You might think that your doctor would know if a new drug would cause bad side effects in combination with one you already take. Or that your pharmacist could tell if a prescription you thought was for Darvon, (a painkiller), really should be for Diovan (a blood pressure drug).

But with thousands of drugs (prescription and over-the-counter) of different strengths on the market, you could be wrong. When important information about medicines isn’t communicated correctly at the right time, errors can happen.

Some of them can be very serious, even deadly.

Errors involving drugs are the most common type of medical errors, harming about 1.5 million people each year, according to the Institute of Medicine . Treating drug-related injuries that occur in hospitals costs $3.5 billion per year, according to its 2007 report.

A recent example shows how easily these errors can happen.

A 90-year-old woman was brought to a hospital emergency department (ED) after falling and breaking her hip. The woman’s daughter gave a nurse her mother’s medication bottles from home, including one for high blood pressure.

Using that information, the nurse prepared a list of drugs for the woman’s hospital stay.

Before the patient woman had hip surgery, a physician noticed that her blood pressure was too high. He increased the dosage of her blood pressure medicine from 75 mg to 100 mg.

Shortly before her surgery, the woman went into cardiac arrest. She was successfully resuscitated, but her surgery had to be postponed.

Only when the woman was moved to the intensive care unit did another nurse notice that the dose level of the blood pressure medicine brought from the patient’s home was actually 25 mg, not 75 mg. (The nurse in the ED had written the wrong dosage.)

Fortunately, the woman recovered. Several days later, she was able to have the surgery to repair her hip and was discharged.

After identifying the error, the hospital staff did the right thing: They fixed the mistake, apologized to the patient, and launched a review to find out how similar mistakes could be prevented in the future.

One way the hospital might have avoided this error was to involve a hospital pharmacist. A pharmacist would have recognized that the type of blood pressure drug this patient brought from home did not come in the higher dose that was incorrectly listed on her chart.

More hospitals are working to reduce the chance of drug-related injuries with processes that involve pharmacists, doctors, and nurses. One process is known as “medication reconciliation.”

This involves comparing a patient’s current drug routine to any changes a physician makes when a patient is admitted, transferred, or released from the hospital. (Maintaining and communicating this information correctly is a national patient safety goal for 2012 of the Joint Commission , which accredits hospitals and health care organizations.)

In the case of the 90-year-old patient’s blood pressure drug, medication reconciliation would have verified the patient’s home medication list. The process would have also caught the difference between the real dose and the dose listed by the nurse in the ED.

To help hospitals with this process, the Agency for Healthcare Research and Quality (AHRQ) has funded research for a new toolkit based on a successful program at Northwestern Memorial Hospital in Chicago.

Known as MATCH, the toolkit provides a step-by-step method so hospitals can review and improve current processes or create new ones. It can be used in both hospital and outpatient settings.

Even though more hospitals are working to prevent medication errors, patients have a role, too. Here’s a checklist of tips that can help:

Checklist:

• Bring a list or a bag with all your medicines when you go to your doctor’s office, the pharmacy, or the hospital.

• Ask questions. Ask your doctor or pharmacist to use plain language so that you understand the answers.

• Make sure your medicine is what the doctor ordered. Many drugs look alike and have names that sound alike. Check with your doctor or pharmacist to be sure you have the right medicine.

• Learn how to take medicine correctly. Read the directions on the label and other paperwork you get with your medicine. Ask your pharmacist or doctor to explain anything you do not understand.

• Find out about possible side effects. Many drugs have side effects. Some side effects may bother you at first but will improve with time.

If a side effect does not get better or you get a different one from what you’ve read about, talk to your doctor to see if you need a different medicine or dose.

Medicines can help you, but they can also harm you. Better medication reconciliation processes and smart questions from patients will reduce the chance of harm.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

References

Agency for Healthcare Research and Quality

AHRQ Web M&M: Morbidity and Mortality Rounds on the Web
http://www.webmm.ahrq.gov/case.aspx?caseID=213

Medications at Transition and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation
http://www.ahrq.gov/qual/match/

20 Tips to Help Prevent Medical Errors
http://www.ahrq.gov/consumer/20tips.htm

National Academies of Science

Preventing Medical Errors: Quality Chasm Series
http://www.nap.edu/catalog.php?record_id=11623

Joint Commission

National Patient Safety Goals 
http://www.jointcommission.org/standards_information/npsgs.aspx

Current as of March 2012

Internet Citation:

New Processes Can Help Hospitals Spot—and Stop—Drug Errors. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, March 6, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc030612.htm

By Carolyn M. Clancy, M.D.

