30 September 2018 Blog Post: Finding Value at Santa Monica Primary Care

30 September 2018 Blog Post: Finding Value at Santa Monica Primary Care

A funny thing happened today as I logged into our practice’s Facebook page… A prompt appeared that Santa Monica Primary Care’s “Price Range” tab had been re-analyzed and that our cost was better represented by a single dollar sign (‘$’) than the two dollar sign (‘$$’) designation it had previously held.
 
I found this to be timely, for the reason I was logging in was to post about a recent UC Berkeley study showing that consolidation among hospitals and doctors’ practices in California is linked to higher health insurance premiums and higher prices for specialty and primary care.
 
In California, between 2010 and 2016, the percentage of doctors in medical practices owned by hospitals grew from 25 to 40 percent. The shift is associated with a 12 percent increase in Affordable Care Act insurance premiums, a 9 percent price increase for outpatient doctors’ visits in four specialties — cardiology, oncology, orthopedics and radiology — and a 5 percent price increase for primary care office visits.
 
This wasn’t a small study, either. The study’s findings are based on an analysis of nearly 71 million California medical claims between 2011 and 2016 for every county in the state.
 
All across California, large hospital systems are absorbing individual or small group primary care practices. Santa Monica is no exception to this trend. We are proud @santamonicaprimarycare to remain an independent practice. We provide our patients with outstanding and personalized care that cannot be replicated in an institutional setting. The fact that we can do such while provide a great value should make our patients feel twice as good!
Hospital consolidation in California linked to higher health prices

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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20 September 2018 Blog Post: Flu Shots are IN! But Should You Have One? That’s the Question.

20 September 2018 Blog Post: Flu Shots are IN! But Should You Have One? That's the Question.

The 2018/2019 seasonal flu shots have arrived at Santa Monica Primary Care and we have already begun administering them. The most common question I have fielded so far has been “is it going to be as ineffective as last season’s?”
 
This is a reasonable question as the 2017/2018 flu vaccine was about 36% effective overall and varied by age group (I covered this in a February 16th, 2018 post which can be found below). In fact, the CDC estimated that since 2004, the flu vaccine efficacy has ranged from 10% to 60%.
 
So why is it so difficult to get the flu shot right? Part of the reason is that each year the flu vaccine itself is reformulated, based on an educated guess from historical and current circulating viral strains. A vaccine is produced with three or four strains which can be spot on and effective. However, if a virus modifies itself even slightly (a phenomenon called antigenic drift), then virus can evade the vaccine.
 
So why do I stock it, give it and recommend it? Well, even at 40% effectiveness (such as during 2016/2017), the vaccine prevented 5.29 million illnesses, 2.64 million medical visits and more than 84,000 hospitalizations. Further, anecdotally, we saw that last year among our own patients that those who contracted the flu after vaccination had shorter illnesses and less severe symptoms than those who did not get the flu shot at all. So some protection is better than none.
 
There are other measures you can take as well during flu season – for instance, washing your hands multiple times during the day for 20 second with soap and water will help. If you develop symptoms, give our office a call and set up an appointment. We have point-of-care testing for influenza and can tell you right then and there whether or not you have influenza, or another circulating virus.
 
And cover your sneeze or cough! The flu virus can survive on surfaces for up to 48 hours… Yet another reason to take precautions

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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3 September 2018 Blog Post: New Research in August on “Baby” Aspirin

3 September 2018 Blog Post: New Research in August on "Baby" Aspirin

In the past when patients have asked me about the role of a daily low dose or “baby” (81mg) aspirin in preventing a first heart attack or stroke, I have referred to it as “my desert island drug.” To illustrate its relative usefulness, I have gone on to say, “if you are on a desert island, and wanted to take one drug, then it could be a baby aspirin. Sufficient to reduce your risk of heart attack and stroke and at a low enough dose that if you fall out of a coconut tree, then you won’t bleed.”
 
The largest randomized, controlled clinical trial of its kind was undertaken to evaluate utility of daily aspirin in preventing a first cardiovascular event (i.e. fatal cardiovascular event, non-fatal heart attack, unstable cardiac rhythm or TIA/stroke) among more than 12,500 participants considered to be at moderate cardiovascular risk. Participants were randomly allocated to receive a 100 mg enteric-coated aspirin tablet daily or placebo. The were followed for, on average, 60 months. The study was sponsored by Bayer.
Jury still out on aspirin a day to prevent heart attack and stroke

When considering all cardiovascular events combined, a daily aspirin showed no significant effect. The primary endpoint occurred in 269 (4.29%) individuals in the aspirin group versus 281 (4.48%) in the placebo group.

Of interest, aspirin did reduce the risk of total and nonfatal heart attacks. Aspirin accounted for an 82.1% reduction in these events for those aged 50-59 years of age and and a 54.3% reduction in the 59-69 age group. There was no effect of aspirin use on risk of stroke.

Bleeding was relatively infrequent, and when it occurred, was mild and most commonly from the GI tract – 61 (0.97%) individuals in the aspirin group versus 29 (0.46%) in the placebo group. Other commonly reported side effects of aspirin were indigestion, nosebleeds, gastroesophageal reflux disease, and upper abdominal pain.

So it looks as if I will need to amend my “desert island” advice to exclude any risk reduction in stroke. And 1% of you may get a GI or nose bleed falling out of the coconut tree…

In an equally fascinating study published earlier in the month, Canadian researchers suggested that a low dose daily aspirin could reduce HIV susceptibility. So the aspirin story continues on – a century after becoming available.

Manitoba researchers exploring whether Aspirin can be used to help prevent HIV

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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