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

Experts recommend that older women have regular bone density tests to screen for osteoporosis. But it’s been unclear how often to repeat the tests.

A study of nearly 5,000 women now reports that patients with healthy bone density on their first test might safely wait 15 years before getting rescreened.

Osteoporosis is a disorder marked by weakened bones and an increased risk of fractures. More than 40 million people nationwide either have osteoporosis or are at increased risk for broken bones because of low bone mineral density (osteopenia).

Osteoporosis is often called a “silent disease” because it usually progresses slowly and without symptoms until a fracture occurs.

When low bone density is identified early through screening, lifestyle changes and therapies can help protect bone health and reduce the risk of fractures.

That’s why the U.S. Preventive Services Task Force recommends routine screening of bone mineral density for women ages 65 and older.

To help doctors decide how often to repeat bone density tests in women who don’t have osteoporosis at their initial screening, a research team led by Dr. Margaret Gourlay of the University of North Carolina at Chapel Hill analyzed data on nearly 5,000 women, age 67 or older.

The women were participants in the Study of Osteoporotic Fractures, a long-term nationwide study supported by NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institute on Aging (NIA) and National Center for Research Resources (NCRR).

Researchers divided the women divided into 4 groups based on initial bone density tests that were either normal or showed mild, moderate or advanced osteopenia. They were given 2 to 5 bone density tests at varying intervals during the 15-year study period.

As reported in the January 19, 2012, issue of the New England Journal of Medicine, the scientists found that less than 1% of women who initially had normal bone mineral density went on to develop osteoporosis during the study.

Only 5% of those with mildly low bone density at the start made the transition to osteoporosis. Overall, the data suggest that women in these 2 categories might safely wait about 15 years before being rescreened for osteoporosis.

The scientists also found that about 1 in 10 women with moderate osteopenia at baseline developed osteoporosis within 5 years. For those with advanced osteopenia at the start, about 10% had developed osteoporosis within a year, suggesting that 1-year screening intervals might be advisable for this group.

“If a woman’s bone density at age 67 is very good, then she doesn’t need to be rescreened in 2 years or 3 years, because we’re not likely to see much change,” Gourlay says. “Our study found it would take about 15 years for 10% of women in the highest bone density ranges to develop osteoporosis. That was longer than we expected, and it’s great news for this group of women.”

These findings can help guide doctors in their bone screening recommendations. Other risk factors, such age, medications or specific diseases, would also influence screening frequency.

This article first appeared in NIH Research Matters.

To learn more about osteoporosis:

• Health Info: Osteoporosis

• Osteoporosis: The Bone Thief

• Bone Mass Measurement: What the Numbers Mean

• Article: Keeping Bones Strong and Healthy

Periodically Washington State Department of Health issues an update on disciplinary actions taken against health care providers, including suspensions and revocations of  licenses, certifications, or registrations of providers in the state.

The department has also suspends the credentials of people who have been prohibited from practicing in other states.

Information about health care providers is also on the agency’s website.

To find this information click on “Provider Credential Search” on the left hand side of the Department of Health home page (www.doh.wa.gov).

The site includes information about a health care provider’s license status, the expiration and renewal date of their credential, disciplinary actions and copies of legal documents issued after July 1998.

This information is also available by calling 360-236-4700.

Consumers who think a health care provider acted unprofessionally are also encouraged to call and report their complaint.

Here is the January 26th update issued by the Washington State Department of Health:

Note: Health care providers charged with unprofessional conduct have 20 days to respond to the Department of Health in writing. The case then enters the settlement process. If no disciplinary agreement can be reached, the case will go to a hearing.

State disciplines health care providers

The Washington State Department of Health has taken disciplinary actions or withdrawn charges against health care providers in our state.

The department’s Health Systems Quality Assurance Division works with boards, commissions, and advisory committees to set licensing standards for more than 70 health care professions (e.g., medical doctors, nurses, counselors).

Information about health care providers is on the agency website. Click on “Provider Credential Search” on the left hand side of the Department of Health home page (www.doh.wa.gov). The site includes information about a health care provider’s license status, the expiration and renewal date of their credential, disciplinary actions and copies of legal documents issued after July 1998. This information is also available by calling 360-236-4700. Consumers who think a health care provider acted unprofessionally are also encouraged to call and report their complaint.

Chelan County

In December 2011 the Nursing Assistant Program charged registered nursing assistant Frances J. Pocan (NA00189315) with unprofessional conduct. A patient allegedly gave her money to pay the patient’s bills, and she failed to pay the bills or return the money to the patient.

