February 28, 2016

New Blood Pressure Guidelines Could Save Lives – Part II

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

One in three U.S. adults suffer hypertension, or high blood pressure. According to the  American Heart Association, it is the number-one cause of death, and high blood pressure can lead to serious heart damage, heart attacks, strokes and kidney damage.

Have you checked your blood pressure lately?

Recent developments have been both good and bad:  Heart.org reported a 30 percent drop in the cardiovascular disease death rate from 2001 to 2011. Unfortunately, “the high blood pressure death rate increased 13.2 percent over that same time.”

A groundbreaking new study, the  Sprint Hypertension Trial, could affect millions of people with high blood pressure and save many lives.

This large national study concludes that lowering the systolic blood pressure– the top number in a blood pressure reading – to 120 instead of the commonly accepted 140 would in reduce heart attacks by 30 percent and deaths related to heart disease by 25 percent.

When you consider that 79 million people have hypertension, that is a very big deal.

How do we get there? Challenges remain on multiple fronts. While there are quite a few effective drugs to lower blood pressure, not everyone responds to the standard treatments.

Meanwhile,  high blood pressure, diabetes andobesity in children all are on the rise. Additionally, blood pressure increases with advanced age, and as people livelonger, more face high blood pressure. But if blood pressure is forced down too low,  side effects and other health risks arise, including dizziness and fainting.

There is no permanent, one-shot cure for high blood pressure, but much can be done to help prevent high blood pressure in some people, and much can be done to get the number down and manage it with regular lifestyle changes or medications or both.

Sodium, found in salt, has long been found to contribute to high blood pressure. While there is some controversy as to how much sodium reduction will significantly lower blood pressure, it is a safe and inexpensive way to see if it could work for you.

Two large sodium trials  in the 1980s and 1990s in the U.S. showed a marked reduction in hypertension when salt intake was lowered. An international study called  Intersalt, supported similar results. A 2012 meta-study on sodium looked at results from  167 trials.

Apparently, Americans on average consume an unhealthy amount of sodium. Where is it coming from? Mostly it’s in processed foods, but a surprising top spot on the  list of popular high-sodium foodsis breads and rolls. That’s because baking soda, a leavening agent, contains sodium. Poultry is also among the top six culprits. Most of the raw chicken in supermarkets has been injected with sodiumto make it more flavorful and juicier. More obvious sources of sodium are cured meats, cold cuts, canned soups and, of course, snack foods.

According to  Centers for Disease Control and Preventionwe eat about 3,300 mgs of sodium a day. The recommendation is 2,300 mgs of sodium for healthy people and 1,500 mgs for those with high blood pressure (That’s a paltry three-quarters of a teaspoon per day).

According to an article in the  Harvard Newsletterthat examined long-term benefits of sodium restriction: “Volunteers learned how to look out for hidden salt and avoid it; those who were able to reduce their salt intake by one-third to one-half a teaspoon per day reaped the cardiovascular benefits.”

Of course, there are also  numerous medications to lower blood pressure. However, though to lower it to 120, three drugs may be required, which can lead to complications. Each patient should carefully weigh the risks.

Finally, about 10 percent of hypertensive patients who do not respond to diets, exercise or medication, which translates to about 8 million people. A once-promising surgical intervention called renal denervationhas had a rocky history but is being investigated again as an alternate treatment. The premise is based on debilitating the  renal sympathetic nervesthat have a role in affecting blood pressure.

Good habits are, of course, much easier to keep if started early. The  Centers forDisease Control and Preventioncounts nearly nine in ten U.S. children who consume more sodium than recommended, and about one in six children with elevated blood pressure, which is a major risk factor for heart disease and stroke. As an adult it’s not easy to change your taste preferences, but if you can have a low-salt diet in childhood, you will have instilled a lifetime of better nutrition.

February 20, 2016

New Blood Pressure Guidelines Could Save Lives – Part I

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

The results of a landmark study on high blood pressure – also known as hypertension –published in September 2015 are so stunning that the National Institutes of Health halted the trial three years early so the data could be shared with the public as quickly as possible.

doctor checking blood pressure

The Sprint Hypertension Study included more than 9,300 patients aged 50 and older from all over the United States.

The outcome was indeed remarkable: Heart attacks, strokes and deaths were reduced 30 percent when blood pressure was lowered below the current “gold” standard.

A NIH press release explains that the study “carefully adjusted the amount or type of blood pressure medication to achieve a target systolic pressure of 120 millimeters of mercury (mm Hg), resulting in reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by almost a third and the risk of death by almost a quarter, as compared to the target systolic pressure of 140 mm Hg” (the current gold standard).

