Temple: Prepare now for the flu season, doctors say

It may be too early to predict what the flu season holds, but doctors say there are ways to prevent the sniffles from taking over.

Baylor Scott & White officials say emergency room doctors are already seeing people come in with flu-like symptoms.

In addition to washing your hands, they recommend the annual flu shot or nasal mists to prevent the flu.

This season they have treated two types of flu strains that seem very similar.

“A tends to have more upper respiratory infections, Flu B can have more GI symptoms. But they are very similar it’s really hard to differentiate just by looking at a patient and saying they have Flu A or Flu B” Baylor Scott & White, Dr. Matthew Meece said.

Flu B symptoms include nausea, vomiting and diarrhea.

Source: Temple: Prepare now for the flu season, doctors say

Most Hospital ERs Won’t Treat Your Addiction. These Will. 

BALTIMORE — For Dr. Zachary Dezman, an emergency physician in this heroin-plagued city, there’s no question that offering addiction medicine to emergency room patients is the right thing to do.

People with a drug addiction are generally in poorer health than the rest of the population, he explained. “These patients are marginalized from the health care system. We see people every day who have nowhere else to go.

“If they need addiction medicine — and many do — why wouldn’t we give it to them in the ER? We give them medicine for every other life-threatening disease.”

But elsewhere in the country, all but a few emergency doctors and hospital administrators see things differently. They worry that offering addiction services could attract even more drug-seeking patients than they already see, taking up valuable staff time and beds, said Dr. Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University.

STATELINE STORY 

In Drug Epidemic, Resistance to Medication Costs Lives

Instead of providing anti-addiction medication, most hospitals typically give ER patients with drug-related conditions the telephone numbers of local treatment clinics, he said.

Despite a raging drug overdose epidemic that is killing nearly 200 Americans every day and sending thousands more to emergency rooms, the vast majority of the nation’s more than 5,500 hospitals have so far avoided offering any form of addiction medicine to emergency patients.

That’s starting to change.

In Dezman’s ER at the University of Maryland Medical Center Midtown Campus in West Baltimore — and in 10 other Maryland hospitals — addiction services, including starting patients on the highly effective anti-addiction medication buprenorphine, is a new and growing emergency service.

Similar services are planned for emergency departments in 18 more Maryland hospitals, according to Marla Oros, president of Mosaic Group, a management consulting firm that is providing technical assistance to the state’s hospitals.

Approved by the FDA in 2002 for the treatment of opioid addiction, buprenorphine has been shown to be more than twice as effective as non-medication therapies at helping opioid users quit. Taken daily by mouth, the narcotic medication eliminates withdrawal symptoms and drug cravings, allowing users to feel normal without producing a high.

“We’ve learned that certain places are conducive to engaging patients in treatment. One of them is the ER. The other is the criminal justice system. We need to grab those opportunities and offer patients effective treatment when they’re ready.”

Dr. Eric Weintraubprofessor of psychiatryUNIVERSITY OF MARYLAND SCHOOL OF MEDICINE

A 2017 study by researchers at Yale School of Medicine found that opioid-addicted patients who were given an initial dose of buprenorphine in an emergency room were twice as likely to be engaged in treatment a month later compared with those who were given only referrals to addiction treatment specialists. Lead author Gail D’Onofrio wrote in an email to Stateline that the practice is spreading.

Still, a 2017 survey by the American College of Emergency Physicians showed that only 5 percent of emergency doctors work in hospitals offering the anti-addiction medicationsbuprenorphine or methadone, and 57 percent said that detox and addiction treatment facilities outside of the hospital were “rare or never accessible.”

Dr. Eric Weintraub, an associate professor of psychiatry at the University of Maryland School of Medicine, was an early adopter of buprenorphine in the ER and is now helping spread the concept to other hospitals.

Starting in 2003, he initiated patients on buprenorphine in the psychiatric ER at the University of Maryland Medical Center in downtown Baltimore, and said he found it very effective at allowing patients to feel normal again and start thinking about treatment.

In general, Weintraub said in an interview, “We’ve learned that certain places are conducive to engaging patients in treatment. One of them is the ER. The other is the criminal justice system. We need to grab those opportunities and offer patients effective treatment when they’re ready.”

Waiting for Patients

On a stormy Monday morning in September, the emergency room at Midtown Campus is quiet. Curtained-off patient rooms sit mostly empty and a police officer leans on a counter at the nurses’ station chatting with a doctor.

