Good Carbs v. Bad Carbs

02/05/2010, 03:02 by Joseph Pepe, Jr.

Good_Carbs__Bad_Carbs_by_saturninenights

I was enjoying lunch with a friend a few weeks ago when he took a swig of his soda, read the nutrition facts and said in a puzzled manner “37 grams of carbohydrates. That seems like a lot. What exactly are carbs?”

“The enemy,” I quipped.

Now, this was merely a split-second, subconscious response that needs clarification. So by all means, I beg your pardon. Carbohydrates are not necessarily our adversary, and can in fact be our friend, but only if we understand the difference between “good carbs” and “bad carbs.” Let me explain.

Carbohydrates are essentially sugars or starches that provide energy for our bodies. Sounds good right? Not so fast! “Bad carbs” are high in glucose and, when consumed, cause a quick spike in our blood-sugar levels. This causes our pancreas to pump out insulin to deal with the excess blood sugar. The insulin then disperses the glucose and our blood sugar levels fall, causing us to be hungry again! I’m sure you’ve experienced this without even knowing it. Remember last week when you ripped through that bag of Cool Ranch Doritos, like Sasquatch attacking Jack Link’s Beef Jerky? Or how about when you had the urge to eat that Rocky Road ice cream with a shovel? Excuse my hyperbole, but these cravings are a result of the quick rise and fall of our sugar levels. Bad carbohydrates are very high in sugar and white flour and include: candy, baked foods, ice cream, white pasta, breads, and sodas. These carbohydrates, while tasty, can often lead to obesity, heart disease and diabetes.

Good carbohydrates, however have a low glycemic index and are generally high in fiber, and rich in vitamins, minerals, and nutrients. These carbs raise our blood glucose levels in a much slower and sustained manner, avoiding the spike that leads to more cravings. These carbs, especially those high in fiber, are essential to our everyday diet. They supply our bodies with energy and help to lower our cholesterol. We want our bodies to take energy from carbs because if no carbs are consumed, our protein intake will be unnecessarily used for energy, diminishing their benefits for muscle growth. Good carbohydrates include: fruits, vegetables, sweet potatoes, brown rice, beans, nuts, whole grain cereals and oat meal.

Now you may still crave that pint of ice cream, but it will be less intense and instead of grabbing the shovel, you’ll just take out a spoon. Consciously replace “bad carbs” with “good carbs,” and you’ll decrease your cravings and feel more energy. Oh, and those jeans will fit again!

About Our Celebrity Blogger. Joseph Pepe, Jr. serves as the Director of Project Development for Planet Fitness.  He oversees the Personal Training and Nutrition Department for 14 locations throughout CT.  He is also the Managing Director for the Lose It! Weight Loss System (www.loseitweightloss.com).  Joe received his B.A. in Economics from Wesleyan University. And since he’s our health and fitness guru, lets give him a plug as a athlete in his younger years as an All-NESCAC and Academic All-NESCAC Football Selection at Wesleyan. Go Cardinals!!

Stressed? I Bet you’re Grinding…

01/22/2010, 10:01 by Ryan Finnegan, DMD

Note to the Reader: This is the first in our celebrity blogger program on dentistry!

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So I guess I’ll start this blog with something I’m seeing more and more of at the office.  Do you ever wake up with headaches? neck pain? are your teeth sensitive to hot and cold?   You, like many of my patients, may be grinding your teeth.  Typically, when I ask a patient, “Do you grind your teeth?” they either tell me they have no idea whether they do or don’t or immediately say NO for fear I’m going to yell at them.  First things first, your dentist is not going to yell at you for grinding your teeth, but he wants to treat you properly.

