Retail health clinics: The pros and cons

Retail health clinics: The pros and cons - We moms tend to worry about our children a lot, and think of ways to help them, even when they are older. Case in point: I can not wait to tell my college-age son Chris about my last useful idea because-I-Care. 

It stems from an incident last year when Chris had the flu and ended up going to the emergency room and local university clinic had a wait of two days. This year, I'm Chris arm with a backup: retail clinics.

Retail clinics are part of the great trend for health care is the most convenient. "Twenty years I had to go to an emergency room if he became ill and needed immediate attention there. 

Now we have an explosion of options, such as retail health clinics, "says Dr. Ateev Mehrotra, a researcher on the topic and associate professor of health policy at Harvard Medical School.

Clinical

Health clinics began to appear in retail 15 years. Today there are about 2,000 clinics in the United States, located mainly in pharmacies, grocery stores, settings "big box" and other large distribution chain. 

The clinics are usually open 7:00 to 7:00 p.m., seven days a week and are attended by a nurse or physician assistant. They offer all kinds of health services: everything from the treatment of minor illnesses such as colds, conjunctivitis and urinary tract infections, complete physical examinations (including laboratory work and exams), vaccines and even help you quit smoking.

Pros

Retail health clinics have many advantages. They are easy to enter, with extended and no appointment necessary hours.

Prices have been set for each service, which can be previewed on its website. For example, a tour of wellness is $ 59 at Walmart. CVS cholesterol test is $ 59 to $ 69 "We found in our clinical data that are 30% to 40% cheaper than visiting a doctor, and 80% cheaper than a visit to the OR emergency, "says Dr. Mehrotra. the clinics also have private insurance and Medicare.

But the weaker results of the price of the lower quality of care? "We found that the quality of care in retail clinics is equal or superior to the offices of some doctors, because the clinics are more likely to follow national guidelines for care," says Dr. Mehrotra.

Less

Despite all the advantages, retail health clinics may not be suitable for everyone. "Health care is different for older people. The care that you need, even for a simple problem may be more complicated.

For example, a urinary tract infection affects a very different older woman a younger woman, with wife Elderly at risk of dehydration, confusion, falls, and even sepsis, "says Dr. Mehrotra. And if you have a chronic health problem, a simple illness could indicate something big that could only be made by a doctor who sees you regularly, such as your primary care physician. 

Geriatrician Dr. Suzanne Salamon, assistant professor at Harvard Medical School, is concerned that the details of a patient visit to a retail health clinic are sent.

Although the clinics offer this service, everyone takes them on it. "The risk that scattered attention of several locations can be misleading," says Dr. Salamon. "And if people do not take their full lists of drugs at a clinic, the clinic may prescribe something that will interact with medications they are taking."

What to do

A report of the American College of Physicians recently published in the journal Annals of Internal Medicine said that retail clinics are fine for a short-term illness or a backup when you can not see your doctor. 

But they should not replace a long-term relationship with a primary care. "Going to a clinic in the minute is fine for minor problems, such as a vaccine against the flu or a sore throat, especially if you are generally healthy," says Dr. Mehrotra.

This means lower health clinic would be an excellent choice for my son Chris, or for anyone who is generally healthy and need to consult a healthcare professional immediately. However, there are still some things to keep in mind if you visit a retail clinic, even for a vaccine against the flu:

      * Bring a list of your medications with you.
      * Until your doctor your medical history and any health condition you have.
      * Ask the clinic to send details of the visit to your doctor.
      * Consider a follow-up appointment with your doctor if you have time, so that everyone is on the same page with regard to maintaining your health.

Follow these tips, and is likely to yourself, give your doctor and mother "even good ol some peace. Right, Chris?  
By: Heidi Godman

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The truth about altruism

The truth about altruism - Credit people like Eleanor Roosevelt asking, "When will our consciences grow so tender that we will act to prevent human misery rather than avenge it?" Unfortunately, tenderness is not a characteristic of all human consciousness. So the violence continues, often rationalized as revenge in response to the misery of others.

While altruism is often understood as rooted in tenderness, scientific research suggests otherwise. Rather, altruism may have evolved with the desire to condemn and even punish those who act solely in their own interests. We can be motivated to do good, to avoid being rejected by our community.