Standing nearby, Dezman glances at the automatic glass doors at the entrance and says a wave of overdose victims could start rolling in at any time.

“That’s the way it typically happens,” he said. “We’ll hear from EMS that four people were found within a two-block radius and two more were found dead nearby. It’s almost always because of a bad batch of fentanyl.

“If someone were to come in right now or at any time before 4 p.m. and need treatment, ER personnel would screen them and probably send them across the street to the hospital’s Center for Addiction Medicine.”

Recovery coach Dwayne Dean, left, and Dr. Zachary Dezman confer about a patient at the University of Maryland Medical Center Midtown Campus in West Baltimore.
The Pew Charitable Trusts

But outside of regular business hours when treatment facilities are typically closed, the ER staff would give willing patients their first oral dose of buprenorphine here, hold them an hour or two for observation, and make an appointment for them with a treatment center for the next morning, he explained.

Once patients take buprenorphine their mood changes almost immediately, Dezman said, and they typically are much more open to talking with a coach about follow-up treatment.

On average, about 70 people come to Midtown Campus’ ER every day, and two or more of them are here because of an overdose.

But in West Baltimore, drug use is so prevalent that the emergency department’s standard protocol is to screen everyone for drug and alcohol abuse, whether they come in for a persistent cough, a broken limb or abdominal pain.

First, a triage nurse asks questions about substances patients are using. When patients are suspected of having an addiction, caregivers take urine toxicology screens and a peer recovery coach on staff in the ER talks to patients to see if they are ready to accept treatment.

STATELINE STORY 

Nurses Step In to Boost Treatment for Opioid Addiction

In the meantime, attending physicians and nurses take care of patients’ urgent medical needs.

Dezman has a special Drug Enforcement Administration license that allows him to prescribe buprenorphine, which is a narcotic.

Most emergency physicians don’t have a buprenorphine prescribing license, and Oros said they aren’t willing to complete the eight hours of clinical training required to get it. But under what is known as the three-day rule, doctors without a DEA license can administer a single dose of the medication to a patient within a 72-hour period.

As a result, any of the doctors on duty in the ER at Midtown Campus can begin dispensing the potentially life-saving drug and work with a recovery coach to motivate patients to go to a treatment center to get their second and subsequent daily doses. Once patients are stabilized, they can get a monthly prescription for the addiction medication from any primary care doctor who has a DEA license.

Open Windows

The success of addiction assessment and treatment in the ER depends largely on the phase of drug use or withdrawal the patient is in, and whether she is mentally ready to quit.

In overdose cases, patients typically feel physically horrible because they’ve woken up in heavy withdrawal and want to get a fix as soon as possible. “But some are ready to think about whether they want to keep doing this for the rest of their lives,” Dezman said.

Occasionally, patients will come in on their own and say they want help with their addiction, and they mean it. But it’s not usually that straightforward, explained a Midtown Campus recovery coach, Dwayne Dean. “I might suspect they’re just here for a sandwich and a nap, or to get medications to relieve their withdrawal symptoms. But it’s not for me to judge. I’ve got to catch them in that small window of time.”

Since the buprenorphine initiation program began, in July 2017, recovery coaches on duty here at Midtown Campus from 6 a.m. to 2:30 a.m. have screened and interviewed 87 percent of the patients who visit each day.

In most cases, the patients they miss are those who are critically ill and need surgery or are immediately transferred to intensive care. To ensure even more patients are screened, the hospital is hiring additional recovery coaches to follow up with critically ill patients once they are stabilized.

Breaking Barriers

In Maryland, hospital management consultant Oros says everyone from the executives to the physicians and nurses are enthusiastic about the program.

And dozens of treatment providers in the Baltimore area are participating, taking middle-of-the-night calls from ERs and opening their doors earlier than usual to accommodate patients.

“If you really want to see overdose deaths come down in the United States, getting treatment with buprenorphine has to be easier and cheaper for people with substance use disorders than getting heroin and other opioids on the street.”

Dr. Andrew Kolodnyco-directorOPIOID POLICY RESEARCH COLLABORATIVE AT BRANDEIS UNIVERSITY

In 2016, Maryland’s drug and alcohol overdose deaths shot up two-thirds to more than 2,000. More than half of the fatalities occurred in Baltimore County. And Maryland is second only to Massachusetts in the rate of opioid-related emergency visits, according to federal-state data.

