Can PHRs actually make you healthier
Tue, 05 Feb 2008 00:01:50 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Just like with do-it-yourself taxes, a growing software industry lets patients create their own "personal health records." No more answering 10-page questionnaires every time you visit a new doctor — just hit the print button before leaving home to arrive armed with your life's medical history.
Doctors have been slow to switch from error-prone paper records to digital ones, so the trend promises to empower patients to take matters into their own computers.
But can using personal health records, or PHRs, actually make you healthier? The government is spending millions on the first studies to find out — and if so, the findings would give doctors a big push to get on board.
The idea: Put records from every health encounter in one patient-controlled spot, such as a password-protected Internet site. Then if you travel, change doctors, or a disaster destroys paper charts — like when Hurricane Katrina flooded doctors' offices — you'll always have on hand information that could prove crucial.
But the quality and scope of PHR programs varies widely, and a good one is supposed to be more than a static repository.
Say someone with hypertension starts listing morning blood pressure in a PHR that automatically creates a graph. It shows a pattern of spikes that a one-time check in the doctor's office never would catch, prompting a call for help.
More sophisticated programs allow e-mails for prescription refills, automatic downloads of lab-test results, even blood pressure monitors that plug into the computer to directly record measurements.
"As patients, we don't think of ourselves as the person driving the health care," says Dr. Peggy Wagner of the Medical College of Georgia, who is leading one of the studies. PHRs may be "changing what it means to be a patient."
"People want all their information at their fingertips," adds Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention.
She says PHRs are evolving much as online financial tools for tax preparation did, eventually giving people more control and understanding of complicated data
Yet just having a PHR isn't automatically better than a family keeping good paper records.
"It's not about a PHR in every pot. It's about PHRs that make a difference," says Dr. Jon White, health technology chief for the U.S. Agency for Healthcare Research and Quality.
So his agency is funding four unique projects around the country — in California, Georgia, Iowa and Virginia — to compare whether patients randomly assigned to use strong PHRs fare better than their counterparts who don't go digital. The studies will measure such things as improvement of chronic diseases, use of cancer screenings and immunizations, and proper medication use.
The Medical College of Georgia, for example, will track 720 patients with high blood pressure. Half will get standard care. Half will be taught to use a PHR that links directly to the health system's own records plus allowing patients to record daily blood pressure, diet and other lifestyle factors and e-mail doctors.
Floyd Moore, 60, of Augusta, Ga., is pilot-testing the program. He has congestive heart failure, and uses the PHR daily to record both his blood pressure and fluctuations in weight that could signal dangerous fluid retention.
But he's finding more valuable the PHR's warnings about interactions between various prescription and over-the-counter drugs. Moore also has a kidney condition and arthritis, and says his different doctors' paper records seldom have his slew of medications completely up to date.
"It's always something that's changed," says Moore, who prints his PHR medication record and brings it to every appointment.
President Bush says all Americans should have electronic health records by 2014. That focus has been on converting patients' formal charts — the records controlled by hospitals and doctors — from paper to digital, to reduce paperwork costs and medical errors.
While large hospital and insurance networks are making the switch, few private doctors have. And even then, software differences mean one doctor's system can't always share information with another's.
Hence the patient-driven trend. More than 100 vendors, from insurers to free Web sites, offer individuals or families the option of creating PHRs — records that they control.
The programs range from very simple electronic diaries to more comprehensive programs that link directly with doctors or hospitals for direct downloading of formal e-charts.
It's an evolution still in early stages, and no one yet knows what features will prove most valuable to patients, cautions Stephen Downs of the Robert Wood Johnson Foundation. His nonprofit agency has numerous projects under way to design more user-friendly PHRs.
"Diet and sleep and pain symptoms. When you actually took your medications. Did you take them?" lists Downs. "This information is really quite important" but many PHRs until now have "given short shrift to that."
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EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Study warns of chemicals in baby items
Mon, 04 Feb 2008 23:53:47 GMTBy LINDSEY TANNER, AP Medical Writer
CHICAGO - Baby shampoos, lotions and powders may expose infants to chemicals that have been linked with possible reproductive problems, a small study suggests.
