Hospitals across the country have been adding programs in palliative care—which focuses on treating pain, minimizing side effects, coordinating care among doctors and ensuring the concerns of patients and their families are addressed—at a feverish pace. The field has expanded so rapidly that a majority of American hospitals now have palliative programs, to the delight of patients who say they've finally found relief and a sympathetic ear. Palliative care has its roots in the 1970s, but was slow to grow. Several pieces of research helped to advance the cause, though, showing widespread untreated pain in hospitals and nursing homes and the positive impact palliative programs had on such patients.
The growing scarcity of sterile, injectable drugs is one of the biggest issues confronting hospitals across the country, and will be a key issue at the annual American Society of Clinical Oncology meeting in Chicago this weekend. Health officials blame the shortages on industry consolidation that has left only a handful of generic manufacturers of these drugs, even as the number of drugs going off-patent is growing. Some drugmakers have been plagued by manufacturing problems that have shut down multiple plants or production lines, while others have stopped producing a treatment when profit margins erode too far.
On Wednesday, Medicare announced an initiative to reduce the use of antipsychotics drugs among dementia patients by 15 percent by the end of the year, using techniques like the one above. Federal officials said such drugs are dangerous for elderly patients with dementia—nearly doubling the risk of death —and are overused as a way to control difficult behaviors of nursing home patients. In fact, every two in five nursing home patients with dementia is given antipsychotics even though they have no diagnosed psychosis, said Dr. Sherry Ling, deputy chief of the Center for Medicare and Medicaid Services, during a telephone news conference on Wednesday.
Hospital-at-home programs refashion care for chronically ill patients with acute medical issues, testing traditional notions of how to treat people who become seriously ill. Only a handful of the initiatives exist. The concept is getting more attention with increased pressure from the national health overhaul to improve the quality of medical care and lower costs. Hospital-at-home programs do both, according to research led by the concept's pioneer, Bruce Leff, director of geriatric health services research at Johns Hopkins School of Medicine in Baltimore.
One out of every seven patients having a non-emergency angioplasty to clear a clogged artery in the heart didn't meet criteria for needing the procedure, in a new study from New York. And based on guidelines, it was uncertain whether the stent-inserting surgery was appropriate in another one-half of patients. Stent procedures have exploded in popularity in recent years—and several studies have raised concerns about overuse (see Reuters Health reports of July 5, 2011 and July 7, 2011). Angioplasty procedures cost around $12,000 to $15,000, compared to medications, which can be several hundred dollars per year. Many patients who have a heart procedure also take medications.
Some hospitals are trying to make their patients' stays a little less unpleasant. They're members of an organization called Planetree, which was founded by a patient named Angelica Thieriot, who had a not-so-good hospital experience back in the 1970s. Today Planetree has certified, or "designated," 30 hospitals and nursing homes in the U.S. and four countries as meeting a specific list of criteria that qualify them as providing truly patient-centered care. Among the 14 Planetree hospitals in the U.S. is Fauquier Hospital, a 97-bed facility in Warrenton, Va., on the outskirts of Washington, D.C. CEO Rodger Baker says there was an element of business to his decision to transform his hospital into a more patient-centered place.