End of life regulation and the role of government agencies in health education

Merry Christmas and Happy New Year to all.

Although I am on vacation this week, I could not resist posting this blog in response to the media frenzy created yesterday as it relates to the proposed “end of life” regulation. The main reason as to why I felt so compelled to blog on this topic is the immoral actions taken by national media in labeling it “death panels”. The proposed new regulation speaks to “end of life issues” where a licensed independent practitioner will be entitled to reimbursement when it is addressed during the course of a consultation. That’s it. No pulling the plug on “grandma” or anyone else.

I recognize that “end of life” is a very sensitive topic subject to cultural, personal, ethical and religious belief. The purpose of this blog is not to offer any position on the right or wrong of sustaining life or withdrawal of life support. The purpose is to educate, those who care to read my blog, that the proposed new regulation is NOT about “death panels’ and to please help me disseminate the right information.

In a television broadcast from December 27^th, 2010, Dr Betsy McCaughey said “Government shouldn't be making brochures and videos about these decisions”. Excuse me Dr. McCaughey but I would like to invite you and your colleagues to review the United States Department of Health and Human Services (USDHHS, 2010) website which clearly explains why certain government agencies should and have a responsibility to educate the public. The USDHHS mission is to “enhance the health and well-being of Americans by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.” There are many ways to provide effective health and human services and within the public health domain, educating our fellow Americans with evidence-based information is certainly part of it. In other words, I disagree with her statement that government should not be making brochures and I would argue that it is part of the public health responsibilities of any government to educate its population. Knowledge does not belong on book shelves, should not only rest in the minds of researchers and elite intellectuals since we have a moral responsibility to share it with everyone.

In this blog I offered my opinion as it relates to the end of life recommendation in the new proposed regulations. I explained the fact that the regulation has nothing to do with “death panels” and it is my hope that you, as a reader, will disseminate this information. I also postulate that it is the responsibility of any government to offer public health education to its constituents.

Nurse Syl  

     

Health Care Reform & Primary Care Physicians

By 2014, an estimated additional 32 million United States (U.S.) citizens will have access to health insurance, either from a private insurer or Medicaid, regardless of pre-existing conditions. This represents a significant increase in potential consumers seeking healthcare. In this blog, I will explore an issue relating to the capacity needs of the U.S. healthcare system resulting from enactment of the Patient Protection and Affordable Care Act (the Affordable Care Act or ACA) such as the availability of primary care physicians. I will also share with you a tip on how to take charge and control of your health as you prepare for your annual visit you’re your primary care provider.

Primary Care Physicians

The ACA includes a number of provisions to stimulate the supply of primary care physicians, such as an increase in primary care residency positions and increase in the Medicaid reimbursement rate to 100% of the Medicare rate for years 2012 and 2013.  How do we know that renewing a primary health care system will positively impact the delivery of care and consumer outcomes? The lessons learned from the Spanish health system may offer us a lesson on how to improve health outcomes in a cost effective manner by focusing on prevention and a solid primary health care approach. In 1978, Spain moved to a tax-based health system that offers universal access to care for the entire population.  A critical part of the transformation was the organization of the system at the local level around primary care teams responsible for health promotion, treatment and community care (Health Affairs, 2010). In the 30 years since the start of reform, Spain has made marked gains in improving population health at low cost relative to the U.S.  In 2007, Spain spent $2,671 per person (8.5% of gross product GDP) on health care as compared to $7,290 per person (16% of GDP) in the United States (Organization of Economic Cooperation and Development, 2009). In addition, the infant mortality is estimated at 4.21 deaths per 1,000 live births in 2010 as compared to 6.22 for the United States (Central Intelligence Agency, 2010).  Could we extrapolate the same results in the United States? The Spanish experience appears to reinforce the importance of primary care to achieving the quality improvement and cost control objectives underlying the ACA; however, it also suggests that the issue goes far beyond ensuring an adequate supply of primary care physicians.  Rather, Spain’s success is based on a complete change in focus where the care is offered and sought within each community.  Are U.S. citizens ready for this cultural change?