The function of altruism

These impulses to act for the good may have helped our early ancestors enforce social norms, in an earlier era formal laws, contracts and courts have forced cooperation.

A few years ago, an international group of researchers led by anthropologist Joseph Henrich from Emory University in Atlanta, tested this theory. They created three experimental games and they played with people who lived in Africa, South America, New Guinea, the South Pacific and the US Midwest.

In these games, players were anonymous to each other. All received real money (or "game") to operate:

        *  The dictator Thurs. The player to decide how much your participation to give the player B. Player B must accept any amount offered. If player A is stingy, no fault.
 
        *  The ultimatum game. Player A decides how much to share with the player B. Player B, before hearing the amount, deciding which offer is acceptable. If B rejects A's offer, both players receive nothing.
 
        *  The third game of repression. Player A decides how much to share with the player B. Player C is given an independent participation. If C feels was too stingy A, C can be punished by reducing the benefits of, but C should pay part of their participation for the privilege. 

The interest dictates that all players must have all the money they receive, because it is a time that the anonymous meeting and reputation does not matter.

In fact, the interest does not govern the results. Few have acted purely selfish. Overall, there was an almost universal to act altruistically and share the trend of play.

Player A is usually offered something that the player B and frequently gave media. In the third game of the punishment, Player C was generally willing to sacrifice some money to punish selfishness. A player, when you know that the punishment was possible, tended to be more generous.

Since Player A has more stingy, most players have chosen to punish him if they were the target of selfishness A player or just a spectator. Local customs affect the amount of trade and the punishment threshold.

Human values and standards

The studies do not show whether it was induced by a desire for revenge or feelings of envy or competition. In any case, people can be more generous when they expect to be punished by selfishness which is outside the cultural norm or when behaving fairly is a high value of the community.

What this means for Eleanor Roosevelt's desire for a tender of universal human consciousness? Human beings with a greater capacity for altruism may have had a survival advantage in primitive societies. 

But it was the people who were good with a spear and had a talent for looking for food or agriculture. In evolutionary terms, being the time both strong and selfless seems to be the winning combination. 

If it is pure altruism, Heinrich study provides no evidence. But it supports the idea that even if we are being "unselfish", we serve our own interests.

Mrs. Roosevelt could argue that society becomes more bearable when people feel good to be kind and generous, rather than the harsh and unforgiving heart. And if I could look around today, she would probably not think of tenderness flourished worldwide since his death in 1962.

But it can be encouraged to know about research showing "altruism" or consciousness as a natural emergent property of human societies. We humans seem to have the ability to play clean, though we sometimes fear of punishment that can help us do that.

By: Michael Craig Miller,M.D.

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Vacation Travel: Keeping children safe and healthy

Vacation Travel: Keeping children safe and healthy - Traveling with children can be a great way to explore new places, spending time together as a family, and visiting friends and relatives who live nearby. For the safest and healthiest possible, consider these travel tips.

 
Wear the important things in your medicine cabinet

      * Pack prescription medications your child. Make sure you have enough for the whole trip.

      * Bring commonly used over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), antibiotic ointment, medications against colds (as recommended by your doctor) and diphenhydramine (Benadryl).

      * Keep a thermometer and bandages on each trip; which can come in handy. Consider a pair of pliers, so if your child is often chips.

Children need car seats

* Make sure you have the proper place to the age and weight of the child, and is properly installed in the vehicle is moving. The website of the American Academy of Pediatrics offers tips on choosing and installing car seats. 

* If traveling by plane, the Federal Aviation Administration strongly wear safety seats for infants and toddlers and attachment to a seat tickets recommended. Remember that you have to buy a separate ticket for the child to use the seat.

Check with the airline to see if there are discounts available. The seat must be less than 16 inches wide to fit; Be sure to measure before you go! Booster seats are not allowed on planes.

Be aware of common health problem Travel

       * If your child gets dizzy easily, make sure it is high enough in the car to see out the window, as this can help. Keep a broken window open for a breeze, and have snacks like pretzels available; both can help eliminate nausea. If your child is particularly bad car sickness (eg, she vomits each way), talk to your doctor about medications that might take.

        * Ear pain can be a problem when people steal. Having a baby nurse or take a bottle during takeoff and landing is a good idea because it helps to fight against the evils swallow ears. For older children, they try to have a drink, chew gum (sugarless, of course!), Or play a game yawn to prevent their ears hang.