So, for Maryland hospitals, it made financial sense to help as many people as possible with their addictions so they wouldn’t have to keep showing up in their emergency departments, Oros said.

Although the stigma associated with addiction is starting to wane among the general public, Brandeis University’s Kolodny said, emergency doctors and nurses see the worst of the worst when it comes to drug users, and many don’t want anything to do with them. Hospital administrators also consider people with addiction to be poor insurance risks in states that have not expanded Medicaid, he said.

“But if this movement in Maryland and other states is successful and starts to become normalized nationwide, it could change everything,” Kolodny said.

“If you really want to see overdose deaths come down in the United States, getting treatment with buprenorphine has to be easier and cheaper for people with substance use disorders than getting heroin and other opioids on the street. And what could be easier than walking into an ER and getting started on buprenorphine?”

Hospitals That Offer Buprenorphine

Buprenorphine initiation and other addiction services are offered in:

  • Baltimore at Bon Secours Hospital, Mercy Hospital, MedStar Harbor Hospital, MedStar Union Memorial, MedStar Good Samaritan, University of Maryland Medical System, University of Maryland Medical Center Midtown, Johns Hopkins Bayview and St. Agnes Hospital
  • Baltimore County at MedStar Franklin Square and Greater Baltimore Medical Center
  • Boston at Massachusetts General Hospital
  • Brunswick, ME, at Mid Coast Hospital
  • Camden, NJ, at Cooper University Health Care
  • Charleston, SC, at the Medical University of South Carolina University Hospital and two other locations
  • Eureka, CA, at St. Joseph Hospital
  • Los Angeles at LA County and University of Southern California Medical Center, Harbor UCLA Medical Center and Olive View-UCLA Medical Center
  • Marin County, CA, at Marin General Hospital
  • New Haven, CT, at Yale-New Haven Hospital
  • Oakland, CA at Highland Hospital
  • Philadelphia at the Hospital of the University of Pennsylvania
  • Placerville, CA, at Marshall Medical Center
  • Redding, CA, at Shasta Regional Medical Center
  • Sacramento, CA, at UC Davis Medical Center
  • San Francisco County at Zuckerberg San Francisco General Hospital, St. Mary’s Medical Center and St. Francis Memorial Hospital
  • Syracuse, NY, at Upstate University Hospital
  • Plus 17 other hospitals in California

Source: Stateline research

Source: Most Hospital ERs Won’t Treat Your Addiction. These Will. | The Pew Charitable Trusts

MultiBrief: Could ketamine help reduce opioid use in emergency rooms?

As opioid abuse continues to make headlines across the nation, medical researchers are busy looking at different, safer ways to treat patients who present with acute pain.

A recent study in the journal Academic Emergency Medicine compares the analgesic effect of the drug ketamine to opioids in an emergency room setting. The conclusion? Ketamine could be a useful, safe alternative in many cases.

It has long been accepted by the medical community that opioids, such as morphine, are an effective way to treat acute pain. However, with the growing opioid epidemic now reaching alarming levels in the U.S. and abroad, alternative treatments must be explored.

There are a number of reasons to consider alternative analgesics for the treatment of acute pain in the emergency room. They include:

  • The potential for addiction
  • Respiratory depression (particularly in older patients)
  • Patients with certain cardiovascular issues are not good candidates
  • Patients with seizure disorders are not good candidates
  • Patients with substance use disorders are not good candidates

Most medical professionals agree that replacing opioids entirely is not necessary, but having other options available will be useful and will help reduce their overall usage.

About Ketamine

Although ketamine has become somewhat infamous for its use as a recreational drug, it cannot be disputed that it is an effective anesthetic. Ketamine has been used in medical settings since its initial approval by the Food and Drug Administration (FDA) way back in 1970.

In the decades that have passed, ketamine has also been trialed for use in the treatment of other conditions, including depressionaddiction, and even migraine headaches.

Despite ketamine’s somewhat shady reputation, it is effective, relatively safe, and well-tolerated in most cases.

It is worth mentioning, however, that possible psychological effects can be disturbing for some patients. But perhaps most important to note; ketamine is not particularly addictive and does not cause respiratory depression in patients.

