This page is devoted to policies and reforms that will be needed to reduce the rampant waste in U.S. healthcare and to introduce reforms that focus on disease prevention and long-term health improvement by providing community-specific resources that address the diverse needs of cohorts based on age, education, gender, race- ethnic identity.
More specifically, to avoid widespread reliance on synthetic pharmaceuticals as the primary therapeutic means of delivering healthcare and, failing that, offering surgery as the next best option for health improvement.
Following the passage of the Affordable care Act (2010), there is increasing hope that the ~$1 TRILLION dollars of annual waste in U.S. healthcare , i.e., healthcare related activities that provide little benefit for the patient, will be reined in and health care operations will become more transparent, ethical, and accountable.
The fiscal costs of incompetence in U.S. healthcare dwarfs our annual defense budget but cannot get the attention of politicians from either party. It appears that protecting the taxpayer from ~$1, 000, 000, 000, 000 per year of unnecessary healthcare costs is too complex an undertaking for our elected representatives.
Details are in the April 2012 article, by Berwick & Hackbarth, in the Journal of the American Medical Association .
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Evaluation of dimensions and measurement scales in patient-centeredness
Jördis M Zill, Isabelle Scholl, Martin Härter, Jörg Dirmaier
Patient Preference and Adherence (2013):7 345–351
As this exploratory article points out, “patient-centeredness”, as an operating philosophy, has gained importance over the last two decades. However,there is an absence of shared understanding or clarity of vision regarding the principal factors or dimensions of patient-centeredness in healthcare operations/organizations.
Clinicians are beginning to acknowledge that an increased emphasis on the participation and self-determination of patients in their health care will increase both quality and efficiency and therefore reduce health care costs also.
This trifecta has been labeled the “triple aim” of enlightened healthcare in the 21st century. Three factors of relevance are Person- and Family-Centered Care, Patient Safety, and Quality, Cost, and Value. More on this from the IHI.
For additional information on this subject, see
The Triple Aim: Care,Health, And Cost
Donald M. Berwick, Thomas W. Nolan, John Whittington
Health Affairs 27, no. 3 (2008): 759–769
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In “The Strategy That Will Fix Health Care“, which was published by the Harvard Business Review (October, 2013), authors Michael Porter and Thomas Lee claim that providers must lead the way in making “Value” the principal goal of health care. The need for “Integrated Practice Units”, with diverse specialists working together to define and to accomplish value creation for patients seeking health care is critical.
Sadly, except for a few leading organizations, like the Cleveland Clinic in the US, medical doctors remain firmly entrenched in their belief that only they have the knowledge to deliver the required services to achieve optimal health outcomes. The evidence base of system level incompetence over the last two decades of healthcare in the U.S. is still being lost in discussions of relevant non-pharmacological options to improve health outcomes.
More specifically, discussions incorporating the use of non-pharmacological interventions for pain management, such as acupuncture, chiropractic, massage, and relaxation techniques including mind-body medicine practices that include Qigong ( Tai Chi) and Yoga.
Even though the Agency for Healthcare Research & Quality(AHRQ) noted in December 2013 that there was need for a systematic review of the the benefits and harms (risks) of long-term use of opioids for chronic pain management. After decades of clinical use by medical doctors without adequate recognition of the harms to patients from long-term use of opioids, most hospitals and health care organizations continue to cling to the status quo.
To offer greater “Value”, organizations selling health care insurance, in the United States and around the world, will need to become more aware and to promote non-pharmacological interventions for pain management.
(AHRQ document excerpt)
I. Background and Objectives for the Systematic Review
Chronic pain, often defined as pain lasting longer than 3 months or past the time of normal tissue healing, is extremely common. According to a recent Institute of Medicine report, up to one-third of U.S. adults report chronic pain.
Chronic pain is by definition persistent, and frequently difficult to treat. There has been a dramatic increase over the past 10 to 20 years in the prescription of opioid medications for chronic pain, despite limited evidence showing long-term beneficial effects. In addition, accumulating evidence indicates increasing rates of harms associated with prescription opioids, including accidental overdose, abuse, addiction, diversion, and accidents involving injuries (such as falls and motor vehicle accidents).
Of perhaps most concern is the dramatic increase in overdose deaths associated with opioids. In 2010, there were 16,651 fatal overdoses involving prescription opioids. Prescription opioid misuse and abuse resulted in over 400,000 emergency department visits in 2010, over twice as many as in 2004.
Substance abuse treatment admissions for opiates other than heroin increased more than six-fold from 1999 to 2009. Opioids are also associated with other well- known adverse effects such as constipation, nausea, and sedation.
More recent data have reported potential associations between use of long-term opioid therapy and other harms such as adverse endocrinological effects and hyperalgesia.
The Discussion section in the October 2014 AHRQ report, “The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain”, following the review initiated in 2013, reads as follows (excerpt)
Based on our review, most clinical and policy decisions regarding use of long-term opioid therapy must necessarily still be made on the basis of weak or insufficient evidence.
This is in accordance with findings from a 2009 U.S. guideline on use of opioids for chronic pain, which found 21 of 25 recommendations supported by only low-quality evidence,105 and a 2010 Canadian guideline,106 which classified 3 of 24 recommendations as based on (short-term) randomized trials and 19 recommendations as based solely or partially on consensus opinion.
Although randomized trials show short-term, moderate improvements in pain in highly selected, low-risk populations with chronic pain, such efficacy-based evidence is of limited usefulness for informing long-term opioid prescribing decisions in clinical practice.
Followed by-
Conclusions
Evidence on long-term opioid therapy for chronic pain is very limited, but suggests an increased risk of serious harms that appears to be dose-dependent.
Based on our review, most clinical and policy decisions regarding use of long-term opioid therapy must necessarily still be made on the basis of weak or insufficient evidence.
More research is needed to understand long- term benefits, risk of abuse and related outcomes, and effectiveness of different opioid prescribing methods and risk mitigation strategies.
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As Pain Specialists, Acupuncturists are committed to providing non-pharmacologic options for patients experiencing chronic pain. According to the IOM, one in three Americans is considered to fit in this category.
The Joint Commission, which accredits and certifies more than 20,500 health care organizations and programs in the United States, recently (November, 2014) released an update to its Pain Management guidelines recommending non-pharma options.
Revisions to pain management standard effective January 1, 2015 (Standard PC.01.02.07, excerpts)
The experts affirmed that treatment strategies may consider both pharmacologic and nonpharmacologic approaches. In addition, when considering the use of medications to treat pain, organizations should consider both the benefits to the patient, as well as the risks of dependency, addiction, and abuse of opioids.
The identification and management of pain is an important component of [patient]-centered care. [Patients] can expect that their health care providers will involve them in their assessment and management of pain.
Both pharmacologic and nonpharmacologic strategies have a role in the management of pain. The following examples are not exhaustive, but strategies may include the following:
♦Nonpharmacologic strategies: physical modalities (for example, acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy), relaxation therapy, and cognitive behavioral therapy
♦Pharmacologic strategies: nonopioid, opioid, and adjuvant analgesics
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Integrating TCM & Western Medicine, a Science (AAAS, 2014) Supplement
This wonderful series of articles, including one from the National Center for Complementary & Alternative (Integrative) Medicine (NCCAM )Director Josephine Briggs, makes a great case for the integration of traditional medicines such as Traiditional Chinese Medicine (TCM) into modern medical systems (e.g., U.S.).
It also offers insights into cutting-edge healthcare initiatives, from the new Traditional Medicine Strategy at the World Health Organization (WHO) to the application of systems biology for studying TCM.
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