February 7, 2012

With Valentine’s Day around the corner, hearts shapes are everywhere – on cards, candy, and clothing. But every day of the year, your heart plays a big role in your health and well-being. And conditions or habits that harm our hearts, like high blood pressure or smoking, put our hearts at risk.

The risk is serious. Heart disease and strokes kill more than 800,000 Americans each year and cost $445 billion each year, according to the Department of Health and Human Services (HHS) (PDF File, PDF Help). People with heart disease are often unable to work or enjoy normal activities. They are also at higher risk of early death.

To help combat heart disease, especially heart attack and stroke, HHS recently joined several groups that include doctors, nurses, pharmacists, insurance companies, and drug stores in a campaign called Million Hearts.

Over the next 5 years, the partners aim to help millions of Americans improve their heart health by preventing and treating high blood pressure, high cholesterol, and tobacco use.

The goals are ambitious. But the good news is that heart disease can be prevented or reduced with two approaches.

The first is making healthy choices, like quitting smoking (or never starting), and lowering the amount of salt and trans fats we consume. Today, 19 percent of the U.S. population smokes; in 5 years, the partnership aims to cut that to 17 percent.

The second approach is making treatment for heart disease available for people who need it. Simple but effective techniques, known as the “ABCS,” help focus these efforts. The ABCS stand for: Aspirin for people at risk, Blood pressure control, Cholesterol management, and Smoking cessation.

We have good tools to treat heart disease, but they’re not used enough. Today, less than half (47 percent) of people at risk for heart disease take a daily aspirin. The Million Hearts campaign hopes to increase that to 65 percent by 2017. Reducing salt intake, a factor in high blood pressure, by 20 percent, is another goal.

HHS is working with partners to help attain the Million Hearts goals. The partners include:

• The American Heart Association  is offering access to online tools , including one that helps you understand your heart health.

• America’s Health Insurance Plans  and its members are hosting programs to reduce heart disease with programs that promote fitness, lower obesity and manage chronic disease.

• The Y is expanding coverage of its diabetes prevention program  and other national disease prevention programs to better address risks for diabetes, heart attack, and stroke.

My Agency, the Agency for Healthcare Research and Quality (AHRQ), supports the Million Hearts campaign and has tools and knowledge that can support its goals.

For example, one AHRQ-funded resource that highlights innovative practices describes how pharmacists can help people lower their risk for heart disease.

In the HealthyHeartClub.com program, pharmacists educate patients to lower their heart risk by changing their diet, exercising more, and taking the right medicines. Working with primary care doctors, pharmacists meet with patients, email them weekly, and provide access to classes and tools that support their goals. It works! After 3 months, patients’ weight, blood pressure, and daily activity all improved.

AHRQ’s Effective Health Care Program produces free, plain-language booklets that can help you learn about treatment options for high blood pressure and high cholesterol. They describe treatment options, discuss risks and benefits, and identify areas where more research is needed.

All these resources for the Million Hearts initiative have one thing in common—they are an excellent source of information to share with your health care provider. Together, you can discuss steps you need to take to be sure you’re healthy for many more Valentine’s Days in the future.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

U.S. Department of Health and Human Services: Million Hearts

New public-private initiative aims to prevent 1 million heart attacks and strokes in five years
http://millionhearts.hhs.gov/docs/Million_Hearts_Press_Release.pdf [PDF Help]

Million Hearts
http://millionhearts.hhs.gov/

Heart Disease Prevention: Million Hearts
http://millionhearts.hhs.gov/about-hd-prevention.shtml

Agency for Healthcare Research and Quality

AHRQ Innovations Exchange: Innovation Profile
http://innovations.ahrq.gov/content.aspx?id=3182

Effective Health Care Program

Choosing Medications for High Blood Pressure: A Review of the Research on ACEIs, ARBs, and DRIs
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=75

Treating High Cholesterol: A Guide for Adults
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=351