“Ketamine appears to be a legitimate and safe alternative to opioids for treating acute pain in the emergency department. Emergency physicians can feel comfortable using it instead of opioids,” said senior study author Dr. Evan Schwarz.

Specific findings on the study mentioned were published in the journal Academic Emergency Medicine.

Source: MultiBrief: Could ketamine help reduce opioid use in emergency rooms?

Medical Liability Reforms Key to Texas Patient Access According to Texas Alliance for Patient Access

Today the Texas health care community recognizes the fifteenth anniversary of Texas’ landmark medical liability reforms. Passed by the voters in 2003, Prop. 12, created a constitutional amendment affirming Texas’ non-economic damage cap in medical liability lawsuits.

The cap has been a magnet in attracting a record number of new doctors to the state, said Dr. Howard Marcus, an Austin internist and chairman of the Texas Alliance for Patient Access. TAPA is the statewide coalition of doctors, hospitals, nursing homes, charity clinics, and physician liability carriers that helped draft and successfully lobbied for the passage of Texas’ 2003 reforms.

The number of physicians who treat patients with complex illnesses and high-risk conditions has grown substantially because of the reforms, Dr. Marcus noted.

Texas’ medical liability reforms have been nationally considered the gold standard for medical liability legislation,” said Governor Greg Abbott. “Tort reform has significantly reduced lawsuits and liability costs in our state and contributed greatly to the increasing number of doctors practicing in Texas.”

Before the reforms, doctors were restricting their practice, avoiding the emergency room, leaving the state, or leaving practice altogether, said Dr. Marcus. For example, during the crisis years, HoustonDallasFort WorthLubbockTempleand Waco all saw a massive loss of obstetricians, he said.  Some obstetricians quit practicing, others stopped delivering babies and limited their practice to office visits to make skyrocketing insurance costs manageable. Since the reforms took place, Texas has added more obstetricians than any state in the nation, Dr. Marcus said.

Net Change in Direct Patient Care Ob-Gyns

2006-2015

Nationwide

Net gain of 1,826

Top Gainers

Texas             

+390

California         

+265

Florida              

+195

Arizona              

+101

Colorado

+ 98

Minnesota

+ 92

Biggest Losers

New York      

-141

New Jersey   

– 34

Michigan        

– 26

Delaware        

– 20

Hawaii             

– 15

Mississippi       

– 15

Source:

The Obstetrician- Gynecologist Workforce in the United States, 2017

Facts, Figures, and Implications

The American Congress of Obstetricians & Gynecologists

William F. Rayburn, MD, MBA, FACOG

“Because of the tort reform measures passed by the Texas Legislature in 2003, the number of Texas primary care, high-risk, and total physicians have expanded at a rate greater than population growth,” Dr. Marcus said. “Physician sub-specialties that have seen robust growth include cardiologists, geriatricians, pediatricians, pediatric specialists, vascular surgeons, anesthesiologists, and emergency medicine physicians,” said Dr. Marcus.

“Maintaining this steady, annual three to five percent expansion in our state’s physician workforce is critically important for improving access to medical care,” noted TAPA Director Jon Opelt.

Source: Medical Liability Reforms Key to Texas Patient Access According to Texas Alliance for Patient Access

Goodbye summer, hello flu season: what Amarillo medical experts

After last year’s deadly season, some local health officials are urging you to start taking precautions to protect yourselves and your families.

You may be wondering if it’s too early to get a flu vaccine?

However, both the American Academy of Pediatrics and the federal Centers for Disease Control and Prevention recommend getting a vaccine now.

“Now is a good time of year to ask your physician to check your Vitamin D levels, and if they’re low there’s good supplementation with vitamin D-3 to kind of help raise your vitamin D levels,” said Emergency Room Physician David Haacke.

Vulnerable populations most at risk for coming down with flu should get the vaccine as soon as possible.

These groups include young children, people 65 or older, women who are pregnant, and people who have underlying illnesses.

“The flu vaccine can give your body additional defenses against the flu,” said Haacke. “That way, if you do get the flu it may not last quite as long.”

According to the CDC, last year’s brutal flu season was the worst for kids, with 179 dying from flu-related illnesses.

“Eat plenty of fruits and vegetables and make sure to get plenty of rest,” said Haacke. “Stress is another thing that can diminish our immune system and make us more likely to come down with the flu.”

