much smaller scale, with 15 fatalities between the three nations.

Health officials in Guinea reported a mysterious bug in the south-eastern regions of the country before the WHO confirmed it was Ebola.

Ebola was first identified by scientists in 1976, but the most recent outbreak dwarfed all other ones recorded in history, figures show.

HOW DID HUMANS CONTRACT THE VIRUS?

Scientists believe Ebola is most often passed to humans by fruit bats, but antelope, porcupines, gorillas and chimpanzees could also be to blame.

It can be transmitted between humans through blood, secretions and other bodily fluids of people – and surfaces – that have been infected.

IS THERE A TREATMENT?

The WHO warns that there is ‘no proven treatment’ for Ebola – but dozens of drugs and jabs are being tested in case of a similarly devastating outbreak.

Hope exists though, after an experimental vaccine, called rVSV-ZEBOV, protected nearly 6,000 people. The results were published in The Lancet journal. 

Source: Read Full Article