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New publication guidelines, oral health care gaps, and indication creeping

July 2, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our health care system toward the right care for all patients.

Join the conversation: Post your comments in our new section at the bottom of this page.

 

Features:

 

In the wake of its recent retraction of a study by Michael LaCour of UCLA and Donald Green of Columbia University, Science published guidelines devised by the Transparency and Openness Promotion (TOP) Committee outlining recommendations for improving transparency, openness, and reproducibility in research. The Committee faults a perverse incentive structure in academia for failures in these realms. The TOP guidelines delineate eight standards within which studies may be ranked on a level from zero (does not meet guidelines) to three (most stringent). The guidelines include categories like replication and research materials transparency, and offer a refreshing departure from typical current journal guidelines, which often do not venture beyond defining “where to set the margins, where to put the figures – copy-editing stuff,” laments Brian Nosek, PhD, in The New York Times, who is the first author of the guidelines and executive director of the Center for Open Science.

 

Many health plans do not cover a key aspect of preventive medicine—dentistry. As USAToday reports, emergency room visits for dental conditions are escalating as a third of all working adults and more than 60 percent of seniors lack dental insurance. Paying out of pocket means that some patients are forgoing regular visits until problems, like cavities, are exacerbated, leading to hospitalizations and sometimes death. “People still die from their teeth in the U.S.,” says George Kushner, DMD, MD, of the University of Louisville, who is quoted. In a HealthAffairs blog, writers Brenda Sharpe, et al, convey that a quarter of adults in the nation have untreated cavities and a fifth of adults have periodontal diseases, resulting in pain, tooth loss and infections. Delaying treatments also results in wasteful health care spending, especially when patients seek relief at ERs. Oral health affects overall health and quality of life, say the blog writers, who advocate making oral care part of good primary care. They cite successful collaborative arrangements between dentists and primary care practitioners who provide preventive care and self-care guidance in primary care settings. Approaches like these not only address necessary oral care, but also reaffirm the value of comprehensive, “whole-person” care.

 

A growing trend among health care entities is direct-to-consumer marketing of screening tests. Primary care physician Hanna E. Bloomfield, MD, MPH, received a mailing from her local medical clinic suggesting she receive three tests to uncover possible vascular disease. She knew all of the tests were unnecessary and was so incensed she wrote a commentary in the Star Tribune describing the dangers of unnecessary medical testing. Gary Schwitzer of HealthNewsReview followed up with Bloomfield and learned she had also complained to the clinic’s chief medical officer, who agreed to discontinue the campaign. However, Jay N. Cohn, MD, in a letter to the newspaper argues for the necessity to screen for cardiovascular disease, which can present without symptoms. Recently, a Lown Institute employee received a similar mailing which suggested “life-saving” vascular screening, not recommended by her doctor, at a nominal out-of-pocket cost of $150. (They didn’t know who they were messing with!)

 

Announcements:

 

  • What an overwhelming response! Thanks to all the rising chief residents who applied for the new RightCare Educator Program. We received applications from so many physicians throughout the nation. Now comes the hard part, reviewing applications and working with our first class of RightCare Educators to shape a more rational medical culture by implementing RightCare Rounds in their institutions. Stay tuned to learn more in the coming weeks.

 

  • What if clinicians around the country kept a running count of medical overuse, underuse, or both, and posted their  findings in one place for all to see? TheRightCare Count, as Shannon Brownlee calls it, is her idea for RightCare Action Week. Watch her explain it here. If you haven’t done so already, sign up for RightCare Action Week–our grassroots initiative that engages people across the country to take action to show what our health care system should look like. On RightCareActionWeek.org, you’ll find an Action Forum, where you can submit, vote on, and discuss Action Ideas with your friends and colleagues. Sign up today.

 

Headlines:

 

More on publication guidelines

 

Transparency

 

Overdiagnosis

 

Evidence-based medicine

 

Health reporting

 

Patient experience

 

Social determinants of health

 

COI

 

Practice

 

Shared decision-making

 

Disease-mongering

 

Tech & innovation

 

Population health

 

Policy

 

Patient engagement

 

Cost of care

 

Design

 

End-of-life care

 

Health insurance

 

Public health

 

 

RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.