Source: Goodbye summer, hello flu season: what Amarillo medical experts – KXXV Central Texas News Now

Emergency Rooms Help Stem Opioid Crisis with Addiction Treatment

An increasing number of hospitals are starting to offer on-demand addiction treatment to patients who come into emergency rooms with opioid use disorders.

It is currently becoming more common to see emergency rooms provide patients experiencing withdrawal symptoms from the discontinued use of opioids with medication-assisted treatment with either buprenorphine, naltrexone or methadone — the medications that are approved by the U.S. Food and Drug Administration (FDA) to treat opioid use disorders.

A number of accredited healthcare providers and addiction treatment specialists have publicly expressed support for the initiation of medication-assisted treatment in emergency rooms when needed. And the American College of Emergency Physicians — a national medical society that represents more than more than 38,000 emergency medicine physicians, residents, and students — also recommends that emergency rooms provide an alternative to opioids, in the form of medication-assisted treatment, when physicians deem appropriate.

The Annals of Emergency Medicine, the peer-reviewed scientific journal of the American College of Emergency Physicians, notes that medication-assisted treatment, overall, improves long-term outcomes for the patients who need it.

In recent years, research has prompted a number of hospitals — such as the Staten Island University Hospital, Richmond University Medical Center and Highland Hospital in Oakland — to start offering medication-assisted treatment on demand at emergency departments. However, on a national level, the practice still remains remarkably uncommon.

A comprehensive approach to opioid addiction treatment

Dr. Brent Boyett, a board-certified addiction medicine specialist and the chief medical officer at the Alabama-based addiction treatment center Pathway Healthcare, said: “When a patient with an opioid use disorder comes into an emergency room and they are not offered medication-assisted therapy, the question should be ‘why not?’”

“Detox does not equal addiction cure and recent studies show that’s true,” he said. “Just to take patients into a hospital setting and manage their withdrawals then discharge them without at least offering medication-assisted treatment is the equivalent of taking a diabetic person, getting their blood glucose under control and claiming that their diabetes is cured.”Boyett emphasized that while patients with opioid use disorders should be provided medication-assisted treatment at emergency rooms, that’s not all that is needed to sustain recovery.

Controlling the chemical addiction should simply be the first step for professionals who aim to help patients with substance use disorders, Boyett added.

“The take-home message is that when patients come into emergency rooms with an acute exacerbation, either with withdrawals or overdosing, doctors need to recognize that while they are stabilizing the patient in an emergency situation, they also need to be responsible for arranging long-term chronic disease management follow-up just as they do for diabetes, asthma, hypertension, and other chronic diseases.”

Emergency rooms have been notorious elements fueling the opioid epidemic.

Visits to emergency rooms caused by problems associated with opioid use have increased approximately 100 percent throughout the past decade, according to a May study led by the Society for Academic Emergency Medicine.

“I have been working in emergency rooms for years and for years [opioids] have been a problem among patients,” Boyett said. “There are a couple of different presentations: One would be the drug overdose patients — patients who overdosed on opioids or a combination of drugs; then, there are those patients who come in with withdrawals. The latter group would always complain about some kind of physical or somatic pain. There’s a variety of situations but I think it’s important to recognize that probably the most common symptom of an opioid withdrawal is physical pain. Patients that are in withdrawal literally are in physical pain.”

Physical pain management has been one of the primary focuses of U.S. emergency room physicians.

In June, the Annals of Emergency Medicine published an analysis which highlighted that the emergency medicine community has been primarily focused on improving opioid prescribing practices, finding other alternatives to manage patients’ pain, and lowering the number of opioids that are prescribed.

But emergency departments are not a major source of opioid prescriptions. In fact, the share of opioids prescribed in emergency settings has been decreasing — a study published earlier this year in the same journal found that most people obtain opioid prescriptions from other sources of care, such as primary care physicians, rather than emergency departments.

Closing the treatment gap

The authors of the analysis, dubbed ‘Identification Management and Transition of Care for Patients with Opioid Use Disorder in the Emergency Department’, noted that there has been an increasing interest in evidence-based methods of identifying and assisting people with opioid use disorders who come into emergency rooms.

Patients who receive medication-assisted treatment in emergency departments are more likely to continue to be involved in addiction treatment after a month and less likely to misuse opioids than the patients who had received only counseling, the analysis emphasized.