So why do we grind our teeth?  STRESS.  It’s the body’s subconscious way of dealing with stress.  Perfect example of what we see: College student who has never had a cavity in their life comes in over christmas break complaining that they have had sensitive teeth a few weeks back.  They’ll report that it was very uncomfortable but has gotten better- can anyone say finals???  As we know stress has been increasing for a lot of us lately, worries about the economy, our job security, our mortgage, etc…  And we have seen many more patients who are clenching their teeth.  How does stress make your teeth hurt?  Basically there are 2 effects of grinding: tooth sensitivity or jaw pain/headaches.  The tooth sensitivity comes from the teeth being ground together, this will cause inflammation of the nerve inside the tooth and the patient will experience sensitivity.  The headaches / jaw pain are result of overuse of the muscles of the face, these muscles are contracted when we are grinding.  I tell people to imagine how their kness and legs would feel if they were jogging for 6 hours…

So what to do?  Diagnosis can be difficult because everyone’s symptoms are different and other factors can present the same way.  So step one is to see your dentist to rule out a tooth infection, cavity or other dental issue.  Treatment usually will consist of a nightguard, an anti-inflammatory [medication], possible a muscle relaxant in severe cases.  Other treatments that have proven effective for long term treatment of stress relief are therapeutic massage, acupuncture, and a few cases may need to be addressed surgically.

About Our Celebrity Blogger. Ryan Finnegan is a partner in a 35-year old private practice in Branford, Connecticut.  Completing his undergraduate work at Fairfield University, Dr. Finnegan attended the University of Connecticut School of Dental Medicine where he earned his DMD.  The good doctor continued his studies with a dental residency at SUNY Stony Brook. (Little interesting tid-bit: He eats lunch at the same time, in the same place, with the same person, every Sunday. No, it’s not his wife. And yes, more often than not, he orders the same dish!)

There is no “I” in team!

01/20/2010, 10:01 by Kevin Aniskovich

swish

My old high school basketball coach used to drive home the belief that every player had an important role within the program – regardless of how much they played.  Whether you were a starting point guard or a bench-riding, green shirt-wearing, never-gonna-get-in-a-real-game, practice player, the plan was simple – show up early, know your role and play it to the best of your ability.  Oh, and you shouldn’t make any mental errors either.  ;-)

The idea was, if an individual focused on the role granted to them, the program would be competitive.  As a teenager in a strict program, that philosophy got old, or at least confusing, real fast.  What the teenager can’t see is what we all know today to be true in business, that “the whole is greater than the sum of its parts.”  It’s a very non-egotistical way of viewing your role in the world.

In sports, families, or in an industry as complex as health care, no single individual can provide expertise on every issue.  Don’t get me wrong, there are plenty of people out “there” who think they can, but that’s simply an inflated ego at work.  Successful and thoughtful organizations rely on a team of specialists to ensure an accurate knowledge base.  Intelecare is no different.  Relying on a diverse group of individuals to ensure our products and services reflect the needs of the markets we serve – whether they be the patient or a managed care organization – Intelecare values its diversity.  In order to make this blog worth our readers’ time, energy and effort, we are going to let those expert voices be heard!

Beginning this Friday, we will have celebrity bloggers (and yes, I am getting razzed about using this term) contributing on a weekly basis.  Representing dentistry, the law, pharmaceutical marketing, hospitals, employee benefits, mental and substance abuse disorders, nutrition and more!  We are even going to work in discounts and freebies when it makes sense.

From our inception, we’ve listened to the opinions of people to mold our offerings.  Our blog is no different.

Thanks for reading and I look forward to your comments and suggestions as to how we can continue to evolve and make this blog, well, relevant for you.

Let It Begin (Again!)

01/14/2010, 10:01 by Kevin Aniskovich
Intelecare's Alex Sicre

Intelecare's Alex Sicre

When Intelecare decided to enter the social media space with its first blog entry in 2007, I was less than bullish on the idea.  I suppose it was just a fear of the unknown – a suspicion of the efficacy or usefulness of something I just didn’t understand.  But nearly 3 years later, Intelecare boasts a presence on Facebook and Twitter, is a biscuit away from launching various consumer-centric videos and a weekly Podcast (also available on YouTube) and, today, a resuscitated blog in honor of the man who started it all – Alex Sicre.

