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GreenField’s Health Matters: November, 2005
Communication & Follow-up
Update on Avian Flu
Antibiotics & Antibiotic Overuse
Medicare
Holiday Schedule
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Communication and Follow-up
It is our goal to have very open and timely communication and follow up with you. We have intentionally constructed systems that help us to do this, but such systems are never failsafe. We do want you to have high expectations of us. We also ask for your assistance in helping to safeguard our communications to make sure that we’ve followed up on important issues.
Here are a few things that we’d ask you to do:
Urgent Care and Emergency Care: Individuals sometimes visit urgent care centers or emergency rooms without our knowledge. You are obviously free to do so, but it would be our preference to speak with you first before you proceed to one of those centers. You can call us any time, day or night. We can often help avoid such visits by seeing you or managing the problem over the phone. Obviously, if you do have a real emergency, please do not hesitate to call 911, but for any and all instances, if you or a family member can call us, it would help us to help you. Alternatively, you can request that the emergency room staff contact us when you get there.
Phone Calls: If you call us after hours or on a weekend, we should be back in touch with you within 5-10 minutes – nights or weekends. If we are not back in touch with you in less than 30 minutes, it generally means that there has been a problem in communication with our answering service. Please call us back if you have not heard from us.
Test and Lab Results: If you have a lab test, we generally have those results back within 24 hours – pap tests generally take 48 hours. It is our intent to get those results back to you as quickly as possible, preferably the next day. Obviously, there are times when we are not in the office or the test may return over a weekend. That may delay our communicating the results to you by a few days. However, if you do not hear from us several days after a test is performed, please make sure you contact us.
Follow-up After a Visit: Medical visits can be both busy and confusing, particularly if you have a complicated problem or multiple problems. If you do not fully understand the information given or the appropriate follow-up, or if we failed to address an issue of concern, then please do contact us for clarification or follow-up. We value your participation in the thoroughness of your care.
Specialists: Coordination of care is very important, yet it often happens poorly between independent medical practices. We work hard to communicate with the specialists that we use and that we send you to, but we can use your help also. Whenever you receive care outside of GreenField, it is valuable if you ask them to make sure to send us the results of the test or consult as soon as possible. Unfortunately, you need to reiterate this time and time again, wherever you go – be it to a specialist or to an emergency room. Communication tends to happen slowly and unreliably, often taking weeks for us to receive a test result or consult note from some specialists. As the patient, your reiteration that you expect communication to be timely and thorough is always helpful. GreenField is in fact working with Kryptiq Corporation and others in Portland to create a secure email network among physicians to enable much more timely electronic communication and transmission of information.
An Update on Avian Flu
Please see our October Health Matters for details about the Avian Flu.
The media frenzy about avian flu has certainly picked up in the past month, and concordant with that, we have had some requests from individuals to provide prescriptions for Tamiflu. Thus far, we have not provided such prescriptions, nor have any of us obtained the medication for our personal or family use. Nor have we told people to purchase respiratory masks. We believe that these measures are impractical for a number of reasons.
We do take the situation very seriously, and will continue to track it closely. Please recall the following issues:
* The Avian flu has been around and being transmitted from birds to humans for at least 9 years now, and has not yet learned to move from human to human. Unless it mutates and gains that capability, then there will be no pandemic. Thus far, it has not. It is exceedingly unlikely that it will do so in 2005-2006.
* Tamiflu is the only medication that would theoretically work, and that is only theoretical – we don’t know for sure when it mutates if it would work.
* If you were going to take Tamiflu, you’d have to take it for a prolonged period of time – not knowing when the bug would appear in our local area and when it would be safe to stop it. It is not practical to provide that much medication to cover someone for weeks or months.
* Should a pandemic start – the best thing to do will be to stay at home and avoid contact with people so as to not be exposed. That would be the best strategy, though itself not that practical for a prolonged period of time obviously.
If you would like additional information, you can go to the Center for Disease Control’s web site at http://www.cdc.gov/flu/avian.
Understanding Antibiotics and Avoiding Antibiotic Overuse
Every year during the fall and winter, you and your family face your share of colds, upper respiratory infections, sore throats, and flu-like illnesses. Many individuals believe that they would benefit from an antibiotic during these illnesses, and they often come in for a visit expecting a prescription for antibiotics because they want to get better as quickly as possible. When people feel “sick” due to such illnesses, they frequently seek medical attention looking for relief, and they may be surprised or even angered if the physician doesn’t prescribe an antibiotic. Because of this, physicians frequently prescribe antibiotics simply to meet patient expectations.