American Heart Association

AHA
http://www.heart.org/HEARTORG/

American Heart Association/American Stroke Association 

My Life Check
http://50.56.33.51/mlc01/main_en_US.html

America’s Health Insurance Plans (AHIP)

AHIP Statement on Million Hearts Initiative
http://www.ahip.org/News/Press-Room/2011/AHIP-Statement-on-Million-Hearts-Initiative.aspx

The Y

The Y Joins CDC, HHS, CMS in Million Hearts Initiative
http://www.ymca.net/news-releases/20110913-cdc.html

Current as of February 2012

Internet Citation:

Million Hearts Campaign Aims to Lower Risk, Improve Care. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, February 7, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc020712.htm

Credit: Wikipedia - Creative Commons License

By Carolyn M. Clancy, M.D.

January 3, 2012

Whether it’s music, lifestyles, or a refuse-to-age outlook, Baby Boomers think of themselves as trailblazers.

Now, that generation born between 1946 and 1964 can claim credit for another “first”—a dramatic increase in knee replacement surgeries.

Women and men between the ages of 45 and 64 were more than twice as likely to have had knee replacement surgery in 2009 than in 1997, recent data from the Agency for Healthcare Research and Quality (AHRQ) show. The rates among women were even higher.

Knee replacement surgery is most common in people whose knees have been damaged by osteoarthritis (OA), rheumatoid arthritis, or injury.

Due to their age and fondness for sports, Baby Boomers fit neatly into each category.

The percentage of people who have osteoarthritis, the most common type of arthritis, grows with age. About 27 million Americans have this condition, and, after age 45, it is more common in women. Osteoarthritis occurs when the cartilage that coats the end of each bone breaks down. This can cause the bones to rub against each other, causing pain and stiffness.

Knee pain may also be caused by rheumatoid arthritis, a less common form of arthritis that occurs when the membrane surrounding the joint becomes inflamed. Over time, inflammation damages cartilage, resulting in pain and stiffness. Rheumatoid arthritis affects about 1.3 million people—more women than men. It often begins in middle age, but can occur in children and young adults.

Arthritis after a serious knee injury or repeated stress is another reason for knee replacement surgery. Pain caused by ligament tears or bone fractures caused by sports injuries, for example, may be managed non-surgically for years. Over time, however, pain and limited knee function causes some patients to consider knee replacement surgery.

If you have knee pain from one of these causes, you’ve probably heard about treatments that are intended to relieve pain and even postpone the need for surgery. Some, but not all, of these options work, a review of 86 research reports funded by AHRQ has found.

What has been shown to work?

• Exercise. Becoming more active—whether through walking, swimming, or water aerobics—can reduce pain and make movement easier. Physical therapy may also help, so ask your doctor if you would benefit.

• Maintain a healthy weight. A 10 percent weight loss combined with a moderate exercise program reduced knee pain in patients with knee osteoarthritis by 50 percent, a recent study  by Wake Forest University researchers has found.

• Pain medicines. Medicines can relieve osteoarthritis pain, AHRQ’s research review concluded. Your doctor or nurse may prescribe an over-the-counter or prescription medicine. Learn more about choosing pain medications for osteoarthritis in this guide developed by AHRQ.

What has been shown not to work?

• Glucosamine and chondroitin. Some people take nutritional supplements to help build new cartilage. Studies have found that people who take these supplements report less pain, but people who don’t take the supplements report the same result.

• Joint lubrication shots. This treatment is a gel-like substance given by a shot into the knee. Studies have found that most people who get the shots do not improve very much.

• Arthroscopic knee surgery. In this procedure, a flexible tool is inserted into the knee, which is used to rinse the joint. It can be helpful for other types of knee problems, but not for knee osteoarthritis.

If conservative treatments don’t provide relief from pain, it may be time to consider knee replacement surgery. The good news is that this procedure has been shown to give a better quality of life that makes it worth the cost, a Government-funded study has found.

The benefits of this procedure are even better if the surgery is done at a hospital that does a large number of knee replacement procedures.