        * Since schedules and what you eat when traveling to different frequency than when you are at home, constipation (not having a bowel movement often as usual) may occur. Give your child plenty to drink, and make sure it is not the fiber (fruits, vegetables, whole grains) in your diet. 

        * Germs can be anywhere when traveling. Carry hand sanitizer with you at all times to help you carry within them with you!

Do not forget to child sealing

        * Bring a test kit for the child with outlet covers, cabinet locks, and everything you use at home.

        * If you are staying in someone's home, you can not be held throughout the childproof. Ask if there is a room can be completely childproof, so you can relax more while your child is there. 

Think of the greatest dangers, such as medication, cleaning products, knives and potential choking hazards. Ask if these and other particularly dangerous things can be moved and / or blocked out of reach during your stay.

        * For babies and toddlers, a portable crib can serve as a bed and a safe place to play.

        * Consider safety gates to block stairs you or to help keep your child safe. Your host can appreciate that scaling, if the guy that open, contrary to what needs to be done is used.

Do your homeworks

        * Note medical information of your child, especially drug allergies (if you forget the name of the antibiotic that gave the eruption Know before you go!), Health problems and prescription drugs. Keep it with you at all times. If your child needs to see a doctor while you're away, she needs to know these things.

        * Bring your child the names and phone numbers of everyone you see doctors, including specialists, if you see a doctor or need to communicate with them.

        * Ask your doctor about the best hospitals in the region where you travel, if you know where to go if necessary.

        * Make sure to bring your health insurance card, and check with your insurance company about coverage in your area. Most urgent care business is covered if your child needs, but you may need to call for approval or go to a particular hospital.

If you are traveling outside the country ,,,

* For travel to some countries, your child may need special vaccinations. For the latest recommendations, visit the section of the health community on the website Centers for Prevention (CDC) and disease control. 

Do this for at least six to eight weeks before your trip, as most vaccines must be given at least one month before the trip and you can have an appointment at a clinic Special trip for some vaccines. 

* Ask about specific health risks, such as malaria and dengue fever in the country where you are traveling and you can talk to your doctor before going on how to prevent them. 

The CDC website can help with this. It also has a large number of practical and useful information on topics such as food safety and water and traveler's diarrhea. 

That sounds like a lot, but mostly it is just a matter of planning. And it can make a big difference when it comes to make your trip memorable for all the right reasons.

By: Claire McCarthy, MD 

 

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Medicare Advantage: When an insurance company to make house calls

When I was a kid, my doctor visits are always made when we were too sick to come to his office. But he stopped to visit people at home before retiring. 

He and his patients realized they were perhaps better served by going to your own office, well equipped for the care they needed.

So I am more than a little surprised when a woman representing my health insurance plan have called to book a home visit, a nurse or doctor. I have a Medicare Advantage plan, and thought it offered me this visit, because the appellant assumed he was frail and leave. 

I assured him that he could easily reach my doctor's office if necessary. I also just had my annual physical, my vaccines and tests were under way, and I felt great. Why do I need a call from home?

The only reason I can give is that the doctor would have more time with me than my doctor did. The house tour was to last 45 minutes to an hour and include a medical history, physical examination and health advice. Since I work full time, you can program the visit of a weekend. And she even threw in a gift card for $ 25 Walmart if I finished the exam. 

I refused, feeling a little creeped out - especially after consultation with my doctor and learn that she knew nothing of this. So I did a little research. 

I learned that these visits are legitimate - indeed, more than one million patients are registered for them so far. And I learned that a further examination has reduced hospitalizations, especially for patients with diabetes, heart failure or chronic obstructive pulmonary disease.

But what always puzzled me was why my insurance company want to hire the extra expense of doubling the examination and tests my doctor came. I do not have serious medical conditions and my regularly receives top marks from all classification systems.

A method for the alleged insanity

Dr. Michael McWilliams suggested an answer. As a partner of the health care policy at Harvard Medical School, which includes the arcane rules covering how Medicare reimburses my Medicare Advantage plan for care teacher. 

