Health and wellness

New HPIO, OSU policy brief explores link between clinician wellbeing and patient care and safety

The Health Policy Institute of Ohio, in partnership with the Ohio State University College of Nursing Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, has released a new policy brief titled A Call to Action: Improving Clinician Wellbeing and Patient Care and Safety.

A growing body of research indicates that healthcare clinicians face serious problems related to their overall health and wellbeing, including high rates of burnout, depression, addiction and suicide. Understanding the relationship between clinician well-being and patient care and safety enables state policymakers and healthcare leaders to implement evidence-informed policies and programs that improve outcomes for clinicians and their patients.

This brief serves as a call to action to improve clinician wellbeing and its impacts on patient care and safety, providing a:

  • Framework for the relationship between clinician wellbeing and patient care and safety
  • Summary of research findings
  • Review of evidence-informed policies, programs and practices that improve clinician wellbeing and support high-quality, safe patient care
  • Set of evidence-informed state policy options

HPIO forum to explore healthy behavior, personal responsibility

The Health Policy Institute of Ohio is hosting a forum on Oct. 2 in Columbus titled “Promoting Healthy Behaviors and Personal Responsibility: Politics, Perceptions and Health.”

In Ohio and across the country, there is a growing interest in encouraging healthy behaviors and promoting personal responsibility to improve health. This forum will explore the role policymakers and others can play in engaging people in their health.

Speakers will address diverse perspectives on the issue. The event also will address how community conditions impact our health choices and potential policy implications in Ohio.

Speakers include:

  • Joan Alker, Executive Director/Co-Founder, Center for Children and Families, Research Professor, Georgetown University McCourt School of Public Policy
  • Dr. Bruce Rogen, Chief Medical Officer, Cleveland Clinic Employee Health Plan
  • Dr. Megan Amaya, Assistant Professor of Clinical Nursing, Director of Health Promotion and Wellness, Ohio State University College of Nursing
  • And more to be announced

Study: 1% drop in smoking among Medicaid enrollees could save Ohio $60 million a year

Researchers estimate that cutting smoking in each state by 1% in a year would lower the cost to taxpayer-supported Medicaid by $2.6 billion the following year, including more than $60 million a year in Ohio, according to findings of a new study (Source: “Cutting smoking could save Medicaid $2.6B during a year, study says,” United Press International, April 12, 2019).

According to the study, which was published in JAMA Network Open, a 1% drop would have median savings of $25 million for states each year, with California leading at more than $630 million.

The researchers looked at state-by-state rates of Medicaid recipients who also smoked. They figured that reducing smoking in that group by 1% would lower per-capita health care spending by 0.118%.

Researchers estimate that 15% of U.S. Medicaid costs are attributable to cigarette smoking. Fourty-six percent of working-age Ohio Medicaid enrollees were current smokers in 2017.

Ohio Senate considers banning smoking in cars with young children

Ohio lawmakers are considering a law banning drivers from smoking if there’s a passenger in the car under the age of 6 (Source: “Ohio may ban smoking in cars with young children,” Dayton Daily News, March 19, 2019).

Senate Bill 78, sponsored by state Sen. Tina Maharath, D-Canal Winchester, proposes a $500 fine for violators of the law, and for subsequent violations be fined $500 plus $250 for each additional violation.

The bill has been referred to the Senate Judiciary Committee. Similar bills have been considered in prior  legislative sessions. The law has been promoted to protect children from the health consequences of second-hand smoke, which can lead to asthma, ear infections and other health problems.

Ohio has a poor record when it comes to children exposed to the health risks of secondhand smoke. Ohio ranked 49th on the percentage of children who live in a home where someone uses tobacco and smokes inside the home, according to the Health Policy Institute of Ohio’s 2017 Health Value Dashboard. The 2019 Health Value Dashboard is set to be released early next month.

Studies: Life expectancy down in U.S., other wealthy countries

Life expectancy is declining in high-income countries worldwide, driven in part by the effects of the opioid epidemic on younger adults in the U.S., two new studies suggest (Source: “Life expectancy declines seen in U.S. and other high-income countries,” Reuters, Aug. 22, 2018).

Life expectancy is a measure of the health and wellbeing of a population. Widespread or sustained declines in life expectancy may signal problems in a nation’s social and economic conditions or in the provision or quality of its healthcare services, researchers write in The BMJ (formerly the British Medical Journal). 

The first study looked at trends across 18 high-income countries and found that most countries experienced declines in life expectancy in 2015. Out of 18 countries in the study, 12 experienced life expectancy declines among men and 11 experienced life expectancy declines among women.

In the U.S., the source of reduced life-expectancy was concentrated at younger ages, particularly deaths among those in their 20s and 30s, and largely driven by increases in drug-overdose deaths related to the nation’s ongoing opioid epidemic.

A second study in The BMJ suggests, however, that the problems driving life expectancy declines in the U.S. are broader than just the opioid crisis and may extend to a wide range of causes unrelated to drug use or substance abuse.

“A leading cause is fatal drug overdoses - fueled by the opioid epidemic - but we make a mistake if we focus only on the drug problem, which is just the tip of the iceberg,” said lead study author Dr. Steven H. Woolf of Virginia Commonwealth University in Richmond. “Deaths from alcoholism and suicides have also increased, what some call deaths of despair.”