Before you have surgery, prepare yourself for the best possible outcome by asking questions of your surgeon. You will feel more in control of your health if you have a good idea of what to expect before, during, and after surgery.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Healthcare Cost and Utilization Project

Statistics on Hospital-Based Care in the U.S., 2009
http://www.hcup-us.ahrq.gov/reports/factsandfigures/2009/TOC_2009.jsp

Effective Health Care Program

Osteoarthritis of the Knee: A Guide for Adults
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=132

Choosing Pain Medicine for Osteoarthritis
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageAction=displayProduct&productID=4

Having Surgery? What You Need to Know
http://www.ahrq.gov/consumer/surgery/surgery.htm

National Institute of Arthritis and Musculoskeletal and Skin Disease

Handout on Health: Osteoarthritis
http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp

Handout on Health: Rheumatoid Arthritis
http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp

Total Knee Replacement Found Cost-Effective for End-Stage Knee OA
http://www.niams.nih.gov/News_and_Events/Spotlight_on_Research/2009/knee_OA_replacement.asp

American College of Rheumatology

Weight Loss Best Medicine for People with Knee Osteoarthritis
http://www.rheumatology.org/about/newsroom/2011/2011_ASM_21_weightloss.asp

Current as of January 2012

Internet Citation:

Baby Boomers Trigger Major Increase in Knee Replacement Surgeries. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, January 3, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc010312.htm

Good doctor-patient communication is a key to improving the quality of your care, the agency says. and a good way to start the conversation is with a question.

But because so many doctor’s visits are so brief, the agency is providing tools to help you prepare their questions before your appointments.

The tools are available online at the agency’s website “Questions are the Answer“. The site also provides brochures, videos and other tools providers can use to encourage their patients to speak up.

The website provides:

• A 7-minute video featuring patients and clinicians who discuss the importance of asking questions and sharing information – this tool is ideal for a patient waiting room area and can be set to run on a continuous loop.

• A new brochure, titled “Be More Involved in Your Health Care: Tips for Patients,” that offers helpful suggestions to follow before, during and after a medical visit.

• Notepads to help patients prioritize the top three questions they wish to ask during their medical appointment.

To promote the initiative, the agency is also offering providers the opportunity to co-brand the materials so that providers can add their organization’s name and logo to the brochures and notepads.

Providers interested in learning more about the initiative can contact the agency by phone at 1-800-358-9295 or by email AHRQpubs@ahrq.hhs.gov.

To learn more:

• Read Dr. Carolyn Clancy’s article: Patients should ask more questions about their care

Welcome to November—with its shorter days, cooler weather, and, for many, decisions about choosing a health insurance plan for the coming year.

Whether you’re covered by an employer’s plan, by Medicare, or you are self-employed or unemployed, doing homework during “open enrollment” can help you get the best value for your money.

You may find that you have more options for 2012.

Overall, employers that offer health coverage are providing more choices, according to recent data from my agency, the Agency for Healthcare Research and Quality (AHRQ).

Large firms that offer health insurance are more likely to offer workers two or more plans now than they were 10 years ago. Unfortunately, our report also found that the percentage of employees who are offered health coverage is less today than it was a decade ago.

When you know your options and how they work, you can better decide which option fits your personal situation. Your choice may be different depending if you have a spouse or dependent children or if you need certain medicines.

Getting Started

To help people covered by Medicare review their options, the Federal Government expanded its open enrollment period for 2012. Open enrollment continues through December 7, 2011, which is the deadline to pick a new Medicare plan. (You don’t have to do anything if you want to keep the one you have.)

Compare your choices using Medicare’s Plan Finder. This tool will help you find and compare the different kinds of Medicare Advantage health plans (or Part C) and Medicare prescription drug plans (Part D). An online demonstration of this tool is available on YouTube.

If you’re self-employed or unemployed, finding a health plan takes more work. Healthy individuals who can afford out-of-pocket expenses might consider a high-deductible plan.  Under these plans, you will have to pay much more yourself before the plan covers any expenses.

The advantage is that premiums are lower than other types of coverage. The National Association of Insurance Commissioners offers tips  to help you understand and apply for individual coverage.

If you’ve lost health coverage due to a job loss, you may be able to continue it for 18 months. You will pay higher premiums, however. A Federal law known as COBRA lets workers who have lost group coverage continue those benefits. Select for more information on how this law works.

