Jennifer Anyaegbunam is a Fellow at The American Resident Project. Her post appears on THCB as part of The Health Care Blog’s partnership with ThinkWellPoint. Stay tuned for more. Follow the American Resident’s Project on Twitter @Amresproj.
I’ve spent the past four weeks learning about primary care on my Family Medicine rotation. A significant portion of patient care in this setting is focused on “health maintenance” or disease prevention.
Physicians can provide their patients with evidence-based recommendations for various screening tests and vaccinations, but it is ultimately up to the patient to decide what services he or she will receive.
According to the Centers for Disease Control and Prevention (CDC), the best way to prevent influenza, more affectionately called “the flu,” is to get vaccinated each year. During flu season, which extends from October to May, many primary care physicians offer their patients the flu shot as a routine part of their health maintenance.
Over the past month I’ve had a number of interesting conversations about the flu shot that have allowed me to evaluate my role as an educator. How do you assess patient understanding? How hard do you need to drive certain points? Will patients perceive you as bossy or overbearing?
I respect my patients’ right to choose, but sometimes I’m concerned that they make choices based on fiction rather fact. It’s been quite a challenge learning how to debunk misconceptions, without seeming too pushy.
This week I helped care for an elderly woman named “Ms. Jade.” She visited the office for a follow up visit to manage her hypercholesterolemia, or high cholesterol. After discussing her chronic condition, I took the opportunity to assess her health maintenance and check if she was up-to-date with all the assessments recommended for a woman of her age.
Ms. Jade was on track with everything from her annual vision screening to her colonoscopy. The only preventive health maintenance item she was missing was the flu shot. Her chart read “flu shot advised 2012, declined,” meaning that she was offered the flu shot last year and opted not to take it.
This week the Centers for Disease Control and Prevention will kick off its annual campaign aimed at reducing the overuse of antibiotics, drugs that one by one are becoming useless in the war against antibiotic-resistant microbes.
The CDC campaign – “Get Smart: Know When Antibiotics Work” – urges consumers to use these drugs sparingly and many Americans have taken that message to heart. Recent data from the CDC show that antibiotic use is leveling off in the United States. In 1994, 300 out of every 1,000 pediatric office visits resulted in an antibiotic prescription. By 2007, that number had fallen to 229, a 24 percent decrease. However, interactive maps by Extending the Cure, a research project of the Center for Disease Dynamics, Economics & Policy, show regional disparities in the use of antibiotics, including very high consumption in some Southeastern states.
These findings can and should be used by public health officials to understand why certain regions show high patterns of consumption and then put in place solutions, including public education campaigns tailored to stop the overuse of these powerful drugs.
The new research reveals a high rate of antibiotic use in some Southeastern states and much lower rates in the Pacific Northwest, compared to the rest of the country. West Virginia and Kentucky had striking rates of antibiotic use: People living in those states took twice as many antibiotics as people living in states like Oregon and Alaska.
High rates, like those seen in the southeastern United States, might reflect an environment in which consumers are anxious to get an antibiotic prescription for a case of the flu – and doctors are only too willing to comply. But antibiotics do nothing to combat viral illnesses such as common colds or influenza.
A study published in the July issue of Infection Control and Hospital Epidemiology shows that antibiotic prescriptions tend to spike during flu season, even though influenza is caused by a virus and cannot be treated with antibiotics.
Some of these antibiotic prescriptions are justified – bacterial pneumonia, which must be treated with antibiotics, is also common during the winter months. And getting the flu puts you at higher risk for developing complications from secondary infections, including bacterial pneumonia.
Yet some people suffering from the flu virus alone may demand–and get–an antibiotic even though viral infections do not respond to antibiotic treatment.
According to Extending the Cure, a nonprofit project funded by the Robert Wood Johnson Foundation’s Pioneer Portfolio, between 500,000 to one million antibiotic prescriptions are filled each year during flu season for patients who have the flu and no bacterial illness.
Why should we care about how many antibiotics are prescribed?
When antibiotics are overused or inappropriately used, bacteria can develop antibiotic resistance, or the ability to withstand antibiotic treatment, making bacterial infections difficult to treat. Antibiotic resistance can develop quickly. Today’s antibiotics – the wonder drugs that transformed modern medicine – are used so commonly that we face the prospect of a future with a multitude of resistant bacteria and a shelf full of ineffective drugs.