Study: More than a third of Americans take medication that can cause depression

Over one-third of Americans take at least one prescription drug that lists depression as a potential side effect, a new study reports, and users of such drugs have higher rates of depression than those who don’t take such drugs (Source: “Common Drugs May Be Contributing to Depression,” New York Times, June 13, 2018).

According to the study published in the Journal of the American Medical Association, many patients are taking more than one drug that has depression as a side effect, and the study found that the risk of depression increased with each additional such drug taken at the same time.

About 200 prescription drugs can cause depression, and the list includes common medications like proton pump inhibitors (P.P.I.s) used to treat acid reflux, beta-blockers used to treat high blood pressure, birth control pills and emergency contraceptives, anticonvulsants like gabapentin, corticosteroids like prednisone and even prescription-strength ibuprofen. Some of these drugs are also sold over-the-counter in pharmacies.

Dima Mazen Qato, an assistant professor and pharmacist at the University of Illinois at Chicago who was the lead author of the paper, acknowledged that there are still “a lot of unanswered questions,” and that the study only points to a correlation, not a cause-and-effect relationship. 

“We didn’t prove that using these medications could cause someone who was otherwise healthy to develop depression or suicidal symptoms. But we see a worrisome dose-response pattern: The more of these medications that have these adverse effects that you’re taking concurrently, the higher the risk of depression,” Qato said.

Meal delivery linked to fewer ED visits, lower costs, study finds

Providing home-delivered meals to food insecure people may decrease healthcare spending, according to a study published by Health Affairs (Source: “Study: Meal delivery programs linked to fewer emergency visits, lower costs,” Becker’s Hospital Review, April 3, 2018).

For the study, researchers examined data for members of a Boston-based nonprofit healthcare organization that serves adults ages 21 to 64 who are dually eligible for Medicaid and Medicare.

Researchers found medically tailored meals program participants experienced fewer emergency department visits, inpatient admissions and emergency transportation use compared with nonparticipants. They said nontailored food program participants also saw fewer ED visits and emergency transportation use, but not fewer inpatient admissions.

Additionally, both the medically tailored meal program and the nontailored food program were associated with lower medical spending, according to the study. The estimated average monthly medical spending per person was $843 for the medically tailored meals program compared with $1,413 for nonparticipants. For the nontailored food program, it was $1,007 for participants and $1,163 for nonparticipants.

"These findings suggest the potential for meal delivery programs to reduce the use of costly healthcare and decrease spending for vulnerable patients," the study authors concluded.

County Health Rankings spotlight link between health and wealth in Ohio

The University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation released the latest edition of the County Health Rankings & Roadmaps this week (Source: “Wealth means health in Ohio rankings,” Columbus Dispatch via Canton Repository, March 15, 2018).  

Once again the counties rated the healthiest in Ohio were also among the state’s most affluent. Delaware County was the healthiest county in Ohio in 2017, a title it has held for eight of the nine years that the rankings have been issued.

Four of the five healthiest counties are affluent suburban areas. The bottom five, with Adams ranked the lowest at No. 88, are among Ohio’s most impoverished Appalachian counties. In a statement accompanying the release of the national report Wednesday, RWJF’s president acknowledged the clear link between poverty, other social factors and poor health outcomes.

“We can’t be a healthy, thriving nation if we continue to leave entire communities and populations behind,” said Dr. Richard Besser, the foundation’s president and CEO.

This year’s report also shows that gaps in health persist not only based on geography, but also by race and ethnicity. HPIO recently launched a new resource page on health equity. The web page is the first in a series of health equity products that HPIO, through support from County Health Rankings and Roadmaps, will be releasing throughout 2018 to bridge the gap in knowledge and understanding of the issue.

Study: Lead exposure accounts for 10 times more deaths than reported

A study published this week found that lead exposure may be responsible for up to 10 times more deaths in the U.S. than previously thought (Source: “Study: Lead Exposure Linked to 10 Times More Deaths Than Reported,” U.S. News and World Report, March 13, 2018).

The study, published in the journal The Lancet Public Health, concluded about 400,000 deaths per year can be attributed to lead, a much higher number than previously reported.

Included in these deaths is 256,000 annual deaths from cardiovascular disease. The researchers found that individuals with a blood lead concentration at the 90th percentile had a 70 percent increase in cardiovascular disease mortality compared to those with a blood lead concentration at the 10th percentile (1.0 microgram per deciliter), which suggests lead exposure could be an overlooked contributing factor to this cause of death.

The researchers wrote even "low-level lead exposure is an important, largely overlooked, risk factor for deaths in the USA, particularly for cardiovascular disease deaths." They also concluded the estimated number of deaths attributable to lead were comparable to the number of deaths from tobacco smoke exposure.

Ohio near bottom in national wellbeing ranking

Ohio once again ranks near the bottom in a national scorecard of health and wellbeing (Source: “Ohio ranks low on wellness survey,” Dayton Daily News,  Feb. 14, 2018) 

Using a survey of more than 2.5 million Americans, The Well-Being Index ranks states based on factors such as whether its residents like what they do every day; have supportive relationships, financial security and a positive community environment; and report having good health.

Ohio ranks sixth from the bottom among the 50 states. South Dakota ranks No. 1 and West Virginia has the lowest ranking.

The overall score for the U.S. on the index dropped in 2017 from 2016. The report said it is the largest year-over-year decline in the 10-year history of the the index and no state showed statistically significant improvement compared to the previous year.