With a whopping 79 million people suffering from high blood pressure, why didn’t we figure this out sooner?

Up to now, there has been controversy regarding the risks and benefits of lowering blood pressure. Only two years ago, The Journal of the American Medical Association published research in which a panel of 17 experts announced the systolic blood pressure target should be pushed higher – to 150 mm Hg – instead of 140.

But five panel members later dissented and published a follow-up article in the Annals of Internal Medicine warning that the change upwards could put more patients at risk for heart disease and stroke.

A Reuters article pointed out why there is such disagreement about the ideal blood pressure numbers: “Other cardiologists said the risks of more aggressive treatment need to be explored more rigorously before applying it widely. Patients in the 120 systolic blood pressure group, for example, had a higher rate of kidney injury or failure, as well as fainting.”

Several medical organizations, including the American Heart Association, disagreed with raising the number to 150. “Hypertension influences a person’s health status over a time horizon that is much longer than the follow-up of many of the randomized controlled trials included in the evidence review,” said Dr. Elliott Antman, American Heart Association president. “Therefore it’s not surprising that we still have uncertainty about the optimal way to evaluate and manage hypertension.”

So why should we pay attention? Heart.org puts it quite plainly: “high blood pressure can kill you.”

Blood pressure is particularly insidious because there are no symptoms and it can lead to heart disease, strokes, kidney damage, artery disease and other life-threatening conditions.

Blood pressure is represented by two numbers, described as one over another. The systolic or top number, represents the pressure in the arteries when the heart beats.  The diastolic or bottom number, represents the pressure in the arteries between heart beats. For a normal reading, the systolic (top number) should be lower than 120 and bottom number (diastolic) lower than 80.

Typically the top number is more important, but both need to be considered. Blood pressure usually rises with age. As arteries lose their suppleness, the heart must exert more pressure to keep blood flowing.  Blood pressure that is too low also also have adverse effects, including dizziness and fainting, which can cause older people to lose their balance and fall.

While many drugs effectively lower blood pressure, some health-care experts are concerned about prescribing too much of them.

A Sept. 11, 2015, story in The New York Times noted: “A systolic pressure that is naturally 120 might be good, but it is quite another matter to artificially drag pressure down so low with drugs. Reaching a target that low would mean giving people more and more medications, and the side effects could cancel any benefit.”

The Centers for Disease Control and Prevention reports that one in three Americans have high blood pressure and about half of those go undiagnosed and untreated. Almost 80 percent of women 75 and older have high blood pressure, and African Americans are 20 percent more likely to suffer high blood pressure than the rest of the population. Most people who have suffered a stroke or heart attack have a history of high blood pressure.

My second blog on this topic will look at underlying factors for hypertension as well as medications, diets and controversial procedures for patients who do not respond to standard treatments.

February 10, 2016

HIPAA, Part IV: How Patients Can Exercise Their Right to Decide

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

HIPAA Part IV: How Patients Can Exercise Their Right to Decide

Who has the right to manage care for patients with a long-term illness? How do patient privacy concerns affect children who care for elderly parents as they lose their independence? Is health information really private – even from relatives and friends – or can they be authorized to participate in an individual’s health care?

privacy

There are many instances in which patients will want health information kept private, or conversely, shared with a trusted person. The government has put into place a legal provision called HIPAA, the Health Insurance Portability and Accountability Act of 1996, that governs the use of personal health information.

Upon entering a doctor’s office or hospital, patients are asked to sign a Notice of Privacy Practices, which defines how and when medical records will be disclosed. Many patients and health-care professionals do not have a clear understanding of this privacy rule, which gives providers and others – known as covered entities –rights to use, disclose or protect a patient’s information.

Medical records, including those about psychiatric or elder care, may be shared with family and friends based on the provider’s discretion. Patients are not legally required to sign or acknowledge HIPAA’s privacy rule. Moreover, the U.S. Department of Health & Human Services website explains that “Signing does not mean that you have agreed to any special uses or disclosures of your health records. And refusing to sign does not prevent the entity from using or disclosing health information as the rule permits it to do.”

Given that sharing information under HIPAA can be problematic, how can anyone make sure their health-care wishes are followed?

In order to share personal health information with a specific party, patients can sign an authorization form. The HHS site explains that an “authorization is required by the privacy rule for uses and disclosures of protected health information not otherwise allowed by the rule.” Patients must specify to their doctor, hospital or health insurer exactly what they want to be disclosed and to whom, along with an expiration date.