He said that each of us covered by these plans is assigned a risk score. As we develop more health problems, increases our risk score. "Home visits by Medicare Advantage plans allow the capture of more diagnoses, which in turn increases the risk score that adjusts Medicare payments. In general, recorded diagnoses, plus the payment," says Dr. Williams.

He explained that the risk equalization system was created to ensure that the plans are not only enroll healthy patients who are less likely to have to pay for expensive procedures and hospital stays. To provide an incentive for insurers to cover the sickest patients, the plans pay proportionally more for their care.

I received two calls from that rejected the home visit, each more persistent than the last. Now I understand why. If your doctor can diagnose me with a serious health problem, the company could increase my credit score and get a higher Medicare reimbursement each time you visit the doctor.

What to consider if he is offered a home visit

If you or someone you know has offered a home visit from a Medicare Advantage plan, consider the following:

       *  If you have a serious health problem, special attention can help prevent hospitalization.
       *  The care they provide is not permanent. This is the only time you see the doctor who examined. The test results and evidence will be sent to your doctor regularly for follow up.
 
       *  If you're healthy and stay results in an increase in the risk score, you will not have to pay more for their care. But the higher Medicare reimbursement received your insurance may contribute to rising costs of the nation's health care.
 
       *  You are not required to have a tour of the house - they are completely optional. 
By: Beverly Merz 

 

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Adolescents with optimistic friends can have better emotional health

Adolescents with optimistic friends can have better emotional health - Pediatricians and child behavior specialists who work with adolescents know that adolescence is an important time for social growth.

However, these years can be fraught with anxiety for parents of teenagers. How will you know if your teenager Moody is to be with the right people?

What friends could be a bad influence? How can you help your child develop healthy relationships? 

Recent research has addressed some aspects of these issues. A study entitled "Dissemination of healthy humor in social networks of adolescents" published this year in the Proceedings of the Royal Society of London, examined whether a teenager whose friends have a healthy atmosphere is less likely to be depressed.

He also discussed how emotionally healthy friends affect the recovery of adolescent depression. Basically, the researchers wanted to know: is a contagious good mood?

The study involved nearly 3,000 teenagers. Each study volunteers carried out two surveys, six months apart, in which he or she up to five male and five female friends listed. Then each teenager was monitored over time to see how it changes your mood. 

One of the interesting things about this study is that the researchers define depression as a behavior, not necessarily as a disease that we can get. This allowed them to make them slightly different from previous studies looking at the same statistical analysis of things, and discovered the potential power of positive thinking friends. 

The researchers found that have a social network of friends with a healthy atmosphere cut the likelihood of developing depression half of teenagers over a period of 6-12 months. It has also significantly improved the chances of recovery from depression in adolescents who have had it.

Although the data do not show a cause and direct effect, this study suggests that having friends with healthy mood can reduce the risk of depression and make it a little easier to recover from depression if it product.

Surprising findings in the survey on social networks

This study is a good example of a recent trend in epidemiology - the use of data on the social network from person to learn about this person. This research has led to many interesting discoveries, and given really is a whole new area of research.  

A 2007 study in the New England Journal of Medicine was one of the first of its kind. It has been shown that obese people who had friends and relatives were themselves more likely to be obese. 

Since then, additional research has studied how social networks influence the risk of developing the individual (or avoid) specific health conditions such as obesity, smoking and depression.

The results of these studies are sometimes surprising, giving valuable information to the new medical community. For example, I conducted a study in 2011 called me "The influence of social networks on patients' attitudes towards the type II diabetes." When I began this research, it is assumed that patients are less concerned about having diabetes, if several friends and family members had diabetes. 

I had imagined that these patients might have become so used to the idea that diabetes disease seems common and almost normal. But in fact, my team found the opposite! patients with a higher prevalence of diabetes within their social networks worried over their disease. This unexpected result gave me information that helped me take better care of my patients.

Using network data to improve the mental health of your child

This type of research is not only useful for doctors, but also provides important for anyone trying to improve their own health or that of informing the family of one. 

The study on the positive mood in the social networks of adolescents suggests that parents may be able to reduce their chances of developing adolescent depression - or improve your mood or depression if she has - just promote and support emotionally healthy friendships with their peers.

With much controversy over the use of antidepressants in adolescents, the results are, as they can give parents a simple way to promote the emotional health and well-being in their teens - no drugs involved.
By: Nandini Mani, MD

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