I am sure that many of you may know someone who is already having a hard time accessing a primary care provider. In fact, this is happening not only in rural areas but also in some metropolitan areas. As you prepare yourself for a visit to your primary care provider, think about the laboratory testing that he or she may consider for you. For example, when I prepare for my annual visit with my primary care provider, I make sure I obtain all the basic blood work included in a male comprehensive panel (complete blood count (CBC), comprehensive metabolic panel (CMP), lipid panel (cholesterol, HDL and LDL), prostate-specific antigen (PSA), testosterone, Dehydroepiandrosterone Sulfate (DHEA-S), and a urine analysis. I make a point of getting all this blood and urine analysis 7 to 10 days before my appointment so that when I visit with him he has in his hands the results of all this basic work-up and is able to conduct a complete physical exam. Imagine how impressed your primary care provider would be if you did that and how much time you both can save? I would encourage everyone to consider this practice since it also allows you to take charge and control of your health.  

Conclusion

The ACA will offer access to care to more than 32 million American citizens in the very near future. This new law will change the way healthcare is delivered and influence the overall health of the American population. The success of this reform is based on access to primary care; in other words, an expanded and easily accessible system of primary care physicians and advanced practice nurses providing care at the community level. I also invite you to take charge of your own health and share a tip on how to best prepare yourself for your annual exam with your primary care provider. In my opinion Any Lab Test Now located at 5219A W Lovers Ln is an excellent choice to obtain all your laboratory blood, urine, saliva, nail and hair testing.

American Diabetes Month

Did you know that November is American Diabetes Month^®? Yes it is and it is imperative to acknowledge and communicate to everyone about it. There are over 23 million Americans living with Diabetes and over 57 million at risk. The time to act is now. Diabetes is a serious disease and when left untreated is the cause of many health problems such as eye, foot, skin complications, heart disease, high blood pressure, mental illness, hearing loss, neuropathy, kidney disease, peripheral arterial disease, and stroke to name a few.

If you are not affected by Diabetes today, prevention is the key and the best preventive measures suggested by the American Diabetes Association are:

·         CheckUp America to lower the risk of Type 2 Diabetes.

·         Identify you risk factors.

·         Getting and staying active (fitness)

·         Eat healthy

In order to assess your overall risk it is crucial to seek out a professional opinion and I strongly suggest that you discuss this with your primary care provider. You can facilitate the assessment process for your primary caregiver by visiting AnyLabTestNow and obtain a Diabetes Maintenance Panel which includes a complete blood count, a fasting glucose, an hemoglobin A1c and a urinalysis.  In fact, for this month, the Dallas location at 5219A W. Lovers Ln offers a special coupon (see their website).

Welcome to Nurse Syl Blog

SYLVAIN “Syl” TREPANIER, MSN, RN, CENP.

Welcome everyone and thank you for taking the time to read my professional blog. I thought I should simply introduce myself for this first blog. My name is Sylvain “Syl” Trepanier and all my friends call me Syl. I have 20 years of HealthCare experience. I am originally from Montreal, Canada, where I obtained both my bachelor’s and master’s degrees in Nursing from the University of Montreal. I am currently enrolled as a full time student in the Doctorate of Nursing Practice at Texas Tech University, Health Sciences Center, Anita Thigpen Perry School of Nursing.

I have a comprehensive understanding of the healthcare industry from having worked in many roles such as staff registered nurse, clinical instructor / teacher, research coordinator (including published papers and conference presentation), nursing director and chief nursing officer. I have experience in both a socialized healthcare environment as well as for-profit sector.

I currently serve as the Regional Senior Director for a major for-profit healthcare system and I am the co-owner of AnyLabTestNow (ALTN) located at 5219A W. Lovers Ln, Dallas Texas. At ALTN we offer phlebotomy services, DNA testing, comprehensive laboratory analysis from blood, urine and hair sample. No appointments are necessary and we offer EXCELLENT customer service. 

 I also serve on a National Nurse Executive Council, I am an active member of the American Organization of Nurse Executives (AONE), I am a member of the North Texas Nursing School Consortium and I was recently appointed to the AONE Health Care Reform Task Force.

From time to time I will offer my opinion on healthcare related matters and I am hopeful that you will join my conversation or stop by our ALTN location. Have a great day everyone!