If you are uninsured because of a pre-existing condition, you may be able to receive insurance through a temporary high-risk pool created under the Affordable Care Act. The program is funded by the Federal government, but States can choose how or if they want to participate. The program began on July 1, 2010, and ends on January 1, 2014.

Understanding how different health plans work can make it easier to choose wisely. You may prefer to pay more to get a wider choice of doctors, for example, or to use generic medicines instead of brand-name ones to save money.

Keep in mind that not all health plans pay for the same services or pay the same amounts for services. (One exception is Medicare, which is required by the Affordable Care Act to pay for certain preventive benefits.)

Plans also vary in how much you’ll pay before your insurance covers you. These are called out-of-pocket costs, and they usually are in the form of deductibles or coinsurance. The deductible generally is an annual amount that is not covered by your health plan. It must be paid before your health plan starts to pay for your care.

Coinsurance is the percentage of your health insurance bill that you must pay when you file a claim. You must usually pay this percentage in addition to the deductible.

The Alphabet Soup of Health Plans

Health plans differ in what they offer and the providers you can choose. You are likely to pay more for a plan that gives you many options for choosing doctors and hospitals. Health plans typically fall into one of these groups:

• Conventional indemnity: The least restrictive type of coverage, indemnity plans allow you to see any health provider without affecting what you pay. These plans are not common in populated areas, but still exist in rural areas.

• Preferred provider organizations (PPO): A form of indemnity insurance where coverage is provided through a network of selected providers. You can go to providers outside of the network, but you will pay a larger portion of the costs.

• Exclusive provider organizations (EPO): This is a more restrictive type of PPO. It covers services only if you go to doctors, specialists, or hospitals in the plan’s network, unless it’s an emergency.

• Health maintenance organizations (HMO): The most restrictive type of health plan, HMOs provide medical services to members in exchange for a fixed fee. They stress preventive care as a way to keep patients healthy and save money.

• Medicare Advantage Plans (Part C): These private insurance companies contract with Medicare to provide you with Part A (hospital) and Part B (doctor, outpatient care, home health) benefits. Many, but not all, of these plans include the Medicare prescription drug benefit (Part D).

Readers of this column know I am passionate about making health care better. That’s why I urge you to pay attention to the information about the quality of health plans , including Medicare Advantage plans. This can help you understand what a plan does well, what it needs to do better, and whether it’s a good fit for you.

Of course, choosing a good health plan is no guarantee against getting sick. But a wise choice will make it easier for you to continue to take an active role your health.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality

Medical Expenditure Panel Survey, Statistical Brief No. 344: The Number of Health Insurance Plans Offered by Private Sector Employers in 2000 and 2010
http://www.meps.ahrq.gov/mepsweb/data_files/publications/st344/stat344.shtml

MEPS Insurance Component: Glossary of Health Terms
http://www.meps.ahrq.gov/mepsweb/survey_comp/ic_ques_glossary.shtml

Center for Medicare and Medicaid Services

Medicare Plan Finder for Health, Prescription and Medigap Plans
http://www.medicare.gov/find-a-plan/questions/home.aspx

Medicare Plan Finder at a Glance (YouTube)
http://www.youtube-nocookie.com/embed/iQQJ7ry_H6k

U.S. Department of Health and Human Services

Temporary High Risk Pool Program
http://www.healthcare.gov/news/factsheets/2010/07/temp-high-risk-pool-program.html

Medicare Preventive Services: HealthCare.gov
http://www.healthcare.gov/law/features/65-older/medicare-preventive-services/index.html

National Association of Insurance Commissioners

Consumer Alert: Limited Benefit Plans, High Deductible Plans and Health Savings Plans
http://www.naic.org/documents/consumer_alert_high_deductible_plans.htm

Health Insurance: What You Need to Know When Applying for an Individual Health Insurance Policy
http://www.naic.org/documents/consumer_alert_ind_health_insurance.htm

U.S. Department of Labor

An Employee’s Guide to Health Benefits Under COBRA
http://www.dol.gov/ebsa/publications/cobraemployee.html

National Committee for Quality Assurance

Report Cards: Choosing Quality Care
http://www.ncqa.org/tabid/60/Default.aspx

Current as of November 2011

Internet Citation:

How to Get a Good Value When Choosing a Health Plan. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, November 1, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc110111.htm