Experts

What You Should Know About the Flu — A Chat with the CDC’s Angela Campbell, MD

Flu season is here. And to help us prepare for what the season may bring, we were lucky enough to get a few minutes with Dr. Angela Campbell, a medical officer in the Center for Disease Control and Prevention’s Influenza Division.

To welcome Dr. Campbell to the blog, we started out with one of our favorite questions.

Angela Campbell, MD

Angela Campbell, MD

Q: In a few words, what does Total Health mean to you?

A: Total health means caring for myself physically, intellectually, and spiritually, and working to sustain and improve the health of others.

Q: How does influenza vaccination factor into that view?

A: To me, influenza vaccination is an important component of caring for my own physical health – it is something I choose for myself every year. I am also passionate about encouraging flu vaccination for those whom I love, for my patients, and for the U.S. public at large. Flu is a serious disease that can lead to hospitalization and sometimes death. Even healthy people can get very sick from the flu. Because every flu season is different, it’s important to do what you can every year to protect yourself and those around you – and the first and most important line of defense against the flu is getting a yearly flu vaccination. Flu vaccination can keep you from getting sick from flu and, by protecting yourself from flu by getting vaccinated; you’re also protecting the people around you who may be more vulnerable to complications from flu illness.

Q: What is NIVW?

A: NIVW stands for National Influenza Vaccination Week, which was December 7-13 this year. CDC established NIVW in 2005 to highlight the importance of continuing flu vaccination throughout the holiday season and beyond. Flu vaccination coverage estimates from past seasons have shown that flu vaccination typically drops near the end of November, so this is a time to stress the important reminder that as long as flu viruses are circulating, it’s not too late to get your flu vaccine.

Q: Really? Is it worth getting your flu vaccine in December or even after the New Year?

A: Yes! Flu activity most commonly peaks between December and February, but can continue as late as May, so it’s not too late to protect yourself as long as flu activity is ongoing. In fact, even unvaccinated people who have already gotten sick with flu this season can still benefit from getting vaccinated since the flu vaccine protects against three or four different flu viruses (depending on which flu vaccine you receive) that are expected to circulate each season.

 Q: Can flu be more serious for some people than others?

A: Yes. CDC recommends a yearly flu vaccine for everyone 6 months and older; however, vaccination is especially important for protecting those at high risk for serious flu complications, including young children, pregnant women, people with certain chronic health conditions like asthma, diabetes, or heart and lung disease, and people age 65 years and older. Pneumonia and bronchitis are examples of flu-related complications that can result in a hospital stay or sometimes even death. The flu can also make chronic health problems worse for those who have them. And since babies younger than 6 months are too young to get their own flu vaccine, parents, caregivers and others in the household should be vaccinated to help protect them. By getting vaccinated, you will be less likely to get the flu and, therefore, less likely to spread the flu to others in these vulnerable groups.

Q: Should children receive one or two doses of the flu vaccine? We’ve heard different things.

A: Children 6 months through 8 years of age who are getting vaccinated for the first time, as well as some who have been vaccinated previously, will need two doses. Your child’s doctor, nurse, or other health care professional can tell you if two doses are recommended for your child. If your child has not already received their first dose of vaccine, get your child vaccinated now. Children who only get one dose but need two doses can have reduced or no protection from a single dose of flu vaccine. If two doses are needed, begin the process as early as possible. The doses should be given at least 28 days apart and it usually takes about 2 weeks after the second dose is given for protection to begin.

Q: If you don’t have time to get to the doctor, will insurance work at other vaccination locations?

A: Since September 2010, new health insurance plans are required to cover recommended vaccines without co-pays or deductibles when provided by an in-network health care provider. For more information on the Health Insurance Marketplace, visit https://www.healthcare.gov/. Many private health insurance plans also cover the cost of vaccines, but you should check with your insurance provider before going to the doctor. Flu vaccines are offered in many locations, including doctor’s offices, clinics, health departments, pharmacies and college health centers. They also are offered by many employers, and are even available in some schools. Another useful tool is the HealthMap Vaccine Finder to find the nearest location where you can get vaccinated.

Leadership Perspective: Prediabetes Tsunami — We Can’t Just Wait For It to Hit

Editor’s Note: This post is part of the “Leadership Perspectives” series on the Center for Total Health blog —  a collection of guest blog posts from Kaiser Permanente leaders all about why we need to take a Total Health approach.

Today’s guest author is Trina Histon, PhD, senior principal consultant with the Kaiser Permanente Care Management Institute, who shares her thoughts on prediabetes.


