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States Looking for More Effective Ways to Encourage Vaccinations

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By Michelle Andrews

Kaiser Health News

When kids start school this fall, it’s a sure bet that some won’t have had their recommended vaccines because their parents have claimed exemptions from school requirements for medical, religious or philosophical reasons. Following the much publicized outbreak of measles that started in Disneyland in California in December, these exemptions have drawn increased scrutiny.

Illustration by Sarah Kaiser, via Juhan Sonin, flickr creative commons

Illustration by Sarah Kaiser, via Juhan Sonin, flickr creative commons

That outbreak, which eventually infected 147 people in seven states, was a wake-up call for many parents, who may not have realized how contagious or serious the disease can be, and for states as well, say public health officials.

“States are beginning to realize that they have effective measures to combat these outbreaks, and philosophical exemptions are eroding these protections and resulting in significant costs to states,” said Carrie Byington, professor of pediatrics at the University of Utah and chairwoman of the American Academy of Pediatrics Committee on Infectious Diseases.

In addition, research shows that eliminating vaccine exemptions or making them harder to get can improve vaccination rates and reduce disease outbreaks.

California and Vermont passed laws this year eliminating exemptions in 2016 for philosophical reasons; California’s law eliminates religious exemptions as well.

The federal Centers for Disease Control and Prevention provides suggested vaccination schedules for children and adults, but there’s no federal requirement that parents vaccinate their children. All states, however, have laws or policies requiring that children be up to date on recommended vaccines in order to attend school or day care. Unvaccinated children can generally attend only if their parents have obtained a vaccination exemption approved by the states.

Every state allows medical exemptions for children whose immune systems are compromised because of congenital problems or cancer treatment, for example. Nearly all states allow exemptions from vaccinations because of religious beliefs; excluding California and Vermont, 18 permit exemptions because of parents’ personal or philosophical convictions, according to the National Conference of State Legislatures.

Just three states – West Virginia, Mississippi and, now, California – allow vaccine exemptions only for medical reasons.

In recent years, exemption rates for children have soared, but they vary. On the low end, New Mexico’s rate was less than half a percent in 2012, while the top state rate was Oregon’s at 6.5 percent, according to a study this month in the journal Health Affairs.

More than 1500 pharmacists in North Carolina have gone through the approval proces to give immunizations.

Photo courtesy U.S. Army Corps of Engineers Europe District, flickr creative commons

Local rates may be much higher though. There are pockets in California and Colorado, for example, where the exemption rates top 30 percent, said L.J Tan, chief strategy officer at the Immunization Action Coalition, an advocacy group that works to increase immunization rates.

But since in most places the percentage of children getting the recommended vaccines tops 90 percent for most diseases, many parents have never seen someone with measles, for example, or whooping cough, and may not understand their dangers.

“In the absence of disease, the alleged risks of the vaccine become easier to sell,” Tan said.

Those risks are real, said Barbara Loe Fisher, co-founder and president of the National Vaccine Information Center, a group that advocates that people be able to decline mandatory vaccines based on their philosophical or personal beliefs. Fisher testified before the California State Assembly against the new law, which takes effect next July.

“Some people are more susceptible than others to injury or death from vaccines,” Fisher said. “But it’s not clear who is at higher risk.”

For the vast majority of people, however, vaccines are very safe, and studies have failed to show a link to autism, a common concern of parents who don’t vaccinate their kids.

“The risk of getting the disease is higher than the risk of getting a vaccine,” said Mark H. Sawyer, a pediatric infectious disease specialist at the University of California, San Diego.

The Health Affairs study analyzed the different elements of state rules to tease out the extent to which they affected vaccine exemptions. It found, for example, that policies that required the state health department to approve nonmedical exemptions or permitted exemptions only for specific vaccines rather than all vaccines had a significant effect on reducing vaccine exemptions.

So too did laws that imposed civil or criminal punishments such as expulsion from school (for the child) or criminal negligence charges (for parents) for not complying with vaccination rules.

The threat of penalties alone may be enough to deter parents from refusing vaccinations, said study co-author W. David Bradford, a professor of public policy at the University of Georgia.

The more restrictive policies were reflected in lower rates of whooping cough. States with the most effective exemption policies had an average incidence of 7.3 pertussis cases per 100,000 people from 2002 to 2012, while states with the least effective policies had an incident rate more than twice as high, at 16.06 cases, the study reported.

More broadly, the study shows that there are tools that work.

“There is room for lots of states to improve their policies in ways that encourage people to get their kids vaccinated,” Bradford said. “I take that as encouraging.”

This story originally appeared in Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Press Release: Counterfeit Medical Device Warning

EMS, Fire and Law Enforcement Officials should be on the lookout for dangerous counterfeit tourniquets

August 25, 2014 – Joint Release from the N.C. Department of Insurance and the N.C. Secretary of State

Raleigh – A recent CBS News television story highlighted the fact that counterfeit brand-name tourniquets have now been found in the United States. The fakes mimicked a line of high-quality tourniquet medical devices that are made to self-apply in emergency situations or to be put onto a patient quickly by a trained first responder.