Bacteria, Viruses and How Do Antibiotics Work
Antibiotics were first used in the 1940’s and represent one of the greatest advances in the history of medicine. Very few medical advances have been responsible for significantly extending human life expectancy – in fact, the two most critical advances in the history of medicine are sanitation and antibiotics.
To understand how antibiotics work, you have to understand the two types of germs – bacteria and viruses. Although certain bacteria and viruses cause infections with similar symptoms, they are very different types of organisms that multiply and spread quite differently. Antibiotics are effective against bacteria, and not against viruses.
Bacteria are living organisms existing as single cells. They cause illness by invading healthy human or animal tissue, making toxins, or rapidly reproducing in ways that interfere with normal body processes. Some examples include:
* Pneumonia, or lung infection, is cased by bacteria that enter and multiply in the lungs
* Cellulitis, or skin infection, is caused by bacteria that enter and multiply tissue beneath the skin
* Bacteremia or sepsis, commonly called blood poisoning, both represent bacterial infections of the blood with sepsis resulting when the infection becomes overwhelming to the body, leading to a drop in blood pressure
* Food poisoning may be caused directly by bacteria or may be caused by toxins created by bacteria on food that is subsequently ingested
Antibiotics can either inhibit bacteria growth or they can directly kill bacteria through a wide number of different mechanisms that involve disrupting the bacteria’s internal processes – their internal mechanics. While people like to think of some antibiotics as being “stronger”, that really isn’t the case. Different antibiotics are affective against different types of bacteria so physicians choose an antibiotic not based upon its “strength” per se, but rather based on the type of infection and the likely type of bacteria that causes such an infection.
Viruses, on the other hand, are not living organisms and cannot exist on their own - they require living cells to survive, because they can only "live" and reproduce inside of cells they have invaded. They spread between cells so they can survive for periods of time outside of cells but they cannot grow or reproduce outside of other cells. Viruses are much smaller particles than bacteria and they are made up of different types of outer chemical walls and have different internal chemistry. There are many, many types of viruses whose structures vary quite widely – much more so than bacteria. While there are many types of bacteria, all bacteria have a lot more in common than the various types of viruses have in common with each other.
So antibiotics work against bacteria, but not against viruses. Anti-viral agents do exist, but they are generally effective against a very narrow range of viruses. Anti-viral agents are not effective against bacteria.
Many viruses can produce illnesses that are indistinguishable from illness cased by bacteria. This is particularly true of infections of the upper airways including colds, sinus infections, sore throats, bronchitis and other upper respiratory infections.
Many viruses and bacteria are fought off by the body's own immune system before they cause illness. In fact, our skin has bacteria all over it, our colons are packed with bacteria, and our oral cavities carry a huge number of bacteria. Likewise, bacteria are everywhere in the environment and frequently in food that we eat, yet we don’t generally get sick from them. Yogurt is in fact largely bacteria. Bacteria are necessary and having the proper bacterial balance on your skin is good. The fallacy of antibacterial soap is thus two-fold. First, all soap has antibacterial properties. Secondly, you don’t really want to use soap that has excessive antibacterial properties because it kills the normal bacteria that live on your skin and which keep other bad bacteria away.
Both viruses and bacteria can also cause infections that simply run their course and thus resolve on their own such as most colds, sore throats, and bronchitis as well as specific infections like chicken pox.
Why Antibiotic Overuse is Harmful
While antibiotics are obviously helpful in the right situations, they have been significantly overused for many years, particularly in conditions for which they are not helpful. Over-prescribing and overuse of antibiotics is problematic for several reasons. First, it has resulted in the development of resistant strains of bacteria that are no longer affected by the antibiotic. Second, those who take antibiotics run the risk of adverse reactions, such as allergic reactions, stomach upset and diarrhea. These risks are acceptable if you really need the antibiotic, but the risks are unwarranted if the antibiotics are being used in situations where they are not helpful – where the causative infection is likely viral for instance.
Secondly, bacterial resistance to antibiotics is a significant and growing problem. Bacteria that were once highly responsive to antibiotics have become increasingly resistant. The Centers for Disease Control and Prevention (CDC) calls this "one of the world's most pressing public health problems." The more antibiotics are taken for unnecessary reasons, the less useful antibiotics will be when we really need them.
What Should You Do?