The chemicals, called phthalates, are found in many ordinary products including cosmetics, toys, vinyl flooring and medical supplies. They are used to stabilize fragrances and make plastics flexible.
In the study, they were found in elevated levels in the urine of babies who'd been recently shampooed, powdered or lotioned with baby products.
Phthalates are under attack by some environmental advocacy groups, but experts are uncertain what dangers, if any, they might pose. The federal government doesn't limit their use, although California and some countries have restricted their use.
Animal studies have suggested that phthalates can cause reproductive birth defects and some activists believe they may cause reproductive problems in boys and early puberty in girls.
Rigorous scientific evidence in human studies is lacking. The current study offers no direct evidence that products the infants used contained phthalates, and no evidence that the chemicals in the babies' urine caused any harm. Still, the results worried environmental groups that support restrictions on these chemicals.
"There is an obvious need for laws that force the beauty industry to clean up its act," said Stacy Malkan of Health Care Without Harm.
The study's lead author, Dr. Sheela Sathyanarayana, a University of Washington pediatrician, said, "The bottom line is that these chemicals likely do exist in products that we're commonly using on our children and they potentially could cause health effects."
Babies don't usually need special lotions and powders, and water alone or shampoo in very small amounts is generally enough to clean infant hair, Sathyanarayana said.
Concerned parents can seek products labeled "phthalate-free," or check labels for common phthalates, including DEP and DEHP.
But the chemicals often don't appear on product labels. That's because retail products aren't required to list individual ingredients of fragrances, which are a common phthalate source.
The Food and Drug Administration "has no compelling evidence that phthalates pose a safety risk when used in cosmetics," spokeswoman Stephanie Kwisnek said. "Should new data emerge, we will inform the public as well as the industry."
The federal Centers for Disease Control and Prevention says the health effects in humans are uncertain.
"Although several studies in people have explored possible associations with developmental and reproductive outcomes , more research is needed," a 2005 CDC report said.
The new study, which appears in February's issue of the journal Pediatrics, involved 163 babies. Most were white, ages 2 to 28 months and living in California, Minnesota and Missouri.
The researchers measured levels of several phthalates in urine from diapers. They also asked the mothers about use in the previous 24 hours of baby products including lotions, powders, diaper creams and baby wipes.
All urine samples had detectable levels of at least one phthalate, and most had levels of several more. The highest levels were linked with shampoos, lotions and powders, and were most prevalent in babies younger than 8 months.
John Bailey, chief scientist at the Personal Care Products Council, questioned the methods and said the phthalates could have come from diapers, lab materials or other sources.
"Unfortunately, the researchers of this study did not test baby care products for the presence of phthalates or control for other possible routes of exposure," Bailey said.
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Pediatrics: http://www.pediatrics.org
New asthma inhaler approved for children
Tue, 05 Feb 2008 00:01:03 GMTBy LINDA A. JOHNSON, AP Business Writer
TRENTON, N.J. - A new inhaled steroid treatment for preventing asthma attacks in young children has been approved by the Food and Drug Administration, the drugmaker Schering-Plough Corp. said Monday.
Its Asmanex Twisthaler is the first once-a-day, inhaled corticosteroid medicine for asthma — the most common chronic condition among children — that can be taken by children as young as 4.
The Kenilworth-based company got FDA approval two years ago to sell the product as a maintenance treatment to prevent asthma flare-ups in adults and children 12 and older. The dosage for children aged 4 to 11, 110 micrograms, is half the adult dose.
Competing products are approved for children as young as 6, or must be taken more times a day.
Asthma afflicts 7 percent to 10 percent of U.S. children under 18. It is blamed for more than 14 million missed school days and nearly 1 million emergency room visits by children each year, according to the Asthma and Allergy Foundation of America.
Flare-ups of the sometimes-deadly lung disease are triggered when allergens such as pollen or irritants like smoke aggravate airways, causing trouble breathing, wheezing, coughing and tightness in the chest.