Screen Shot 2015-08-25 at 11.11.11 AMNo complaints about the fake tourniquets have been documented in North Carolina at this time, but North Carolina Secretary of State Elaine F. Marshall and North Carolina Commissioner of Insurance and State Fire Marshal Wayne Goodwin are cautioning emergency first responders that they need to be checking the supply of tourniquets they have on hand, and to order them from reliable sources to ensure that the products they purchase are authentic.

The fakes appear to look almost exactly like the real ones, except the parts are of low-quality, breakable, and do not restrict blood flow to an injured limb as a real tourniquet does.

“We often point out that the crooks who counterfeit products do not care what happens to those who buy their shoddy merchandise,” Secretary of State Elaine F. Marshall said Monday. “In this case, they are more than willing to let injured people die in their pursuit of making a dishonest buck.”

“Our state’s first responders are saving lives every day, and it’s a critical concern that counterfeiters may compromise their ability to do that,” said Insurance Commissioner and State Fire Marshal Wayne Goodwin. “I urge all fire and rescue workers to remain vigilant that counterfeit or low-quality equipment does not make its way into North Carolina.”

The North Carolina Secretary of State’s Office pursues product counterfeiters as part of its trademark protection law enforcement duties.

The North Carolina Department of Insurance Office of State Fire Marshal is committed to supporting efforts of the fire and rescue service through training, inspections, injury prevention programs and grant distribution.

The counterfeit devices found so far have included knock-offs of the C-A-T brand tourniquet distributed by North American Rescue (NAR) LLC brand products.

That company has issued a warning to customers that they have seen fakes imitating their “C-A-T” tourniquet and illegally using C-A-T trademarks.

The C-A-T device is often carried by a wide range of emergency personnel including EMTs, firefighters and law enforcement officers.

In a statement prepared in partnership with the NC Secretary of State’s Office and the NC Department of Insurance, NAR General Counsel Curtis Stodghill noted “Counterfeit tourniquets are a serious problem, for North American Rescue with the Combat Application Tourniquet(r) and Tactical Medical with the SOF(r) Tactical Tourniquet and the public. The C-A-T(r) and SOF(r) T are class 1 life-saving medical devices and the only tourniquets approved by the Committee on Tactical Combat Casualty Care.  The fakes are not made with the high standard quality control processes and are not reliable. North American Rescue is aware of catastrophic failures of the counterfeits during actual life-saving applications. It is essential for anyone purchasing a life-saving tourniquet to know they are buying authentic and quality medical devices. Lives and limbs are at risk!  To ensure your Combat Application Tourniquet(r) (C-A-T(r)) is authentic, contact North American Rescue at 888-689-6277 or for the SOF(r) Tactical Tourniquet (SOF(r) T) Tactical Medical at 864-224-0081.”

The fakes appear to be imported from China and sold on-line by resellers on websites such a eBay and Amazon at prices that are far below what the real products cost. The authentic models of both brands mentioned by Stodghill are manufactured in the USA.

Officials fear that well-meaning first responders trying to stock their emergency kits may be lured into buying the fakes because of the low prices.

Secretary of State Marshall requests that anyone in North Carolina finding a counterfeit tourniquet also call her Department’s Trademark Tipline at 919-807-2178 with details so that state law enforcement agents can pursue the matter.

“If these dangerous knock-offs show up anywhere in North Carolina,” Marshall said, “we want to be chasing after whoever is selling them here just as quickly as possible.”

Study: 2 Million Exchange Enrollees Miss Out On Cost-Sharing Assistance


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By Michelle Andrews

Kaiser Health News

More than two million people with coverage on the health insurance exchanges may be missing out on subsidies that could lower their deductibles, copayments and maximum out-of-pocket spending limits, according to a new analysis by Avalere Health.

image of a piggy bank with dollar bills sticking out of it.

Image courtesy TaxCredits.net, Flickr Creative Commons

Those who may be missing out are people with incomes between 100 and 250 percent of the federal poverty level ($11,770 to $29,425). Under the health law, people at those income levels are eligible for cost-sharing reductions that can substantially reduce their out-of-pocket costs. But there’s a catch: The reductions are only available to people who buy a silver-level plan.

(Cost-sharing reductions are a different type of subsidy than the premium tax credits that are available to people with incomes up to 400 percent of the poverty level regardless of the type of plan they buy.)

In its analysis of exchange income data for those enrolled in the health insurance marketplaces in 2015, Avalere found that 8.1 million individuals with this coverage had income levels that should have qualified them for cost-sharing reductions. But only 5.9 million received the reductions, which are automatically applied if people enroll in silver-level plans.

