While Young said he is disappointed the partnership will not continue – especially if it results in an inability to grow the number of primary care physicians in rural and underserved parts of eastern Washington – he “can’t imagine” that the Legislature wouldn’t approve funding in 2015 for UW’s plans to expand WWAMI. He talked with the PSBJ about what this means for the future of the program.
Q: What brought about the decision to split up?
A: It was the view of the UW that in order to continue our participation in the WWAMI program we had to be “100 percent in,” and that was the term that was used by UW. And by that they meant we could not continue in the WWAMI program while pursuing aspirations to have a second medical school in the state.
By Michael McCarthy
We’re living longer, but many of us are living with chronic illnesses that significantly lower the quality of our lives, according to a new study led by researchers at the University of Washington.
The survey, called the Global Burden of Disease Study, finds that there has been a major change in the causes and impact of poor health over the past decades, with a shift away from early death to chronic illnesses and disability.
The survey found that since 1970 life expectancy has increased by 11.1 years for men and 12.1 years for women and that deaths among children under age 5 have plummeted, except in subSaharan Africa where childhood mortality remains high.
In general, improvement in life expectancy has been steady, but it slowed in the 1990s largely due to deaths from HIV infection in sub-Saharan Africa and alcohol-related deaths in in easter Europe and central Asia.
With our longer life expectancy, the major burden caused by disease is no longer early death but instead chronic illnesses that cause pain and disability, such as arthritis, diabetes and dementia, and psychological disorders, the study concludes.
The study was led by University of Washington’s Institute for Health Metrics and Evaluation and funded by the Bill & Melinda Gates Foundation.
“We’re finding that very few people are walking around with perfect health and that, as people age, they accumulate health conditions,” said Dr. Christopher Murray, director of IHME and one of the founders of the Global Burden of Disease.
“At an individual level, this means we should recalibrate what life will be like for us in our 70s and 80s. It also has profound implications for health systems as they set priorities,” Murray said.
Dr. Paul Ramsey, chief executive officer of UW Medicine and dean of the University of Washington School of Medicine, said the study will serve as “a management tool for ministers of health and leaders of health systems to prepare for the specific health challenges coming their way.”
“At a time when world economies are struggling, it is crucial for health systems and global health funders to know where best to allocate resources,” Dr. Ramsey said.
The study found that while heart disease and stroke remained the two greatest causes of death between 1990 and 2010, all the other rankings in the top 10 causes changed.
Diseases such as diabetes, lung cancer, and chronic obstructive pulmonary disease moved up the list, and diarrhea, lower respiratory infections, and tuberculosis moved down, the researchers report.
Explore the changes with this interactive chart.
And while malnutrition used to be a major cause of illness and death, today poor diet and physical inactivity are to blame for soaring rates of obesity, diabetes, heart disease and stroke the study found.
“We have gone from a world 20 years ago where people weren’t getting enough to eat to a world now where too much food and unhealthy food – even in developing countries – is making us sick,” said Dr. Majid Ezzati, Chair in Global Environmental Health at Imperial College London and one of the study’s lead authors.
The study appears in this week’s issue of the medical journal The Lancet.
By Tony Woodward, MD, MBA
Medical director of the Emergency Department and chief of the Division of Emergency Medicine at Seattle Children’s Hospital.
Some would say Halloween has always been scary.
It was first called “All Hallows’ Eve,” and people believed that there were no barriers separating the world of the living from the world of the dead.
As a result, many locked themselves in their homes because they feared that ghosts and demons were roaming the streets.
If people absolutely had to go out, they disguised themselves in costumes.
Halloween has become a lot more fun today, peppered with costumes, sweet treats and community events.
But, if you’re a parent, it can still generate some anxiety.
To help ease any worry, Seattle Children’s would like to share some guidelines to help you and your child have a fun and safe Halloween.
- Don’t let young kids handle knives. Have them draw their designs on the face of the pumpkin with a black marker – then you do the carving.
- Use a sharp knife or a mini-saw that’s pointed away from your body.
- Keep kids at a safe distance while you’re carving the pumpkin, so that they don’t distract you or get in the way of sharp objects.
- Remove the insides of the pumpkin safely. Let your little one get messy by scooping it out with their hands or an ice cream scoop.
- Clean up the mess right away so that no one slips or trips.
- Skip the candles. A burning candle in a pumpkin may become a blazing fire if left unattended. Instead, use a glow stick to safely light your jack- o’- lantern.
- Avoid long or baggy skirts, pants, or shirtsleeves that could catch on something and cause falls.