 

Few would deny the burden diabetes places on those who suffer from it and their loved ones who support them as they manage this disease. Estimates suggest that Americans with diabetes spend about $6,000 out of pocket per year managing their disease, monies that could be put to other use if we had more comprehensive ways implemented nationwide to prevent diabetes.

Trina Histon, PhD

Trina Histon, PhD

Many liken the next wave of diabetes as a tsunami that will hit the United States and its citizens, so let’s play that analogy through. Recent weather patterns have shown how devastating tsunamis are in the world, so much so, that efforts have been put in place to create sophisticated warning systems. So should another tsunami strike, countries will have advance warning so they are able to evacuate low-lying coastal areas and get people to safety.

In the U.S., the screening equivalent of that warning system for diabetes is an a1C test and the ADA has established a range of 5.7-6.4 as placing the individual in the “prediabetes” range. There are other tests, such as fasting blood sugar, but more and more health care is moving away from fasting blood work as it’s hard for people to fast for long periods of time. So this a1C range is our early warning system, and like most systems, it’s not perfect. In the literature this year, a few articles that discuss diabetes care and BMI have called into question the value of addressing prediabetes. These critiques are valid and perform an important function in both advancing the science and dialogue of where we want to spend our precious health care dollars.

Preparing for a Disaster We Know is on the Horizon

Kaiser Permanente today has 600,000 members with diabetes. We have also developed a cohort of just under one million members with lab values in the prediabetes range. Rather than wait for perfect science on exactly who needs an intervention, we feel ethically that if someone has a risk we should inform them and partner with them to address that risk, should they choose. One of the complexities of determining prediabetes risk is the prediabetes range has varying origins. For example, an a1C of 5.8 does not necessarily mean you will convert to diabetes, but you are at higher risk, and clearly are showing early signs of beta cell damage. What we do see is those with an a1C of 6.0 and higher and with BMIs in the obese range are most likely to convert. We are looking at our own data to see how we can further subtype the prediabetes risk spectrum and then subtype the interventions.

The Powerful Effect of Lifestyle Changes

The good news is lifestyle is the first line of treatment. The original diabetes prevention program (DPP) and subsequent translation trials show that those who lost 5 to 7 percent of their weight and increased their activity to 150 minutes/week prevented or delayed diabetes in 58 percent of participants over a three-year period – and 52 percent over 10 years. For most people, that translates to a 12- to 15-pound reduction, more attainable than the 30-40 percent of weight people might like to lose as reported on consumer surveys.
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When it Comes to Health Care, What Matters Most to Consumers?

Introduction from Bernadette Loftus, MD

Introduction from Bernadette Loftus, MD

Anyone who has had to choose a health insurance plan knows how confusing the process can be, even with the help of a friendly human resources professional. For the millions of Americans purchasing their coverage through exchanges, the process can be even more daunting.

Many consumers struggle to determine which plan is going to provide the best value – the coverage they need at a price they can afford. Dozens of organizations and publications – from the National Committee for Quality Assurance (NCQA) to Consumer Reports – rate health care plans each year. Some of these rankings are meant for the average consumer, but many are for industry insiders – laden with clinical terminology and detailed beyond what most people want to know.

On October 28, the Mid-Atlantic Permanente Medical Group and the Center for Total Health hosted what we hope to be the first in a series of events examining how we can translate these often technical ratings into something more consumer-friendly and how best we can get those ratings into the hands of the consumers.

Helen Burstin, MD, MPH, FACP, from The National Quality Forum, and Margaret O’Kane, from NCQA, set the tone for the day, reminding us that the patient must be at the center of all the industry does – not just care delivery. We must seek to provide our patients with the information they want in a way that is meaningful and accessible for them, while remembering that health care is a personal experience and much of what matters most cannot be measured. Dr. Burstin reminded us: Not everything that counts can be counted; not everything that can be counted counts.

Consumer Voices Panel

Consumer Voices Panel

Kaiser Permanente’s own Bernadette Loftus moderated a panel to understand what counts for consumers. Doris Peter, PhD, of Consumer Reports, emphasized that people can handle data.

“Just look at ESPN,” she reminded the audience, daring them to find a website with more data collected.

Dr. Peter and her co-panelists, Tina Reed of the Washington Business Journal, and consumer Iris Molotsky, agreed that uniform, consumer friendly terminology is a key step to making quality ratings more accessible for consumers. Ms. Molotsky, the president of Dupont Circle Village, a neighborhood association in Washington, DC, emphasized that “even well-educated, well-read, well-traveled” members of her community are confused by the complexities of standard health care language.