Some of those who were eligible probably bought cheaper bronze-level plans, said Elizabeth Carpenter, a vice president at Avalere.

“Surveys show that people shop for plans based on premiums,” Carpenter said. “But if somebody forgoes cost-sharing reductions in order to pay a lower monthly premium and then has an unexpected accident or illness, their out-of-pocket exposure is likely to be higher.”

Silver plans pay 70 percent of medical costs, on average, while bronze plans pay 60 percent.

Consumers with a silver plan are thus responsible for paying 30 percent of their medical costs in deductibles and copayments or coinsurance, up to a maximum of $6,600 for an individual and $13,200 for a family in 2015. Cost-sharing reduction subsidies reduce those out-of-pocket costs.

People with incomes that are 150 percent of the federal poverty level or less are on the hook for no more than 6 percent of their costs (instead of 30 percent); those with incomes up to 200 percent of poverty pay no more than 13 percent; and those with incomes up to 250 percent pay 27 percent at most. Consumers who are eligible for cost-sharing reductions also have lower maximum out-of-pocket spending limits.

In 2015, a standard silver plan has a $2,556 average annual deductible for medical and drug costs for single coverage on the federal exchange, according to a Kaiser Family Foundation analysis. Cost-sharing reductions would cut the average deductible to $2,077 for someone whose income was between 200 and 250 percent of poverty, and to $737 for someone whose income was between 150 to 200 percent of poverty. Someone whose income was 150 percent of poverty or lower would have a deductible of just $229 for a silver plan.

Kaiser Health News (KHN) is a nonprofit national health policy news service.

To Survive, Rural Hospitals Join Forces


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By Michael Ollove

Stateline

Ask Sam Lindsey about the importance of Northern Cochise Community Hospital and he’ll give you a wry grin. You might as well be asking the 77-year-old city councilman to choose between playing pickup basketball – as he still does most Fridays – and being planted six feet under the Arizona dust.

Lindsey believes he’s above ground, and still playing point guard down at the Mormon church, because of Northern Cochise. Last Christmas, he suffered a severe stroke in his home. He survived, he said, because his wife, Zenita, got him to the hospital within minutes. If it hadn’t been there, she would have had to drive him 85 miles to Tucson Medical Center.

A hospital emergency department may be a good place for a heart attack patient, but advocates say it's the wrong setting for someone in psychiatric crisis.

Photo courtesy CRMF Crumlin, flickr creative commons

There are approximately 2,300 rural hospitals in the U.S., most of them concentrated in the Midwest and the South. For a variety of reasons, many of them are struggling to survive. In the last five years, Congress has sharply reduced spending on Medicare, the federal health insurance program for the elderly, and the patients at rural hospitals tend to be older than those at urban or suburban ones.

Rural hospitals in sparsely populated areas see fewer patients but still have to maintain emergency rooms and beds for acute care. They serve many people who are uninsured and can’t afford to pay for the services they receive.

Several months ago, Northern Cochise sought to strengthen its chances for survival by joining an alliance with Tucson Medical Center and three other rural hospitals in southwestern Arizona. Together, the Southern Arizona Hospital Alliance is negotiating better prices on supplies and services. And the Tucson hospital has promised to help its rural partners with medical training, information technology and doctor recruitment.

“We are committed to remaining autonomous for as long as we can,” said Jared Wilhelm, director of community relations at Northern Cochise. “We think this gives us the best leverage to do so.”

Northern Cochise and the other rural hospitals in the alliance, which is similar to ones in Kansas, Mississippi, Washington and Wisconsin, hope that by joining they will avoid the fate of 56 rural hospitals that have closed since 2010. Another 283 rural hospitals are in danger of closing, according to the National Rural Health Association.

Right now, some Arizonans in the region are learning what it’s like to lose a hospital. Cochise Regional Hospital, in Douglas, near the Mexican border, closed earlier this month, following Medicare’s decision to terminate payments because of repeated violations of federal health and safety rules. The hospital was part of a Chicago-based chain and its closing leaves Arizona residents in the far southeastern portion of the state up to 75 miles away from the closest hospital emergency room.

Sam Lindsey shudders to think what a long drive to Tucson would have meant for him last Christmas.

“If I’d have had to go 85 miles,” he said, “I don’t think I’d be here today.”

Multiple advantages

The alliance offers the rural members multiple advantages. One of the most important is in purchasing. Their combined size will enable them to get discounts that are beyond them now. For example, instead of being a lone, 49-bed hospital with limited bargaining leverage, alliance member Mount Graham Regional Medical Center, in Safford, is suddenly part of a purchasing entity with more than 700 beds.

“If I’m just Mount Graham and I’m going to buy one MRI every seven years, the sales people will say, ‘Oh, that’s very nice,’ ” said Keith Bryce, Mount Graham’s chief financial officer. “But as part of this alliance that they want to do regular business with, they are going to give us a much better price.”

Bryce said that he expects the added purchasing power alone will save Mount Graham “in the six figures” every year.