Inhaled corticosteroids are now the cornerstone of asthma care, the first treatment given newly diagnosed patients because they go straight to the lungs rather than through the bloodstream like the ingredients in pills, said Mike Tringale, spokesman for the foundation. He said each new treatment is helpful.
"The broader sort of palette that a physician has to work with, the more customized their treatments can be, and that's a good thing," he said.
The new product should be available in the second half of 2008, said Schering-Plough spokeswoman Lisa Ellen.
Unlike standard inhalers, the Twisthaler does not have a propellant. It is activated when the patient puts the end in the mouth and takes a breath. A counter shows how many doses are left.
A small study in children 4 to 11 showed the Twisthaler reduced day and nighttime symptoms, plus "interruptions" of daily life such as emergency medical visits or missing school, significantly more than an inhaler with no active ingredient.
Asmanex has some significant side effects, like other inhaled corticosteroids: It can slow growth rate in kids, cause fungal infections of the mouth and increase risk of glaucoma or cataracts. More commonly, it can cause headaches, sore throat, respiratory infection, upset stomach and muscle, bone or back pain.
Schering-Plough shares rose 64 cents, or 3.1 percent, to $21.21 in trading Monday, near the bottom of their 52-week range of $17.45 to $33.81.
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On the Net:
Asmanex/asthma info. http://www.asmanex.com/asmanex/application
Asthma and Allergy Foundation of America: http://www.aafa.org
Docs oppose Aetna plan on colonoscopies
Tue, 05 Feb 2008 04:10:15 GMTBy STEPHEN SINGER, AP Business Writer
HARTFORD, Conn. - A group of doctors from New Jersey is opposing a plan by Aetna Inc. to drop coverage of a type of anesthesia used during colonoscopies.
Gastroenterologists and other doctors say patients anxious about colorectal screening may balk unless they are assured that their insurance coverage includes the cost of anesthesiologists who administer propofol, an anesthesia the doctors say is effective and comfortable.
"The idea should be to encourage these procedures because of their lifesaving ramifications," said John Fanburg, counsel for the New Jersey State Society of Anesthesiologists and the New Jersey Gastroenterology and Endoscopy Society.
Aetna says moderate sedation, which it will continue to cover, works just as well and does not require an anesthesiologist, which can drive up the cost of the procedure by between $200 and $1,000. Gastroenterologists generally decide whether to use propofol or moderate sedation.
As of April 1, the Hartford-based insurer plans to continue to routinely cover moderate sedation, but limit coverage of so-called monitored anesthesia care by an anesthesiologist to patients who are at higher risk due to illness or other complications.
"Propofol works faster, but whether it results in improved patient satisfaction is difficult to prove," said Robert McDonough, head of Aetna's clinical policy unit.
New Jersey specialists are organizing other doctors to oppose the change, and have scheduled a meeting Feb. 15 with Aetna officials. Fanburg did not rule out a lawsuit.
"To the extent litigation is an option, we're looking at all options," he said.
Colorectal cancer is the second leading cause of cancer death in the United States and regular screening could eliminate as many as 60 percent of deaths each year, according to the U.S. Centers for Disease Control and Prevention.
Steven Morris, a gastroenterologist in Atlanta, said doctors have switched to propofol in the last several years because patients experience few side effects.
"For me to be able to tell patients they feel no discomfort helps people overcome their fears and anxieties," he said.
However, McDonough said there is no evidence that the attendance of an anesthesiologist or use of propofol has an impact on screening rates.
Aetna is not alone in refusing to cover the cost of propofol for routine colonoscopies.
Humana said in a statement that medical evidence shows that sedation is just as effective as anesthesia. The insurer said it honors requests for exceptions for a "demonstrated medical necessity" for anesthesia during a colonoscopy.
Wellpoint's policy is that medications such as propofol, administered by an anesthesiologist during endoscopic procedures, may be appropriate in limited circumstances but are not medically necessary. Such medications would typically not be covered by Wellpoint health plans that follow that guideline.
However, UnitedHealthcare covers propofol for routine colonoscopies "because it encourages our members to get screenings and hopefully save lives," spokesman Tyler Mason said.