This sentiment was echoed by the last panel of the day, featuring the chief health officers of the District of Columbia, Maryland, and Virginia, as they lead their populations and health departments in the second open enrollment on the exchanges.

Great connections were made during the Mad Tea Party

Great connections were made during the Mad Tea Party

Leadership Perspectives: Good Health Starts Where You Are

Editor’s Note: Today, we launch a recurring feature on the Center for Total Health Blog. “Leadership Perspectives” is a collection of guest blog posts from Kaiser Permanente leaders all about why we need to take a Total Health approach.

Today’s guest author is Elisa Mendel, national vice president of HealthWorks & Product Innovation for Kaiser Permanente, who shares her thoughts on place-based health.


 

How much time would you guess you spend at work each year? Would you be surprised if I said it’s something like 2,000 hours?

Elisa Mendel, VP of HealthWorks & Product Innovation for Kaiser Permanente

Elisa Mendel, VP of HealthWorks & Product Innovation for Kaiser Permanente

Compare that to the time we spend with our doctor — maybe 15 minutes once or twice a year? That’s why place-based health is so important. At its core, good health starts with us — where we live, work, learn, and play.

That’s one of the reasons Kaiser Permanente partnered with leading national organizations to launch Thriving Schools. The idea is that schools are the hub of every community. Our work in schools focuses on four key areas: healthy eating, active living, school employee wellness, and a positive school environment. One of the active living programs is called Fire Up Your Feet. Fire Up Your Feet’s fall campaign launches October 1, and it encourages kids to walk to school with their parents, giving them much-needed exercise and some quality time together.

Another initiative I really love combines the childhood enthusiasm for play with the workplace. It’s called “Instant Recess.” A manager or wellness champion schedules time with their team —usually about 10 minutes. Everyone stops what they’re doing, and one of the team members leads the group in dancing and exercise. People are moving, getting their blood pumping, and laughing together. It’s had amazing results, because when you’re doing the chicken dance with your supervisor, suddenly things feel a little less stressful.

Kaiser Permanente piloted this in various work settings — call centers, IT, and even the ICU. One of the ICU patients heard the staff doing this Instant Recess every day on the floor and she was determined to get out of bed so she could be wheeled out to participate in the fun.

There’s no limit to the benefits of healthy living. It can lift spirits and deliver real business results. One study in the Journal of Occupational and Environmental Medicine showed that employees who ate healthy and exercised regularly were up to 27 percent less likely to be absent from work for health reasons.

Good health is becoming a national movement. Find your “healthy,” and start to share good health close to your home.

Domestic Violence: It’s a Health Issue

October is Domestic Violence Awareness Month — a good time to pause and consider just how many people are affected by domestic violence and sexual assault. The numbers are astounding. According to the National Coalition Against Domestic Violence, an estimated 1.3 million women are victims of physical assault by a domestic partner each year. And one in every four women will experience domestic violence in her lifetime.

Adults aren’t the only ones affected. Every year, nearly 1.5 million high school students experience physical abuse from a dating partner. One in three adolescents is a victim of physical, sexual or emotional abuse.

This episode of Total Health Radio talks about what teen dating violence looks like and some of the warning signs parents and friends should be watchful for. Guest Nancy Schwartzman, the inventor of the Circle of 6 mobile app, shares ways that young women can both prevent and cope with sexual assault.

How are your kids handling the stress of heading back to school?

Understanding our kids’ physical health is one thing. Tuning in to their emotions can be quite another.

According to the National Institute of Mental Health, the number of children with a diagnosable anxiety disorder is now up to a staggering 25 percent. As we’re now a few weeks into a brand new school year, this might be a good time to pause and check in on the anxiety levels of the kids in our lives.

In this episode of Total Health Radio, we explore key questions around anxiety in children. In what way do symptoms of anxiety look different in a child than in an adult? How do we differentiate between a high level of stress and something more serious? How do we help our kids identify triggers? And importantly, we look at how we can best help our kids by becoming aware of – and getting a handle on – our own anxieties.

What Does Environmentally Sustainable Health Care Look Like?

It’s all you’ve ever wanted to know about the greening of health care!  In our earlier post, we told you about the recent publication of the book, Greening Health Care, by Kaiser Permanente’s Kathy Gerwig.  Today, we begin a series of excerpts from the book — and we start with an introduction and overview from the preface.