Clark County

In December 2011 the Massage Program charged Douglas L. Black (MA00011374) with unprofessional conduct for allegedly having a sexual relationship with a patient.

In December 2011 the Medical Commission charged physician Patrick Chau (MD00030053) with unprofessional conduct. Allegations include failing to comply with terms and conditions set against his license, prescribing controlled substances inadequate notes about why he prescribed the substances, and failing to follow-up with patients.

Douglas County 

In December 2011 the Nursing Assistant Program charged registered nursing assistant Maria Elena Vasquez (NA60168663) with unprofessional conduct. She allegedly borrowed money from a patient and failed to repay the loan.

Jefferson County

In December 2011 the Veterinary Board of Governors released veterinarian Joyce M. Murphy (VT00001824) from terms and conditions set against her license.

King County 

In December 2011 the Unlicensed Practice Program notified Steve Becker that it intends to issue a cease-and-desist order. He’s charged with performing a forensic evaluation, administering psychological tests, and diagnosing a patient without a valid psychologist or counselor license.

In December 2011 the Dental Commission granted the application of dental assistant Jaime Lynn Clarke (D160231847) and placed conditions against her registration. She was convicted of driving under the influence and entered into a deferred prosecution for charges of driving under the influence.

In January 2012 the Nursing Commission amended the statement of charges against registered nurse Flor D. Cruz (RN00076122). She allegedly failed to act on a patient’s change in vital signs, failed to perform a complete assessment of the patient, and failed to communicate the changes in the patient’s condition to a physician or other staff. She also allegedly rented a room in her house to a former inmate at the jail where she worked, and checked the inmates medical records without authorization.

In December 2011 the Secretary of Health ended the probation order against physician Terrill L. Harrington (MD00038084).

In December 2011 the Nursing Assistant Program charged certified nursing assistant Gus Ernie Hayes (NC10013627) with unprofessional conduct. He was convicted of violating a no-contact order and entered a deferred prosecution for charges of assault, malicious mischief, and resisting arrest.

In December 2011 the Medical Commission charged physician Jim Chun Jen Hsu (MD00044903) with unprofessional conduct. The diagnosis and surgery he performed on a patient’s shoulder was allegedly below the standard of care.

In January 2012 the Chemical Dependency Professional Program granted the application of chemical dependency professional trainee Jina Marie Milius (CO60185460) and placed conditions against her certification. She was convicted of vehicular homicide, theft, and underage alcohol possession.

In December 2011 the Health Care Assistant Program ended the probation order against Laura Lena Miller (HC60068282, HC60151774).

In December 2011 the Dental Commission charged dentist Steven H. Nguyen (DE00008242) with unprofessional conduct. It’s alleged that he knowingly allowed an employee without a valid license to perform denturist and dental assistant duties.

In December 2011 the Nursing Assistant Program charged certified nursing assistant Krystal J. Shoulders (NC10100007) with unprofessional conduct. She allegedly took a patient’s debit card and purchased about $250 of groceries for her own use.

In December 2011 the Nursing Assistant Program ended the probation order against certified nursing assistant Maylee B. Vo (NC60156056).

Kitsap County

In December 2011 the Nursing Assistant Program charged registered nursing assistant Ashley Marie Rowland (NA60102636) with unprofessional conduct. She entered into a deferred prosecution for the charge of theft.

Lewis County

In December 2011 the Nursing Assistant Program denied the application of registered nursing assistant applicant Lisa J. Sipe (NA60255488). She was convicted of child molestation.

Mason County

In December 2011 the Chemical Dependency Program denied the application of chemical dependency professional trainee applicant Joseph Lee Schaeffer (CO60245631). He was convicted of methamphetamine possession, two counts of driving with a suspended license, two counts of domestic violence assault, attempting to elude police, and resisting arrest.

Pierce County

In December 2011 the Nursing Assistant Program charged registered nursing assistant Katie J. Byrd (NA60214486) with unprofessional conduct. Allegations include sleeping while caring for a patient, smoking marijuana with the patient, driving the patient while under the influence, and shoplifting. She also allegedly had the patient pawn jewelry so she could get a tattoo.

In December 2011 the Chemical Dependency Professional Program charged chemical dependency professional Terrance O. Jones (CP60044697) with unprofessional conduct. He was convicted of three counts of domestic violence assault, marijuana possession, and two counts of violating a no-contact order.