- Avoid oversized and high-heeled shoes that could cause your child to trip.
- Make sure costumes are flame resistant.
- Make sure wigs and beards don’t cover your child’s eyes, nose, or mouth.
- Check that any props your child carries, such as a wand or sword, is flexible.
- Use non-toxic face paint.
Trick-or-Treating With Young Children
- Kids under age 10 should have an adult with them during trick-or-treating.
- Children should know a home or cell phone number, and how to call 911 in case they get lost.
- Kids should be reminded to walk, not run, between houses and up and down stairs.
Older Kids Trick-Or-Treating Without an Adult
- Make sure you approve of the route your child will be taking and agree on when they will come home.
- Make sure they know a home or cell phone number for a parent and any other trusted adult who’s supervising, and how to call 911 in case they get lost.
- Be sure your child carries a cell phone and a flashlight with new batteries.
- Insist that your child goes in a group that stays together.
- Remind your child to cross the street at crosswalks and never assume that vehicles will see them and stop.
- Tell your child to only stop at houses with porch lights on.
- Remind your child to walk on sidewalks on lit streets, never walk through alleys or across lawns, and never go into strangers’ homes or cars.
Trick-or-Treating at Your Home
- Remove lawn decorations, sprinklers, toys, bicycles, wet leaves or anything that might block your walkway and yard.
- Provide a well-lit outside entrance to your home.
- Keep family pets away from trick-or-treaters, even if they seem harmless to you.
- Consider purchasing Halloween treats other than candy. Stickers, erasers, crayons, pencils, coloring books, and factory-sealed packages of raisins and dried fruits are good choices.
- Offer a well-balanced meal before your child heads out to trick-or-treat so they won’t be tempted to snack on too much of their haul.
- Check all treats when your child gets home to make sure they’re safely sealed and there are no signs of tampering, such as small pinholes, loose or torn packages, and packages that appear to have been taped or glued back together. Throw out loose candy, spoiled items, and any homemade treats that haven’t been made by someone you know.
- Don’t allow young children to have hard candy or gum that could cause choking.
- Consider being somewhat lenient about candy eating on Halloween. Kids who generally eat a couple of pieces and save the rest might be able to decide how much to eat. But if your child tends to overdo it, consider setting limits.
- Store the rest of the candy in a cupboard instead of in your child’s bedroom or in big bags or bowls on the counter. You can then you can let your child have a treat or two a day.
George A. (Tony) Woodward, MD, MBA, is Medical Director of the Division of Emergency Medicine at Seattle Childrens Hospital and Professor of Pediatrics at the University of Washington School of Medicine. He is also the Medical Director for Transport Medicine at Seattle Childrens. He received his MD from Temple University Medical School and his MBA from The Wharton School at the University of Pennsylvania.
Pediatrician Dr. Melissa Hathaway has joined The Polyclinic Pediatrics at The Polyclinic Madison Center.
Dr. Hathaway earned her medical degree from the University of Washington School of Medicine after receiving a bachelor of science in neurobiology.
She completed an internship and residency in pediatrics at Primary Children’s Hospital, University of Utah in Salt Lake City, Utah, and she is is certified by the American Board of Pediatrics.
She joined The Polyclinic Pediatrics from Seattle Children’s Hospitals Emergency Department and Urgent Care Clinics.
She previously worked as a medical assistant at the Seattle Cancer Treatment and Wellness Center.
In addition to providing general pediatric care from birth through adolescence, Dr. Hathaway has a special interest in preventative care through health promotion, disease prevention, and safety advocacy.
She is accepting new patients and may be reached at: 206-292-2249.
By Michelle Andrews
Bette Davis, who had breast cancer and suffered a series of strokes before her death in 1989 at age 81, famously remarked that old age is not for sissies.
Many people assume that as health problems multiply and loved ones die, it’s inevitable that the elderly become depressed.
Not true, say experts. Older people have lower rates of depression than younger groups.
But depression often goes undiagnosed in the elderly, who feel the stigma of mental illness more acutely than younger people and are often less likely to seek help.
At the same time, older people are more likely to have multiple chronic conditions that consume their primary-care provider’s attention in the limited time available during a typical office visit.
The situation may be changing. In October, Medicare began to cover annual depression screening in primary-care settings with no cost sharing for beneficiaries.
Paying doctors to screen for depression — Medicare’s going rate is $17.36 per person — may well increase how often they do it, say experts.
