We need better dental care for elders, research on guns is imperative, and US lags in care coordination

RightCare Weekly
December 10, 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 healthcare system toward the right care for all patients.

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Last summer we reported how ER visits were on the rise for dental problems because many Americans lack dental insurance and forego regular care. But for the elderly, avoidance of care isn’t always based on cost alone, even though Medicare doesn’t cover these services. As explained in The Washington Post this week, accessing this care for some older Americans can be challenging because of illnesses like dementia or a lack of mobility. Dental care is vital to overall health, and chronic illnesses or medications can further affect oral health and the ability to eat. According to the article, a two year study in California examined the extent of dental issues in the elderly. Some 38 percent of those in the state’s long-term care facilities were lacking their original teeth, and half of them had at least a tooth with untreated decay. While some dental programs are offering geriatric dental care rotations, more dentists need to be trained to care for this segment of the population. Says Theresa Anselmo, from the Center for Oral Health, which conducted the study, “The system is not currently equipped to deal with this huge wave of individuals. How do you keep these folks healthy as they age, given it becomes a luxury to afford even basic dental care?”


Not since 1920 had The New York Times published an editorial on its front page, but on Saturday it did so, calling it “a moral outrage and national disgrace that civilians can legally purchase weapons designed to kill people with brutal speed and efficiency.” Equally outrageous: the Centers for Disease Control and Prevention are barred from studying the health effects of guns. Hours before the San Bernardino mass shooting—the 355th one this year— some 2,000 physicians had descended upon Capitol Hill to deliver a petition to Congress, asking them to do away with a restriction, put in place 20 years ago, which prevents the CDC from researching gun violence, a huge public health concern. In The Washington Post, Daniel Webster from the Johns Hopkins Center for Gun Policy and Research, backs the doctors, saying that the epidemic “affects the basic things we care about in public health—the mortality, the life expectancy, morbidity, mental health…If we had a disease that was killing as many people as our guns in our country, we would devote a lot more resources to make sure we had the best data, the best research to know what is most affected.” An editorial in The Boston Globe, echoes the need for research, maintaining “a deeper understanding of the causes of gun violence could help on the prevention side, too.”


Eighty-four percent of primary care doctors in the nation don’t feel equipped to treat severely mentally ill patients, according to a Commonwealth Fund survey released this week. It’s not surprising then, that a new payment model intended to induce primary care doctors to do a better job has not shown any benefits for the mentally ill. The Alternative Quality Contract (AQC), according to The Boston Globe, “has shown some success in slowing health care spending and improving care,” but these benefits have “not yet reached people with anxiety, depression, bipolar disorder, schizophrenia, and other mental illnesses.” Haiden Huskamp, PhD, a professor of health care policy at Harvard Medical School and an author of the Health Affairs study on the early impact of the AQC, points to fragmentation in healthcare as one culprit. The Commonwealth Fund survey also found that many physicians struggle with care coordination for other chronic conditions as well. One in four doctors in the U.S. is “not prepared to effectively manage and coordinate the care of patients who have multiple chronic conditions,” reports Forbes. Among the 10 industrialized nations surveyed, the U.S. has the youngest population but has the highest incidence of chronic disease, and spends between 50 and 150 percent more on healthcare per capita than Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom. Care That Matters (CTM), a project of the RightCare Alliance’s Primary Care Council, is working to improve the quality of the US healthcare system by ensuring quality also means evidence-based, patient-centered, and efficient. Learn more about CTM here.



  • Join us at the 4th Annual Lown Institute Conference, April 15-17, 2016 in Chicago. You’ll hear from keynotes John P.A. Ioannidis, MD, Rita Redberg, MD, Jeff Brenner, MD, and Gordon Guyatt, MD. Learn more about the conference and register here. Learn about conference scholarships here. And don’t forget, we are still accepting abstracts for Research Day to kick off the conference on April 15. Deadline for abstract submissions is this Wednesday, December 15, 2015. For submission information, click here.






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