Alex was a thoughtful, poignant writer.  He loved research and, indeed, spreading the good word about all things he believed in.  His commitment to the idea that educating patients and caregivers through organic, grassroots approaches would result in better, more viable outcomes, was spot-on.  In the time since Alex’s passing in November 2008, he has left us a legacy of kindness and thought-provoking work as we continue the battle to increase medication adherence.

In the past year, Intelecare has broadened its member base and increased its work with managed care organizations, pharmacies and pharmaceutical companies.  Launched a completely overhauled user experience and continued to increase the number of patients using the Intelecare system – all during this volatile economic climate.  In that same time frame we lost touch with that grassroots philosophy that Alex championed to educate a community about the negative effects of non-adherence.  That ends today.

Alex’s work at Intelecare immersed him in the issues of non-compliance, but even he struggled with adherence to his medication regimen.  If medication adherence was difficult for someone like Alex, imagine how trying it can be for patients and caregivers whose busy lives pull them in multiple directions without a direct understanding of the ramifications of non-adherence?  Make no mistake about it, non-adherence is America’s biggest drug problem.

I am reminded of the statistics everyday:

  • 1 out of every 2 people are non-compliant
  • $300 billion in costs to the healthcare system with far reaching health and socio-economic implications
  • $47 billion in hospitalization costs directly attributed to non-adherence

The statistics are daunting, but we can change them.  We can increase adherence and persistency.  At Intelecare, we believe our communications hub permits results based on a preference-based reminder.  Our approach to communications is paradigm-shifting that includes reminders but provides education, rewards and, ultimately, home delivery of medications with a click of a button.

Please join the entire Intelecare family in making this goal of increasing medication adherence a reality today.

Wikipedia Entry for Compliance (Medicine)

11/12/2008, 10:11 by Alex Sicre

I was reading Todd Defren’s PR Squared blog post today about Wikipedia, and if a company should or should not create an entry for themselves. It got me thinking more about Wikipedia, and using it as a go to source for information.

I do not use Wikipedia regularly, however I find increasingly useful for trivial information, such as who is Lonelygirl15, since I missed all the YouTube ballyhoo.

I think UGC (user generated content) is fantastic, however I do not think it is always an authoritative source. With that in mind, I looked up the my favorite terms: medication adherence, medication non-adherence, medication compliance and medication non-compliance. The only listing was Compliance (Medicine).

From the Wikipedia entry:

“Compliance (or Adherence) is a medical term that is used to indicate a patient’s correct following of medical advice. Most commonly it is a patient taking medication (drug compliance), but may also apply to use of surgical appliances such as compression stockings, chronic wound care, self-directed physiotherapy exercises, or attending counselling or other courses of therapy.

Patients may not accurately report back to healthcare workers because fear of possible embarrassment, being chastised, or seeming to be ungrateful for a doctor’s care.

Causes for poor compliance include:
• Forgetfulness
• Prescription not collected or not dispensed
• Purpose of treatment not clear
• Perceived lack of effect
• Real or perceived side-effects
• Instructions for administration not clear
• Physical difficulty in complying (e.g. opening medicine containers, handling small tablets, swallowing difficulties, travel to place of treatment)
• Unattractive formulation, such as unpleasant taste
• Complicated regimen
• Cost of drugs”

The listing goes on to discuss “Adherence: An estimated half of those for whom medicines are prescribed do not take them in the recommended way. Until recently this was termed “non-compliance”, and was sometimes regarded as a manifestation of irrational behavior or willful failure to observe instructions, although forgetfulness is probably a more common reason. But today health care professionals prefer to talk about “adherence” to a regimen rather than “compliance”….”

And “Drug Compliance: It is estimated that only 50% of patients suffering from chronic diseases in developed countries follow treatment recommendations….”

And “Concordance: Concordance is a current UK NHS initiative to involve the patient in the treatment process and so improve compliance….”

Overall it is a great listing. Wikipedia (rather the authors & editors) address the causes, the percentage of patients who are non-adherent, and the differences between adherence and compliance and concordance.

I guess I will have to live the listing title: Compliance (Medicine).