The very nature of health care is changing. Health care reform, clinical innovations, electronic medical records, social connectivity, technological advances, baby boomers’ expectations about quality of life, demands for price to align with value, and ways the environment contributes to disease are some of the factors behind the changes. These changes offer profound, new opportunities to address environmental issues across the health care sector and beyond.image

In this changing landscape, what does environmentally sustainable health care look like? Let’s take an imaginary visit to a hospital for a routine doctor visit. Approaching the medical facility, the first thing we notice is that the building is smaller than we expected. There is a convenient transit stop at the front entrance. And the parking lot pavement allows rainwater to filter through to be cleaned and returned to the aquifer. We notice that instead of lawns there are native plantings that minimize water and pesticide use.

There is a garden path that takes us by a stream that was brought back to life from where it was hidden in a concrete culvert decades ago. We enjoy the birds that have rediscovered this tranquil place. You notice a labyrinth and take a meditative respite.

Once inside, we’re walking on nonvinyl, nonpolluting material on the carpets and floors, and we notice how much natural light floods into the lobby and hallways from specially designed window glass, shades, and blinds that allow sunlight in while minimizing afternoon heat. The walls are painted in soothing colors and patterns that mimic the adjoining landscape. The energy efficient lighting fixtures glow with a pleasing hue. You see a plaque on the wall indicating that the building is carbon-neutral.

In the bathroom, the toilets and sinks are water-conserving, and the soap does not contain harmful anti-bacterial agents. The paper towels are made from 100 percent recycled, post- consumer waste, and the used towels go into a compost container. In the waiting room, the fabric on the chairs was selected to avoid harmful chemicals that can cause adverse health effects.

In the exam room, your temperature and blood pressure are taken with mercury-free devices. You notice the purple exam gloves used by the clinical staff. These are latex-safe for worker and patient safety, and they are environmentally preferable.

If you are here for a biopsy, your doctor will use a rigid endoscope (for minimally invasive surgery) which is steam sterilized to avoid the use of chemicals that are hazardous to the environment and to staff. Read More

Caffeine and Kids: What’s the Buzz?

As your kids head back to school, you may notice that they — and many of their friends — seem to be weighed down with nearly as many commitments as adults. How they manage that level of responsibility is worth considering. With the rise of coffee house culture, the popularity of soda, and the explosion of energy drinks on the market, the amount of caffeine consumed by teens and even younger children is on the rise.

If you are concerned about the caffeine habits of a child in your life, this episode of Total Health Radio can help. In it, Kaiser Permanente’s Michael Nelson, MD, shares the symptoms that signal your child might have a problem, as well as how to broach the topic — and what you can do to protect your child’s health.

Six Burning Questions Health Care Leaders Have about ACOs

ACO imageIf you ask health care leaders what they think about Accountable Care Organizations (ACOs), you won’t be short on answers, writes Samantha DuPont of the Kaiser Permanente Institute for Health Policy, in a recent article and video on the Institute website.

According to the Centers for Medicare and Medicaid Services, ACOs are formed by groups of doctors, hospitals, and other health care providers, coming together to provide coordinated high quality care to their patients.

Early ACOs have had mixed success, and in light of emerging research questions remain as to whether or not they will result in comprehensive delivery system and payment reform that is sustainable.

DuPont chronicles the six themes that emerged from the Institute’s work in asking leaders from across the nation their burning questions about ACOs:

1. What do ACOs look like today?

2. What factors will lead to ACO success?

2. Are current financial incentives strong enough to change provider behavior?

4. Will ACOs integrate with other types of caregivers?

5. Will ACOs successfully engage their patients?

6. What metrics will effectively measure quality?

Informing the Next Generation of Accountable Care Organizations

Some of the biggest buzz in health reform lies in the potential that Accountable Care Organizations (ACOs) have to help to reduce costs, improve care, and move away from fee-for-service to population-based payment.   But questions remain as to whether or not they will result in comprehensive delivery system and payment reform that is sustainable.

Joy Lewis, MSW, MPH, of the Kaiser Permanente Institute for Health Policy, attended a July 13th convening in Washington D.C., hosted by the National Health Policy Forum, that highlighted some of the successes and challenges of early ACOs.

Kaiser Permanente has been supportive of this movement since the concept was first introduced in 2009.  While not technically an ACO, many elements of our care system – such as use of electronic health records, team-based care, and population management tools – ideally will be a part of ACOs.

Read the Kaiser Permanente Institute for Health Policy Observation describing Lewis’ highlights of the meeting, which include tactics for improving quality, increasing savings and overcoming the fee-for-service chassis.

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