Thus, the fact that medication-assisted treatment is still rarely offered in emergency rooms continues to leave a gap in the nation’s opioid addiction treatment efforts.

Boyett — who has also served as the principal clinical investigator in the FDA’s approval for buprenorphine, testifying before its advisory committee and before Congress on the subject — highlighted that stigma is one of the barriers to expanding the use of medication-assisted treatments in emergency settings.

“The biggest challenges are stigma and lack of training from physicians in the emergency staff,” he said. “We say that addiction is a disease. We say it is a chronic disease but it is still difficult for us to remove our personal bias from that and, on many levels, many of us consider the use of drugs, despite adverse consequences, to be a choice. In my mind, to shame a patient over their drug use is like shaming a patient over their blood pressure not being regulated or their renal function not being proper.”

Source: Emergency Rooms Help Stem Opioid Crisis with Addiction Treatment

Hospital Corporation of America constructing new emergency room in Red Oak

Hospital Corporation of America is planning to construct a 20,400-square foot emergency room on 2.1 acres of land on East Ovilla Road in Red Oak.

The facility, which had a zoning change approved by the Red Oak City Council last month, will include supplemental components such as an emergency room, women’s services, imaging and internal medicine. Development plans show that 78 parking spaces and eight disabled-access parking spaces will be constructed for the emergency room — 15 more than the city requirement.

HCA will purchase a portion of the 4.277 acres of land from its current owners, Soulman’s BBQ, and will be located alongside the restaurant when completed. Soulman’s BBQ purchased the property from the Red Oak Industrial Development Corporation in Nov. 2015.

Two non-speakers wrote to the city council during the public hearing for the zoning change. They were both in support of the emergency room’s construction.

“I own a mixed-use medical and dental across the street from this lot,” resident Alan Martin wrote. “I think an ER would be great.”

Fire Chief Eric Thompson said the emergency room would mostly benefit local residents since the facility will send ambulances out more often than bringing them in. Thompson said the city’s emergency services provider would be financially responsible for providing transportation.

“Typically, our ambulances won’t use this as a primary place for transport,” Thompson explained. “But for the general public, this is an option locally that they can go to for anything that potentially they might not need to stay the night for.”

Economic Development Director Lee McCleary said the project is currently undergoing the plotting and permitting process. Construction will begin as soon as the purchase between HCA and Soulman’s BBQ is completed.

Source: Hospital Corporation of America constructing new emergency room in Red Oak

Urgent Care Centers Are More Popular Than Ever, Study Says | Time

Urgent care centers are increasingly becoming Americans’ go-to option for certain health problems, according to a new study.

Visits to urgent care clinics increased by 119% among commercially insured Americans between 2008 and 2015, according to new research published in JAMA Internal Medicine. During the same time period, emergency room visits for low-severity conditions — like those treated at urgent care centers — decreased by 36%.

“Over the last several years, the use of these venues has grown a lot. I think patients are interested in convenience,” says study co-author Dr. Sabrina Poon, who was an emergency physician and research fellow at Brigham and Women’s Hospital when the research was completed, and is now at Vanderbilt University Medical Center. “Cost is also a big factor, and wait times.”

The study looked specifically at Americans younger than 65 who were covered by Aetna, which insured about 20 million people during each of the study years. The Aetna members included in the study made 20.6 million acute care visits during the eight-year research window.

Many people went to urgent care clinics, not emergency rooms, for low-risk acute issues, the study shows. In 2015, there were 103 visits to urgent care centers per 1,000 Aetna members (up from 47 in 2008), compared to 57 ER visits per 1,000 members (down from 89 in 2008).

Telemedicine and visits to retail clinics, such as those in pharmacies and big-box stores, are also getting more popular, the study says — though they still make up a small portion of acute care. In 2015, there were six virtual visits per 1,000 customers (up from virtually none in 2008), and 22 retail clinic visits per 1,000 members (up from seven in 2008). The study didn’t look at pre-scheduled office visits.

The increases don’t necessarily mean that people are choosing urgent care centers when they once would have gone to the ER, Poon says. Overall use of acute care facilities rose by 31% during the study period, and health care spending per person per year rose by 14%, suggesting that people are simply getting more medical care than they used to. That’s partly due to the growing prevalence and popularity of urgent care and retail clinics, which may attract patients who otherwise wouldn’t have sought medical attention, the authors say.