Phillips Develops The iPill

11/11/2008, 10:11 by Alex Sicre

Sorry to have been off on posting over the last week. I came across this article in Reuters that I found interesting, and slightly scary. We want develop the best method for increasing medication adherence, but is this the way?

What do you think?

AMSTERDAM (Reuters) – Dutch group Philips has developed an “intelligent pill” that contains a microprocessor, battery, wireless radio, pump and a drug reservoir to release medication in a specific area in the body.

Philips, one of the world’s biggest hospital equipment makers, said Tuesday that the “iPill” capsule, measures acidity with a sensor to determine its location in the gut, and can then release drugs where they are needed.

Delivering drugs to treat digestive tract disorders such as Crohn’s disease directly to the location of the disease means doses can be lower, reducing side effects, Philips said.

While capsules containing miniature cameras are already used as diagnostic tools, those lack the ability to deliver drugs, Philips said.

The “iPill” can also measure the local temperature and report it wirelessly to an external receiver.

The company plans to present the “iPill” at the annual meeting of the American Association of Pharmaceutical Scientists (AAPS) in Atlanta this month.

The iPill is a prototype but suitable for serial manufacturing, Philips said.

(Reporting by Niclas Mika; Editing by Greg Mahlich)

Today’s Abstract

11/11/2008, 10:11 by Alex Sicre

Today’s medication adherence related abstract, “Supporting the Patient’s Role in Guideline Compliance: A Controlled Study”, comes from The American Journal of Managed Care, and even has a link to the full article.

Objective: Clinical messages alerting physicians to gaps in the care of specific patients have been shown to increase compliance with evidence-based guidelines. This study sought to measure any additional impact on compliance when alerting messages also were sent to patients.

Study Design: For alerts that were generated by computerized clinical rules applied to claims, compliance was determined by subsequent claims evidence (eg, that recommended tests were performed). Compliance was measured in the baseline year and the study year for 4 study group employers (combined membership >100,000) that chose to add patient messaging in the study year, and 28 similar control group employers (combined membership >700,000) that maintained physician messaging but did not add patient messaging.

Methods: The impact of patient messaging was assessed by comparing changes in compliance from baseline to study year in the 2 groups. Multiple logistic regression was used to control for differences between the groups. Because a given member or physician could receive multiple alerts, generalized estimating equations with clustering by patient and physician were used.

Results: Controlling for differences in age, sex, and the severity and types of clinical alerts between the study and control groups, the addition of patient messaging increased compliance by 12.5% (P <.001). This increase was primarily because of improved responses to alerts regarding the need for screening, diagnostic, and monitoring tests.

Conclusion: Supplementing clinical alerts to physicians with messages directly to their patients produced a statistically significant increase in compliance with the evidence-based guidelines underlying the alerts.

(Am J Manag Care. 2008;14(11):737-744)

MY COMMENTS
I am always pleased when another study confirms that patient messaging improves patient compliance. Especially with the rising cost of healthcare, every preventative step should be taken to ensure patients have the best data about their care and their risks.

It is troubling however that the patient messaging was in the form of letters that had a 10 business day delay from the doctor getting the notification “to allow physicians to contact their patients first, if they choose, or to indicate via fax or phone that there are clinical reasons why alerts do not apply (eg, an allergy not revealed by claims data)”. This study did take place in 2006, and I am surprised they did not use email messaging as well.

Here is an exampled of the alert for the doctor:
Your patient is at least 55 years old, has claims evidence for diabetes, has an additional cardiovascular disease risk factor (eg, history of cardiovascular disease, dyslipidemia, microalbuminuria), and has no claims evidence for an angiotensin-converting enzyme (ACE) inhibitor. The American Diabetes Association recommends that, in these patients, with or without hypertension, an ACE inhibitor be considered to reduce the risk of cardiovascular events. If your patient fits this clinical profile, and if not already done or contraindicated, consider starting an ACE inhibitor and titrating the dosage as tolerated.