Similarly, the hospitals expect the combined size of the alliance to result in lower costs for employee benefits, workers’ compensation and medical malpractice insurance.

RURAL HOSPITAL STATSThe alliance also helps the rural hospitals recruit doctors and other medical providers, many of whom are reluctant to work, let alone live, in isolated areas. Rural hospitals rarely have the contacts and relationships that help urban hospitals find doctors.

“We’ve been trying to recruit another primary care doctor to this community for the last year with no success,” said Rich Polheber, CEO of Benson Hospital, another alliance member.

Tucson Medical Center has pledged to use its own recruiting muscle to help its rural partners find providers who are willing to live in rural areas, or at least regularly see patients there. As an incentive, Tucson will offer interested doctors help in managing the business aspects of their practices.

The rural alliance members also want Tucson’s help with medical training and IT. Some have dipped into telemedicine, which is particularly valuable for rural hospitals underserved by specialists, and are looking to expand those efforts.

Copper Queen Community Hospital, in Bisbee, the fourth rural member of the alliance and probably the rural hospital in the best financial shape, is the most advanced user of telemedicine. Its networks in cardiology, neurology, pulmonology and radiology can connect doctors and their patients to specialists at major institutions such as the Mayo Clinic and St. Luke’s Medical Center, in Phoenix.

The alliance also will make it easier for patients who have surgery in Tucson to be transferred back to their home hospitals for recovery and rehabilitation, saving them and their families from traveling long distances.

A defensive strategy 

Despite the numerous advantages for the rural partners, the idea for the alliance began with the Tucson hospital, which approached the others with the proposal last spring. At the outset, some of the rural hospitals were skeptical.

“At first, we were like, ‘OK, so why are they doing this? What’s in it for them? Do they want to absorb us?’” said Bryce, the Mount Graham CFO.

But after a series of meetings, the suspicions disappeared and the rural hospitals eagerly signed on.

The main entrance of Carolinas Healthcare System's Anson Hospital, which opened in TKTK. Photo credit: Taylor Sisk

The main entrance of Carolinas Healthcare System’s Anson hospital, which opened in teh summer of 2014. Photo credit: Taylor Sisk

The Tucson hospital was frank about its motivation: to remain independent in an industry moving toward consolidation. As a result of acquisitions in the last few years, it is the last locally owned, independent hospital in Tucson.

“All of a sudden, we were in a situation where [Tucson Medical Center] found itself isolated and facing its own competitive market pressures because the environment had so dramatically changed,” said Susan Willis, executive director of market development at the hospital and president of the new alliance.

Nearly a quarter of Tucson’s patients come from outside the city, many from the areas served by the rural hospitals in the new alliance. Cementing the relationship with those hospitals, Willis said, will help Tucson maintain a flow of patients who need medical services that are beyond the capabilities of the rural hospitals. The rural members have laboratories, diagnostic equipment and therapeutic services, but some have little or no surgical or obstetrical services. Not one is equipped to perform complicated surgeries.

“Certainly, you could describe it as a defensive strategy,” Willis said.

Decades of pressure

Many of the problems plaguing rural hospitals date to 1983, when Medicare began paying hospitals a set fee for medical services and procedures rather than reimbursing them for the actual costs of providing that care. From 1983 to 1998, 440 rural hospitals closed in the U.S., according to the National Rural Health Association. That prompted Medicare to begin reimbursing certain rural hospitals for their actual costs, which helped stabilize them.

But the recession hit rural hospitals especially hard, as did 2011 budget cuts that reduced Medicare payments by 2 percent. Because the rural population tends to be older, rural hospitals rely heavily on Medicare payments. The pressure increased in 2012, when the federal government reduced by 30 to 35 percent its reimbursements to hospitals for Medicare patients who don’t cover their share of the bill.

“That’s an example of how a little policy change that seems insignificant in Washington can have profound effects in the rural areas,” said Brock Slabach, NHRA’s senior vice president for member services.

Finally, more insurance plans are increasing co-payments and other out-of-pocket costs. Many of the patients at rural hospitals have low incomes. And when they can’t cover their costs, the hospitals have to pick up the tab.

“We don’t have cash reserves,” said Polheber, the Benson Hospital CEO. “We live on the edge, day to day, week to week. [The alliance] seemed like the best way to keep us going.”

Given the threats to the nation’s rural hospitals, many are eager to learn from any models that work, which is why the Arizona alliance has attracted notice.

Slabach, for one, calls it a promising model, although one that may not be replicable everywhere.

“You have to have willing partners willing to collaborate and provide assistance to each other,” he said. “You need partners that share a cultural fit with you.”

The rural members of the alliance are major employers in their communities and assets in attracting other employers and residents, including the snowbirds, who flock to the area every winter. But hospital leaders, workers and patients say saving lives is the main reason the hospitals must remain open.