It is important to realize that most common conditions such as colds, upper respiratory infections, bronchitis, ear infections, “sinusitis,” and sore throats are generally viral infections and do not require antibiotics – not only do they not require antibiotics, but repeated studies have shown that antibiotics are not helpful in making patients better faster. In fact, there is no way to distinguish a viral from a bacterial upper respiratory infection based on symptoms, and no diagnostic test that helps to distinguish them. Nonetheless, numerous studies have examined the value of using antibiotics in these situations and they repeatedly demonstrate that antibiotics are not helpful in otherwise normal individuals.
However, physicians often prescribe antibiotics because they believe that patients want them and they simply don’t want to send people away without doing something for them even if that means prescribing a very expensive, and ineffective, antibiotic.
As an example, we recently had an otherwise healthy patient call and describe an upper respiratory infection that was almost certainly viral. We discussed this with him, but he expressed concern that his wife had the identical symptoms (which further reiterated the high likelihood of it being viral) and she had just been given an antibiotic from an urgent care center – an antibiotic that costs about $75.00. Thus, his underlying expectation was that we give him an antibiotic.
While antibiotics are obviously useful in serious bacterial infections, colds, upper respiratory infections, bronchitis, ear infections, “sinusitis,” and sore throats in otherwise normal adults rarely either require or benefit from antibiotics.
Medicare Prescription Benefit
As many of you know, Medicare is introducing a new Prescription Benefit which will take effect in January 2006. Each Medicare beneficiary does need to take action to take advantage of this new benefit. The following is excerpted from the Medicare website at http://www.medicare.gov.
What is Medicare prescription drug coverage?
Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs.
Who can get Medicare prescription drug coverage?
Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses.
When can I get Medicare prescription drug coverage?
You may sign up from November 15, 2005 to May 15, 2006. If you join by December 31, 2005, your coverage will start January 1, 2006, and you won't miss a day of coverage. If you don't sign up when you are first eligible or by May 15, 2006, you may pay a penalty. Your next opportunity to enroll is from November 15, 2006 to December 31, 2006.
How does Medicare prescription drug coverage work?
Your decision about Medicare prescription drug coverage depends on the kind of health care coverage you have now. There are two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage Plan or other Medicare Health Plans that offer drug coverage.
Whatever plan you choose, Medicare drug coverage will help you by covering brand-name and generic drugs at pharmacies that are convenient for you.
Like other insurance, if you join, you will pay a monthly premium, which varies by plan, and a yearly deductible (no more than $250 in 2006). You will also pay a part of the cost of your prescriptions, including a copayment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible.
Why should I get Medicare prescription drug coverage?
Medicare prescription drug coverage provides greater peace of mind by protecting you from unexpected drug expenses. Even if you don't use a lot of prescription drugs now, you should still consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means protecting yourself from unexpected prescription drug bills in the future.
What if I have a limited income and resources?
There is extra help for people with limited income and resources. Almost 1 in 3 people with Medicare will qualify for extra help and Medicare will pay for almost all of their prescription drug costs.
Again, check http://www.medicare.gov for more information.
Office Notes for the Holidays
The holidays are nearly upon us, and we will be closing the office for the following days:
* Thursday and Friday, November 24 and 25 in observance of Thanksgiving
* Monday, December 26 in observance of Christmas
* Monday, January 2 in observance of New Years Day
As always, one of our physicians will be on call to assist you with any urgent or emergent needs.
Sincerely,
Your GreenField Health Team:
Beth Davis, your Benefits Coordinator and Biller (email)
Chuck Kilo, MD (email)
Cynthia Ferrier, MD (email)
Dia Gaede, MA, your Health Coordinator (email)
Elizabeth Hays, MD (email)
Eric Murray, MD (email)
Jill Arena, your Clinic Administrator (email)
Joel Swartzmiller, IT Manager (email)
Pam Mockenhaupt, CMA, your Health Coordinator (email)
Paula Koeller, MD (email)
Sarah Larson, MA your Health Coordinator (email)
Shelly Banta, your Clinic Manager (email)
Tiana Schmitt, MA, your Health Coordinator (email)
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GreenField Health System
9427 SW Barnes Road, Suite 590
Portland, OR 97225
Phone: 503.292.9560
Fax: 503.292.9510
Web: http://www.greenfieldhealth.com
questions, concerns, comments appreciated:
questions@greenfieldhealth.com
© 2003-2005 GreenField Health
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