Here is an example of the patient alert:
• Our data show that you may have diabetes.
• If you have diabetes, it may help you to take a type of drug
called an ACE inhibitor.
• You may not be taking this drug.
• Ask your doctor if you should take an ACE inhibitor.

Now with that 10 day delay the doctor can reach out to the patient and suggest a medication. The reinforcement from the health plan helps the patient adhere with the doctor’s recommendation. Same applies for screenings, diagnostic and monitoring tests.

This also raises the question: “My insurer told me to get this test or take this pill. If I do not do it, will they deny claims in the future?”

Would you have this fear if your health plan was monitoring your adherence based on claims data? Would you prefer a 3rd party to deliver these messages?

Please let me know your thoughts.

Thanks!

The Great American Health 2.0 Motorcycle Tour

11/05/2008, 10:11 by Alex Sicre

Thanks to ScribeMedia for allowing me to embed this great video from David Kibbe, Director of the Center for Health Information Technology, American Academy of Family Physicians.

Dr. Kibbe hit the road earlier this year to produce (with Scribe) this documentary about Health 2.0. He rode his Honda Gullwing up and down the East Coast, interviewing some of the players in the H20 space, many of which I have blogged about. Included are interviews with the CEOs of MedHelp, Healthline, Hello Health, Patient’s Like Me, American Well and change:healthcare.

Two other interviews I enjoyed: New York Times Well blogger Tara Parker-Pope who doesn’t like the term Health 2.0 because it connotes a software package; and a CVS Minute Clinic RN who is not only providing patients with quick diagnoses in the pharmacy, but also encouraging and setting-up PHRs for them.

Google also makes an appearance in a quick conversation about, what else, Google Health.

Enjoy!

Real Cost of Medication Non-adherence for Diabetics

10/31/2008, 09:10 by Alex Sicre

So I write about the importance of medication adherence on this blog, on Twitter and speak to people everyday about dangers of medication non-adherence and the affect it has on 50% of the patients in the US.

Recent Guidline research published by MedAdNews found that 6 in 10 Americans are now non-adherent to their medications. Now lets talk about what this really means in cost for diabetes patients and the strain medication non-adherence has on the US healthcare system.

The June 2005 issue of Medical Care, a journal by the American Public Health Association, published a study demonstrating that Diabetes patients who are highly compliant with their treatment programs have a 13% hospitalization risk for a diabetes-related problem, but patients with low compliance have more than twice the risk at 30%.

The same study stated the combined drug and medical costs for the most compliant patients average $4,570, which is almost 50 percent below the $8,867 cost for the least compliant group.

A recent report from the CDC states that diabetes rates are rising in the US. More than 23 million Americans have diabetes, with about 1.6 million new cases diagnosed among adults last year.

So currently, according to all these estimates, 13.8 M diabetics are non-adherent to their medication regimes, and cost the healthcare system $122 BILLION. With proper medication adherence, this figure can be reduced in half.

And this number is only going to go up, with almost 1M non-adherent diabetes added each year at a cost of $8.8 Billion.

And this is for one chronic disease.

There are several factors related to why patients are non-adherent to their medications and I do not mean to beat up on diabetics, but I just wanted to illustrate the real costs associated with not taking medications properly.

Engage With Grace: One Slide Project

10/31/2008, 09:10 by Alex Sicre

Last week at Health 2.0, Alexandra Drane and Matthew Holt launched a movement asking everyone to take two minutes at the end of each presentation to show just one slide. The slide asks if you can answer for yourself and your loved ones 5 simple questions about what you want for care at the end of your or their life.

Matthew and Alexandra ask that you download the slide, start a viral movement, have these conversations and transform end-of-life care. To learn more visit Engage with Grace, where you can download the one slde, register for free, learn how to start the conversation and store your answers to the questions.

The questions are very morbid, but deal with an important issues: will your wishes be followed in the event of a terminal illness, do you have an advocate, where do you want to die, do you have a living will, power of healthcare attorney.

Visit the website, think about these questions, answer them and spread the word.

Thank you.

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