“In medicine, distance lessens the chances of survival,” said Pam Noland, director of nursing at Northern Cochise. “Even if a patient has to be transferred to [Tucson Medical Center] or somewhere else, stabilizing them here is the difference between life and death.”

Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.

Bad Health Outcomes for Adults Who Don’t Get Help as Teens


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By Lisa Gillespie

Kaiser Health News

Young people with health problems left uncared for in adolescence face higher risks of leading unhealthy lives as adults, a new study finds.

A study of 14,800 people found that the odds of adverse adult health conditions were 13 to 52 percent higher among those who reported unmet health needs as adolescents than for those who did not have unmet needs as teens but who were otherwise comparable. The study was conducted first in 1994-95 when many subjects were in their mid-teens, and again in 2008 when many were in their late 20s.

Photo credit: Valentin Ottone, flickr creative commons

Photo credit: Valentin Ottone, flickr creative commons

An article about the study was published Monday in Pediatrics, the journal of the American Academy of Pediatrics.

This isn’t the first study to find a link between health services for adolescents and better adult health, but past research relied on country-level data from sources such as the World Bank. The latest study is the most extensive one using individual data, said lead researcher Dougal Hargreaves, a research fellow at Boston Children’s Hospital.

Teenagers with depression whose needs were unmet then were one and a half times more likely to have depressive symptoms in adulthood than counterparts who received help in adolescence. Similarly, poor general health, functional impairment, missed work or thoughts of suicide in a person’s early years – if not addressed – are a predictor for those issues in later life, researchers said.

The study compared people who had reported unmet health needs in adolescence with subjects with similar adolescent health issues, insurance coverage and socioeconomic backgrounds but no unmet health needs.

There could be two reasons for unresolved teenage problems that carry into adulthood, the study’s authors wrote. One explanation might be that health care not provided in adolescence exacerbates a condition in adulthood – although they said they did not study that specifically. Another possibility is teenagers who don’t take care of their health follow the same habit as adults, the authors speculated.

Adolescence is a time when people begin to form attitudes about health and seeking help when it’s needed that stick with them for life. “Adult behavior may be influenced by experiences in childhood as well as adolescence,” the Pediatrics article said.

Adolescent subjects in the study often didn’t perceive their health needs as important. That was the most common reason those needs were not met. Cost was the least common reason, the authors wrote. Other reasons cited were teens’ fear of negative consequences if they sought help and their lack of confidence that their privacy would be protected.

“Oftentimes, we’re worried about financial access problems. But for adolescents, often the access challenge isn’t related to the ability to pay, but the ability to understand the importance of treating problems now and to find a trusted provider who can offer care in a nonjudgmental way,” said Matthew Davis, a professor of pediatrics at the University of Michigan.

Scott Benson, a child psychiatrist for 35 years in Pensacola, Fla., said the study reported in Pediatrics affirmed the stigma he sees many teen patients come in with. Many have no idea they have depression and wonder why they are sad. While many teens had depression symptoms in the study, he said outcomes could have gotten worse because they were not addressed early.

Hargreaves’ takeaway was that teens need to use services more easily, and get around the stigma of getting help, especially for mental illness. They should be able to talk with health professionals about subjects awkward to them, he said.

This story originally appeared in Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Press Release: Amgen to Pay NC $2.1M for Improper Drug Marketing

Amgen to pay $71M Nationwide for Improper Drug Marketing, Attorney General Roy Cooper Says
NC to get $2.1 million for faulty promotion of Aranesp, Enbrel

NC Dept of Justice Press Release
Aug. 18, 2015

Raleigh: Drug manufacturer Amgen will pay North Carolina and 48 other states $71 million to resolve allegations that the company unlawfully promoted two medications, Attorney General Roy Cooper said Wednesday.

Statewide, the Medication Assistance Program gave uninsured North Carolinians access to about $100 million in free medications last year. Photo courtesy of AnoLobb, Flickr Creative Commons

Photo credit, anolobb, flickr creative commons

“Drug companies have a duty to put safety before profits, and that means marketing medicines for approved uses only,” Cooper said.

Cooper’s Consumer Protection Division filed a complaint and consent judgment in Wake County Superior Court against Amgen this morning. North Carolina will receive more than $2.1 million as its share of the judgment.

The settlement resolves allegations that Amgen illegally used a practice called off-label marketing to promote two biologic medications, Arenesp and Enbrel, for purposes that had not been approved by the Food and Drug Administration (FDA) or for which there was not competent and reliable scientific evidence. Once the FDA has approved a particular use of a drug as safe and effective, drug companies are prohibited from marketing it for any unapproved use.

Arenesp
The FDA has approved Arenesp to treat certain types of anemia by stimulating bone marrow to produce red blood cells. In the complaint and consent judgment filed today, North Carolina and the other states allege that Amgen illegally promoted Aranesp for dosing frequencies longer than the FDA approved label without competent and reliable scientific evidence to substantiate the extended dosing frequencies. The states also contend that Amgen unlawfully marketed Aranesp for anemia caused by cancer without credible scientific evidence or the required FDA approval.