“Doctors are trying to do the right thing, but how do you prioritize what to do in 21 minutes with a complex person?” asks Ken Duckworth, medical director for the National Alliance on Mental Illness, [www.nami.org] an advocacy group. “If they get paid for it, they structure it into their practices.”
Medicare covers 60 percent of the treatment for mental health problems, including depression. (Under a 2008 law, that figure is scheduled to rise to 80 percent in 2014.)
A Rapid Test
Most primary-care practices that screen for depression use a tool called the patient health questionnaire. The PHQ-9, as it’s called, asks people to describe how frequently during the past two weeks they have felt down or hopeless or taken little interest or pleasure in doing things. It also asks about sleep patterns, appetite and concentration, among other things. Although the test can be taken in just a few minutes, a 2001 study indicated it identifies depression and pinpoints its severity nearly 90 percent of the time.
Nearly 17 percent of people will have a major depressive disorder during their lifetimes, according to 2007 data from the National Comorbidity Survey of mental health disorders. For people 60 and older, however, the lifetime prevalence is much lower, 10.7 percent. “It’s the survivor factor,” says Michael Friedman, an adjunct associate professor at Columbia University’s schools of social work and public health. “You’re more likely to die young if you have depression.”
The lower figures don’t tell the whole story, say experts. Older people are much more likely to suffer from chronic conditions such as diabetes and heart disease, which can complicate diagnosis and treatment of both depression and other medical problems.
“Depression worsens the effect of other illnesses,” says Charles Nemeroff, a geriatric psychiatrist at the University of Miami. “People with depression are more vulnerable to [disease], and once it happens, it’s worse.”
People with depression often don’t take very good care of themselves. They don’t exercise or eat right. They don’t take their medications or get their blood work done to make sure their blood pressure, blood sugar and cholesterol levels are under control. And people with multiple chronic conditions probably take multiple medications that may interact with each other.
In addition, diabetes and heart disease can actually cause a late-life form of depression called vascular depression, which may occur when blood vessels harden, reducing blood flow to the brain.
All of these factors present a challenge for primary-care providers. There’s no point in screening for depression, after all, if you don’t have the resources to help people get the treatment they need.
An Encouraging Trial
Mental health experts point to a model called collaborative care as one that has shown good results. In one trial conducted at 14 primary-care clinics in Washington state, patients who had poorly controlled diabetes and/or heart disease as well as depression received help from a nurse to improve their efforts to control their diseases over a 12-month period.
The nurse worked closely with a psychiatrist, primary-care physician and psychologist to track patient progress and adjust medications as necessary.
Patients who received the intensive team approach showed significantly more improvement in both their depression and other medical conditions compared with patients who received usual care, according to a study published in the New England Journal of Medicine in December 2010 about the trial. Lead author Wayne Katon, a professor of psychiatry at the University of Washington School of Medicine, said the clinics saved an average of $600 per patient over a two-year period.
Most primary-care practices don’t provide that kind of comprehensive, coordinated care, Katon says.
But as policymakers and insurers increasingly offer incentives to primary care physicians to transform their practices into medical homes for their patients and reward providers for better disease control rather than simply running tests and doing procedures, the landscape should change.
Depressed people are more likely to receive diagnoses and be treated in primary-care settings than elsewhere. Research shows that elderly people, in fact, prefer to deal with their primary-care provider on mental health issues. In that context, coverage of depression screening may help more Medicare beneficiaries get the help they need.
Please send questions or ideas for future topics for the Insuring Your Health column email@example.com.
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
In this year’s list the magazine’s judges included more health-care leaders working outside the Seattle area, including Pullman, Walla Walla and Yakima.
- Lifetime Achievement Award: Rick Linneweh, CEO, Yakima Valley Memorial Hospital
- Outstanding Health Care Executive: Rick Cooper, CEO, The Everett Clinic
- Outstanding Health Care Professional: Margaret L. Hall, Northwest Hospital & Medical Center
- Innovation in Medical Devices: Physio-Control
- Innovation in Biopharmaceuticals: Seattle Genetics
- Global Health Organization: SightLife
- Community Outreach: Providence Senior and Community Services
- Wellness Program (Western Washington): Group Health Cooperative
- Wellness Program (Eastern Washington: Baker Boyer Bank
The University of Washington School of Medicine has been ranked 6th in the nation by U.S. News & World Report.
In the speciality categories, UW ranked:
- 1st in primary care, family medicine, and rural medicine
- 5th in women’s health
- 6th in pediatric and geriatric medicine
- 8th in internal medicine.
To learn more:
- Go to the U.S. News and World Report medical school rankings.