In January 2012 the Counselor Program ended the probation order against agency affiliated counselor and certified counselor Sabryna D. Klug (CG60165266, CL60165237).

In December 2011 the Nursing Commission placed licensed practical nurse Nancy L. Picou (LP00047746) on probation for five years. She allegedly received prescriptions for controlled substances for herself, filled them, and gave them to her husband.

Spokane County

In January 2012 the Certified Counselor Program granted the application of Michael Tyrone Deal (CL60246873) and placed conditions against his certificate. He was convicted of two counts of obstructing police, driving without a license, false statement, two counts of possessing stolen property, attempting to elude police, driving with a suspended license, and illegal drug conduct.

In January 2012 the Nursing Assistant Program granted the application of certified nursing assistant Julie Raeann Potts (NC10096507) and placed her certification on probation. She entered into a deferred sentence for an assault charge.

Thurston County

In January 2012 the Nursing Assistant Program reinstated the certification of James R. Pollard (NC10085152).

Yakima County

In January 2012 the Unlicensed Practice Program notified Randy Allan of its intent to issue a cease-and-desist order. He allegedly advertised and represented himself as an equine dentist without evidence that he is supervised by a licensed veterinarian.

In January 2012 the Chemical Dependency Professional Program granted the application of chemical dependency professional trainee Frances Salinas Gonzalez (CO60256819) and placed her certification on probation for three years. She was convicted of solicitation to obtain Vicodin by fraud, and driving under the influence. Her registered counselor credential was suspended for two years.

Out of State

Virginia: In December 2011 the Nursing Commission reinstated the license of registered nurse Brandon L. Bailey (RN00176831) and placed his license on expired status until he meets reactivation requirements.

 

The first of two articles on the epidemic by InvestigateWest’s Carole Smith appears today on the news and opinion websitce CrossCut.com.

Smith writes:

An InvestigateWest analysis of U.S. Drug Enforcement Administration data shows Washington ranked fourth highest nationally in per-capita prescribing of methadone in 2006 (the most recent year for which reliable data is available) and 11th for oxycodone — the two biggest killers.

Even more disturbing, more than half of all prescription drug-related deaths in the state occur in the state’s poorest and most vulnerable population — people on Medicaid, a population that is itself exploding in our recent economy. A 2009 federal study showed the age-adjusted risk of death from prescription opiates in Washington was nearly six times higher for Medicaid enrollees than those not on the program.

An accompanying documentary will air on KCTS at 9 p.m. Jan. 30. The documentary will be followed by a half-hour in-studio discussion.

The Seattle Times also tackled this issue in its December series: The Politics of Pain.

To learn more:

• Read Smith’s CrossCut article: Prescription for Abuse: Washington tries to get serious.

• Read The Seattle Times series The Politics of Pain.

• Read other LocalHealthGuide coverage of the topic of prescription drug abuse.

• The National Institutes Health has published a brochure to help you select drug treatment programs.

Local Resources:

• Alcohol Anonymous (AA)/Seattle: www.seattleaa.org

• MetroKC Alcohol and Other Drug Prevention program: www.metrokc.gov/health/atodp

• MetroKC Mental Health & Substance Abuse Links: www.metrokc.gov/dchs/mhd/mhlinks.htm

• Northeast Seattle Coalition to Prevent Underage Drinking: www.preventionworksinseattle.org

• Substance Abuse Treatment Facility Locator: http://FindTreatment.samhsa.gov

The booklet, Seeking Drug Abuse Treatment: Know What to Ask, says there are five key questions you should ask about a program:

Five Key Questions:

• Does the program use treatments backed by scientific evidence?

• Does the program tailor treatment to the needs of each patient?

• Does the program adapt treatment as the patient’s needs change

• Is the duration of treatment sufficient?

• How do 12-step or similar recovery programs fit into drug addiction treatment?

To learn more:

• Read the whole booklet Seeking Drug Abuse Treatment: Know What to Ask.

Additional Resources:

• American Academy of Addiction Psychiatry
• American Academy of Child & Adolescent Psychiatry
• Mental Health America
• National Alliance on Mental Illness
• NIDA’s DrugPubs Research Dissemination Center
• NIDA’s Clinical Trials Network
• NIH’s ClinicalTrials.gov
• NIDA’s Principles of Drug Addiction Treatment: A Research Based Guide
• Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Locator: 1-800-662-HELP
• National Suicide Prevention Lifeline: 1-800-273-TALK