Enbrel
Enbrel is approved by the FDA to treat a number of conditions, including certain types of arthritis and plaque psoriasis. The states allege that Amgen promoted Enbrel for mild plaque psoriasis even though Enbrel is only approved by the FDA to treat chronic moderate to severe plaque psoriasis.

Consent judgment requires reforms
In addition to paying $71 million, including $2,142,922.31 to North Carolina, Amgen is required to change its marketing practices to avoid false, misleading, or deceptive promotion of Enbrel or any medication in the same class as Aranesp.

The consent judgment bans Amgen marketing and sales professionals from preparing materials for or submitting supplementary information to drug reference books used by medical professionals. Amgen is also prohibited from misrepresenting the sponsorship, approval, characteristics, ingredients, uses, benefits or qualities of Enbrel or any medication in the same class as Aranesp.

“Patients and doctors deserve accurate information about medications based on sound science, and that’s what this agreement requires,” Cooper said.

Bill Would Require Health Assessments for All New N.C. Public School Kids


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The General Assembly has passed a bill requiring health assessments for all kids entering North Carolina public schools.

By Rachel Herzog

Parents sending their kids to North Carolina public schools for the first time this August will face slightly different health assessment and vaccine regulations.

Previously, North Carolina required health assessments for kids entering kindergarten, but those entering the public school system at any other grade were exempt.

The NC General Assembly passed new rules around immunizations and kids who start school in North Carolina. Photo shows a young boy getting a shot.

The N.C. General Assembly passed new rules around immunizations and kids who enter public schools. Photo courtesy Judy Schmidt, CDC

The North Carolina House and Senate hammered out their differences on House Bill 13, and sent it to Gov. Pat McCrory last week.

“If children do come into North Carolina’s system at a grade other than kindergarten [and] have a hearing impairment or eyesight impairment, maybe those can be treated early,” said primary sponsor Rep. John Torbett (R-Stanley).

Torbett said he wanted to push the measure to allow kids to reach their full potential.

‘We haven’t been doing that?’

Sen. Jeff Tarte (R-Cornelius) said he supported the bill and didn’t think there would be much opposition.

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“It is merely capturing some of the stuff that goes on in a doctor’s office that’s basically primary clinical input and making sure it gets into a school’s record appropriately,” Tarte said.

Torbett said a constituent back home brought the issue to his attention. Most people he talked to about the bill didn’t realize that kids entering at grade levels above kindergarten weren’t assessed.

“It’s kind of funny,” he said. “They’ve got this look on their face, ‘We haven’t been doing that?’”

The bill would not require kids entering private or religious charter schools to undergo assessments.

New vaccines

Lisa Cassidy-Vu, assistant professor of family and community medicine at Wake Forest Baptist Medical Center, said the new requirements match the recommendations from the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention.

She said she hopes the bill will improve the administration of the meningococcal vaccine, which prevents meningitis, in particular for teens and young adults who are heading off to college. The vaccine is now required along with the already-mandatory combined tetanus, diphtheria and pertussis, or Tdap, vaccines.

Two varicella, or chickenpox, vaccines are now required for kindergarteners, as is the last dose of the polio vaccine, before entering school for the first time.

“I haven’t had any pushback from these vaccines,” Cassidy-Vu said. “I think they are less controversial than some others, such as those for HPV prevention, and so they are readily accepted.”

Creating access

Tarte said the bill would help make sure schools and providers have access to updated and accurate information on each child’s health status.

“If a kid has a health issue, it’s good to know about it up front,” he said. “If something develops or turns into an acute situation, the school’s prepared to deal with that kid.”

Torbett said that during committee hearings, legislators expressed concerns about kids not having access to health care to receive these assessments, but he said access is a bigger issue that will exist whether or not the bill is passed.

“If you have that concern, that concern’s already existed,” he said.

Cassidy-Vu said the new regulations could actually make it easier for kids to get access to health care.

“The great thing is that anyone without a primary care physician or with financial strain can be seen at their local health department and receive the necessary immunizations free of charge,” she said.

Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds


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By Lisa Gillespie

Kaiser Health News

Therapy provided over the phone lowered symptoms of anxiety and depression among older adults in rural areas with a lack of mental health services, a new study shows.

The option is important, one expert said, because seniors often have increased need for treatment as they cope with the effects of disease and the emotional tolls of aging and loss.

“Almost all older adults have one chronic medical condition, and most of these have been found to be significantly associated with anxiety disorder,” Eric Lenze, a psychiatrist and professor at the Washington University School of Medicine in St. Louis, said in an interview.

The study, by researchers at Wake Forest University and published Wednesday in JAMA Psychiatry, examined 141 people over the age of 60 living in rural counties in North Carolina who were experiencing excessive and uncontrollable worry that is brought on by a condition called generalized anxiety disorder.