Reductions in ER visits may instead be driven by high costs and long wait times, the study says. In 2015, the average low-severity emergency room visit cost $422 out-of-pocket, compared to $66 at urgent care centers and $37 at retail clinics. At $14 per appointment, telemedicine was even cheaper. However, despite the lower costs, the researchers found that wealthier patients were more likely than lower-income people to use non-ER resources, perhaps because of differences in geographic prevalence and transportation accessibility.

Poon stresses that the emergency room is sometimes the best choice for patients — especially for more serious conditions or accidents. As alternative venues become increasingly popular, she says it’s up to the medical system to clarify for patients where they should go and when.

“I recognize that it’s exceedingly difficult, sometimes, to figure out where the best place to go is,” she says. “The medical system as a whole could probably be better at helping patients figure that out.”

Source: Urgent Care Centers Are More Popular Than Ever, Study Says | Time

Study: Trips to ERs down, urgent care centers up for minor ills

Researchers at Brigham and Women’s Hospital in Boston analyzed 2008-2015 data from Aetna, the commercial health insurance company.

“The drop in emergency department visits is quite striking and represents a substantial shift in where patients go to get care for conditions such as sore throat and minor injuries,” study author and emergency physician Dr. Sabrina Poon said in a hospital news release.

Poon and her colleagues found a 36 percent decline in ER visits for minor conditions and injuries during the study period. Meanwhile, use of non-ER services — including urgent care clinics, retail clinics and telemedicine — rose 140 percent.

The largest increase (119 percent) in non-ER services was at urgent care centers, according to the study.

Given the high cost of emergency room care, many insurance plans encourage patients to go elsewhere for treatment of trivial problems, the researchers noted.

“The increasing popularity of alternatives to the emergency department is likely being driven by a variety of factors, including cost, convenience, and long wait times,” said study co-author Dr. Jay Schuur, an emergency physician at Brigham and Women’s.

“In the next few years, it will be important to see how these trends evolve and whether the growth of alternative sites results in lower cost care or more use of medical care,” Schuur said.

The findings were published in the Sept. 4 JAMA Internal Medicine.

Source: Study: Trips to ERs down, urgent care centers up for minor ills

Study: Emergency Room Visits Decrease As Urgent Cares Become More Popular

People with minor medical conditions are taking fewer trips to the emergency room, trading in the hospital for urgent care centers instead.

According to a study published in JAMA Internal Medicine on Tuesday, emergency department visits from 2008 to 2015 for low-acuity conditions dropped by 36 percent, while visits to non-emergent care facilities, such as urgent care centers or calls in to telemedicine services, grew by 140 percent.

The researchers examined 20.6 million visits of Aetna insurance members from 2008 to 2015 for “low-acuity” conditions, which include ailments such as sore throats, urinary tract infections, rashes and respiratory infections.

They discovered that visits to urgent care centers increased by 119 percent. Visits to retail clinics increased by 214 percent and the use of telemedicine increased from zero visits in 2008 to six visits per 1,000 members in 2015.

“The drop-in emergency department visits are quite striking and represent a substantial shift in where patients go to get care for conditions such as sore throat and minor injuries,” Dr. Sabrina Poon, co-author author and emergency physician at Brigham and Women’s Hospital, said in a press release.

Acute care visits make up more than one-third of all ambulatory care delivered in the U.S. and, according to the study, the rapid increase in the number of urgent care and retail medical centers, as well as the rise of telemedicine, may be driven by patients’ limited access to care, convenience, longer wait times in emergency rooms and increased expenses from hospitals.

Additionally, due to increasing costs in emergency rooms, insurance companies “have created incentives to encourage patients to receive that care elsewhere,” the release states.

According to the study, spending per patient per year for low-acuity conditions increased 14 percent from 2008 to 2015, largely due to a 79 percent increase in cost per emergency department visit for the treatment of such illnesses.

“The increasing popularity of alternatives to the emergency department is likely being driven by a variety of factors, including cost, convenience, and long wait times,” Dr. Jeremiah Schuur, co-author author and associate professor of emergency medicine at Harvard Medical School, said in the release. “In the next few years, it will be important to see how these trends evolve and whether the growth of alternative sites results in lower cost care or more use of medical care.”

Source: Study: Emergency Room Visits Decrease As Urgent Cares Become More Popular

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