Population Health Poses Unique Challenges in Rural Areas

From HealthLeaders Media:

Population health management is being pursued by many healthcare leaders, but it’s a hard strategy to manage when the population is small and spread out. That’s the difficulty facing rural healthcare providers, who have long dealt with an older and sicker demographic, difficulty in finding physicians, and economic constraints, and are now pushed to the brink by healthcare reform.

Yet many rural healthcare leaders are embracing population health as their future—not because it offers economic salvation (it doesn’t), but because it makes perfect sense for their mission: to provide care for the community.

Should Malingering Be on the Differential?

From Emergency Medicine News:

Acute incarceritis is defined as the sudden onset of illness when a person is arrested. Its prevalence is difficult to quantify because the incidence depends on how many newly arrested patients an emergency department sees per year and how knowledgeable those individuals are regarding the mandate by the police to seek care for any medical complaints, even feigned ones. Common symptoms include seizures, asthma attacks, and chest pain, most of which rapidly disappear upon entering the emergency department.

The diagnosis of acute incarceritis carries with it several potential pitfalls. Unless the patient presents with obvious external signs of trauma, he is likely to be dismissed by the examining physician. After all, the problem-solving principle of Occam’s razor suggests that the most likely diagnosis for a newly arrested patient’s chief complaint is malingering. Feigning illness may be a common action taken among arrested patients, but a physician must also be cautious not to miss a true concerning diagnosis in light of this inherent bias.

We Mapped the Uninsured. You’ll Notice a Pattern.

From the NY Times:

Two years into Obamacare, clear regional patterns are emerging about who has health insurance in America and who still doesn’t.

The remaining uninsured are primarily in the South and the Southwest. They tend to be poor. They tend to live in Republican-leaning states. The rates of people without insurance in the Northeast and the upper Midwest have fallen into the single digits since the Affordable Care Act’s main provisions kicked in. But in many parts of the country, obtaining health insurance is still a problem for many Americans.

Doctor who helped launch modern paramedic system dies at 98

From the Tribune:

As a cardiologist in Los Angeles during the 1960s, Dr. Walter S. Graf became alarmed by the number of heart attack sufferers who died while en route to hospitals.

Inspired by an Irish physician who sent hospital doctors and nurses out into Belfast to treat cardiac patients, Graf in 1969 converted a white Chevy van into a “mobile critical care unit.” He went on to outfit ambulances with defibrillators and technicians who knew how to use them, becoming one of a handful of doctors who created the modern paramedic emergency system.

Graf died Oct. 18 while under home hospice care in Los Angeles, according to Dr. Baxter Larmon, a professor at the David Geffen School of Medicine at University of California, Los Angeles. He was 98.

“He was a pioneer,” said Larmon, who knew Graf for 40 years and delivered a eulogy at a memorial last week. “Today ambulances do trauma care, they do respiratory care, they provide all kinds of care. And it’s all based on Graf’s original model.”

A procession of ambulances and fire trucks were driven to Graf’s memorial, which was attended by 100 firefighters, Larmon said Thursday.

Low-dose Ketamine Eases Pain, Reduces Opioid Use in ED

From Medscape:

The use of low-dose ketamine as an adjunct to opioids for pain control in the emergency department led to reductions in pain scores, total opioid dosing, and frequency of opioid dosing, results from a randomized, placebo-controlled trial indicate.

“The reduced frequency of opioid dosing, in particular, may be clinically significant,” said lead investigator Karen Bowers, MD, from the Emory University School of Medicine in Atlanta, Georgia.

She presented the study results here at the American College of Emergency Physicians (ACEP) 2015 Scientific Assembly.

Study: More rural Kansas hospitals at risk of closing

From the Eagle:

Mercy Hospital in Independence closed earlier this month, eliminating 190 jobs and leaving residents in this southeast Kansas town with a 20-minute drive to the nearest hospital emergency room.

Some warn that Independence is not an isolated case.

A national study shows that 17 other rural hospitals in Kansas are at risk of closing.

The study, published by iVantage Health Analytics, a for-profit research group based in Maine, does not identify the hospitals by name out of fear it would worsen the hospitals’ financial problems.

Emergency medicine physicians feel that the “business and regulation of health care” is changing medicine practice for the worse

From Central Penn Business Journal:

The “business and regulation of health care” is changing medicine practice for the worse, according to a majority of emergency medicine doctors.

And, according to them, advance directives, or legal documents informing the doctor of a patient’s health care wishes, would make things easier.

The information comes from a survey released this week by Harrisburg-based health care technology company, Geneia, which surveyed more than 300 emergency medicine physicians nationwide.

The majority – 92 percent – is slightly higher than the results from a survey conducted earlier this year, which found that 87 percent of physicians as a whole felt the same way.

It discovered that emergency medicine physicians scored 3.9 out of 5 on the “Physician Misery index,” whereas physicians as a whole previously surveyed scored 3.7.