The participants had up to 11 phone sessions between January 2011 and October 2013. Half of them received cognitive behavioral therapy, which focused on the recognition of anxiety symptoms, relaxation techniques, problem solving and other coping techniques. The other study participants got a less intensive phone therapy in which mental health professionals provided support for participants to discuss their feelings but offered no suggestions for coping.

The researchers found that severity of the patients’ worries declined in both groups, but the patients getting cognitive therapy had a significantly higher reduction of symptoms from generalized anxiety disorder and depressive symptoms.

Yet many seniors could face barriers getting that therapy because Medicare has stringent requirements for eligibility for these kinds of phone therapies, according to Lenze, who wrote an editorial accompanying the study. Lenze argued that phone therapy is a good alternative to drugs that are often prescribed for anxiety and depression but can make seniors sleepy and disoriented and lead to injuries.

“This demonstrates that [therapy] is just as effective as in-person psychotherapy and reimbursing for it would be a way to increase the reach of mental health care that in a concrete way would allow someone to get treatment for actual problems, not just medicating and ending up in the emergency room with a hip fracture,” Lenze said.

He said he treats some geriatric patients who drive from 100 miles away and doesn’t offer phone sessions because of the payment issue.

Medicare only pays for telehealth services done in rural areas with provider shortages; patients cannot do a phone call in their home, but must drive to a physician’s office or hospital to connect with the mental health professional at another site, he said.

“The reason it isn’t evolving is because it’s trapped in the law that isn’t evolving with modern medicine,” said Joel White, executive director of the Health IT Now Coalition, which is urging Medicare to loosen its strict limits on telemedicine.

Many states have also implemented some roadblocks for telephone therapy with laws requiring that anyone giving medical care must be licensed in the state where the patient resides. Reps. Frank Pallone (D-N.J.) and Devin Nunes (R-Calif.) offered a bill in July that would allow providers licensed in one state to provide care in another state electronically.

The Association of State and Provincial Psychology Boards is working on model legislation to recommend to states next year that would allow psychologists to practice by phone across state lines without having to pay a hefty licensing fee.

Kaiser Health News (KHN) is a nonprofit national health policy news service.

Study: Rural Black Women Suffer Less Depression


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Southern African-American women who live in rural areas are far less likely to suffer from depression than those living in urban or suburban areas, a new study finds. For white women, geography appears to play less of a role.

By Emily Goldstein

Daily Yonder

Rural African-American women who live in the South are less likely to suffer from major depression than their urban counterparts, a research report published in JAMA Psychiatry says.

This is true even though black rural women are more likely to live in poverty and have lower rates of education – factors that are associated with the incidence of major depression.

Image courtesy Blue Skyz Studios, flickr creative commons

Image courtesy Blue Skyz Studios, flickr creative commons

While rural black women fared better with depression, rural white women, on the other hand, fared slightly worse, the study found.

The researchers speculate that the lower rate of depression among rural black women may be because these women have better systems of social support than the other groups considered in the study.

Researchers at the University of Michigan sought to understand how factors such as poverty and low rates of education affect mental illness among rural women. Overall, women are 1.5 to 3 times more likely to report being depressed than men.

The study used data gathered from the National Survey of American Life, a large, long-term study designed to explore racial and ethnic differences in mental health disorders.

Respondents were categorized by where they live, their race and whether they suffered from depression. The full sample used in the paper included 3,570 black women and 891 white women.

About 4 percent of rural African-American women in the South experienced depression at some point in their lives, versus about 10 percent for urban black women. (The data has been adjusted so it more accurately reflects the population the researchers sought to study.)

Suburban African-American women in the South had the highest rate of depression for blacks, at about 13 percent, though the margin of error in sampling could account for that difference. (The study had a standard error of 1.0 and 0.9 percent for rural and urban black women and 5.9 percent for suburban black women.)

Among white women in the South, geography appeared to play a less important role in predicting whether a woman had suffered depression at some point in her life. Depression was more prevalent overall among white women (ranging from 21 percent for rural white women to about 19 percent for suburban white women). But there was far less difference in rates of depression among rural, suburban and urban white women.

Overall, white women in the study were twice as likely as African-American women to have suffered from depression.

Although the relationship between depression and race is complex and multifaceted, the authors theorized that varying levels of social support networks between black and white women contributed to the findings.

Factors such as strong familial support and social ties, high levels of spirituality and a sense of solidarity with other rural women of color could contribute to the lower rates of depression, the study said.

The authors noted more research would be needed to better understand the needs of rural communities and to formulate successful intervention strategies.

This story originally appeared here and is shared by NC Health News through a content-sharing agreement with The Daily Yonder, an online publication dedicated to all things rural in the U.S.