There is much more that can be done. Patients who undergo complex surgery or prolonged cancer treatment, may become too sick to make sound and rapid decisions. By signing a health care proxy, anyone can designate a friend or family member to make medical decisions if necessary. The proxy can be broad or specific. For example, the proxy could say,0 “During my treatment for cancer surgery, I will designate my wife to make health-care decisions.”

Another option is a living will, which gives general instructions, without naming a specific person, about end-of-life decisions. Health-care proxies and living wills often work in tandem.

The AARP website contains a trove of information on managing a hospital stay and helping an elderly relative. Patients are urged to update their list of prescriptions medicines always and to authorize the services of a health-care advocate, who can accompany the patient to medical appointments, stay by their hospital beds, file health insurance claims and find a nursing home.

The Health & Human Services site specifically addresses issues with long-term care and how Medicare and Medicaid come into play.

A durable power of attorney can be used to designate someone to pay or manage a patient’s financial life during extended treatment or hospitalization. According to a MedicineNet.com story on advance medical directives, “a durable power of attorney can also specifically designate different individuals to act on a person’s behalf for specific affairs. For example, one person can be designated the DPOA of health-care or medical power of attorney, similar to the health-care proxy, while another individual can be made the legal DPOA.”

All of these decisions are, of course, deeply personal and fraught with potentially repercussions. It’s always wise to consult with doctors and a lawyer to understand both the legal implications and how a specific medical situation could be affected by the decisions in the documents.

February 2, 2016

HIPAA, Part III: Consumers Are Gaining Protections, Up to a Point

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

The Health Insurance Portability and Accountability Act of 1996, or HIPAA, features a privacy rule that is described by the U.S. Department for Health & Human Services as “carefully balanced to allow uses and disclosures of information—including mental health information—for treatment and other purposes with appropriate protections.”

woman on tightrope

HIPAA forms typically have an explanation of the rules and a signature acknowledgement page for the patient. Each provider creates its own privacy practices form, following the HIPAA guidelines. The Notice of Privacy Practices outlines the ways in which the provider may disclose patient information (the one most of us don’t bother to read thoroughly). The Acknowledgement and Consent form basically says that the patient read and understands the provider’s terms and the privacy rule.

During the last couple of years, there have been increased protections for consumers. For instance, patients now have the right to obtain test results directly from labs.  Patients can also ask for a copy of their medical records in an electronic form, and new limits have been set on using records for marketing or fundraising.

The 2013 Final Omnibus Rule  “expands many of the (privacy) requirements to business associates of the entities that receive protected health information, such as contractors and subcontractors.” That’s because some of the largest breaches have involved business associates.

But some rights have caveats: The HIPAA Guide states that while patients have the right to receive their complete medical records, providers can take up to 30 days to do so.  Patients can request a list of any party that has viewed their records, “except for those about treatment, payment and health-care operations and certain other disclosures.”  Patients may request that sharing of their records be limited, but providers “are not required to agree with your request and may say ‘no’ if it would affect your care.”

The HHS website goes on to list a number of instances in which a provider may communicate with a patient’s family members, friends or “others involved in the patient’s care.” The provider also may “involve a patient’s family members, friends or others in dealing with patient failures to adhere to medication or other therapy; and listen to family members about their loved ones receiving mental health treatment.”

Many in the health-care industry are not highly knowledgeable about the rules. In 2013 The New York Times published a story describing how a hospital worker prevented a woman from accompanying her sister into the emergency room, claiming patient privacy. At the other end of the spectrum, pediatricians and obstetricians who display their patients’ baby pictures in their offices now must to remove them, even if the photos were sent by the parents.

There is widespread misunderstanding about HIPAA, so much so that the Department of Health & Human Services sent a letter to the nation’s health-care providers following the Newtown, Connecticut, shooting  to remind practitioners that HIPAA’s privacy rule “does not prevent your ability to disclose necessary information about a patient to law enforcement, family members of the patient or other persons when you believe the patient presents a serious danger to himself or other people.”

What about employers? When it comes to what your boss knows, HIPAA’s privacy rule “does not protect your employment records, even if the information in those records is health-related.” The rule does not prevent employers from requesting a doctor’s note or other information about an employee’s health if that information is needed to administer sick leave, workers’ compensation, wellness programs or health benefits.

However, health-care providers are not allowed to disclose protected health information to employers without the patient’s authorization.

While the law doesn’t require patients to sign a HIPAA form, some providers refuse to treat anyone who refuses to do so.  Ironically, that refusal constitutes a HIPAA violation.

In the last part of this series, I’ll explore how patients can safeguard their privacy while getting help from family and friends.

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