Legislators and Lobbyists Donate Samples for Bone Marrow Registry


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By Rose Hoban

State employees rallied to support one of their own on Wednesday at the legislative building in an effort to save the life of a lobbyist who represents the State Employees Association of North Carolina.

Jim Blaine, Senate leader Phil Berger's Chief of Staff, swabs inside his cheek to collect a DNA sample for the bone marrow registry. Blaine helped to organize Wednesday's registry event.

Jim Blaine, Senate leader Phil Berger’s chief of staff, and Susan Vick, a lobbyist for Duke Energy, swab the insides of their cheeks to collect DNA sample for the bone marrow registry. Blaine helped organize Wednesday’s registry event. Photo credit: Rose Hoban

In June, Kevin LeConte was feeling run down and had a cut that wouldn’t heal. So he went to the doctor.

“We were down here lobbying, and he called and said, ‘I need to go to the hospital,’” recalled Ardis Watkins, a fellow SEANC lobbyist. “He had been in just two days before and his counts at that point were critical.”

“When he asked the oncologist if he could have a day or two before he went to UNC,” Watkins said, “the answer was absolutely not, the ambulance was coming.”

That’s why Watkins organized a bone marrow transplant registry day at the General Assembly building Wednesday, where more than 200 people submitted swabs to be part of a nationwide database of people willing to donate bone marrow or stem cells.

Too few

LeConte is the second high-profile figure in the Triangle who is now looking for a bone marrow transplant to treat his leukemia. Orange and Chatham county Superior Court Judge Carl Fox is also looking for bone marrow after being diagnosed with another form of blood cell cancer in April.

And it only takes a swab in the mouth to become part of the registry, said Crystal Navarro, a donor organizer from Delete Blood Cancer.

“The swab goes onto a registry, and the person’s information will sit on the registry,” Navarro explained. “If they are found as a match for someone, then what will happen is we’ll contact them and they may be asked to donate either stem cells or bone marrow if there’s a match.”

Bone marrow is used to treat blood cancers such as lymphoma, leukemia and myeloma, along with other blood disorders such as aplastic anemia and sickle cell anemia. The blood-forming cells in bone marrow replace a patient’s unhealthy marrow cells with healthy ones.

Crystal Navarro pulls out a sample collection kit from her "swab bag" at Wednesday's bone marrow registry event at the legislative building in Raleigh.

Crystal Navarro pulls out a sample collection kit from her “swab bag” at Wednesday’s bone marrow registry event at the legislative building in Raleigh. Photo credit: Rose Hoban

A complication for Fox, who is black, is that there are currently too few blacks on the registry. So a number of black lawmakers were rubbing the inside of their cheeks with swabs to give a sample.

“We continually strive to increase the size and diversity of the Be The Match Registry to improve all patients’ chance for a cure,” Alyse Brunella, a press representative for the national registry, wrote in an email.

According to Delete Blood Cancer, about 14,000 people need the donations annually, but only about half can get one, in part because the matching criteria are stringent and there’s often not a match to be found.

Delete Blood Cancer and other organizations recruit and collect donations to be included in the Be The Match Registry.

Came together quickly

Watkins said the event came together quickly once she and her colleagues learned of LeConte’s need for bone marrow. Legislative leaders loaned their support to the effort.

She said House Speaker Tim Moore (R-Kings Mountain) and Senate President Pro Tempore Phil Berger (R-Eden) were at the 9 a.m. kickoff inside the legislative building on East Jones Street.

“That was one of the most inspiring sights I’ve seen around here; everybody was just so invested in it,” Watkins said.

Easy process

Donors must be between the ages of 18 and 55 and in generally good health. Cancer survivors and people with chronic diseases such as diabetes or chronic infections such as HIV or hepatitis are not allowed to donate.

When a person signs up, DNA from cells taken during a cheek swab are analyzed for HLA antigens on the cell, markers known as a person’s “genetic identity.” Eight different markers on the cell are recorded.

Sen. Joel Ford fills out the paperwork for his donor swab. Organizers said African Americans and other minority donors are desperately needed for the national registry. Photo shows an African American man filling out paperwork on a table.

Sen. Joel Ford (R-Charlotte) fills out the paperwork for his donor swab. Organizers said blacks and other minority donors are desperately needed for the national registry. Photo credit: Rose Hoban

Then if a patient needs donor marrow, the registry aims to match at least seven of the eight markers.

“A sibling who is an eligible donor and a full HLA match is the preferred option in most cases,” Brunella wrote. “However, 70 percent of patients will not have a family donor match and can turn to the Be The Match Registry to search for an unrelated donor or cord blood unit.”

If a donor is matched, the procedure for taking the bone marrow is a simple outpatient procedure, Navarro said.

“If you put your hand on your hip, where your thumb rests [is] where we’ll extract it from your hip with a syringe,” she said.

Most people end up with a sore hip for a few weeks.

“It varies per person, but you do recover, and you’ve saved someone’s life,” Navarro said.

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