It's accepted wisdom that 21st century Americans generally mistrust Congress but feel good about their own representatives. Apparently, the same seemingly paradoxical views are true for the medical profession, and in a big way—the US ranks near the bottom among 29 countries in level of trust in the overall medical system, and near the top in satisfaction with individual care.
A study published in the October 23 issue of the New England Journal of Medicine (summary available for free) reports on polling data that show a dramatic drop in Americans' confidence in the medical profession between 1966 and 2014. The decline is significant: in 1966, nearly 3 quarters (73%) of Americans expressed "great confidence in the leaders of the medical profession," but that rate is now 34%.
Americans' lukewarm level of confidence in the medical profession in general puts the US near the bottom of 29 countries surveyed from 2011 to 2013, tied for 24th place with Croatia in terms of the percentage of respondents who agreed with the statement, "All things considered, doctors [in your country] can be trusted." A total of 58% of Americans agreed, putting the US behind countries such as the Philippines (#17), Turkey (#5), and Portugal (#16). Switzerland ranked highest in this category, with an 83% rate of agreement. Only Chile, Bulgaria, Russia, and Poland scored lower than the US.
But in a shift that authors describe as "unique among the surveyed countries," Americans tend to rate their satisfaction with their own medical treatment higher than all but 2 other countries, with 56% of American respondents reporting that they were "completely" or "very" satisfied with their last visit to a physician. Switzerland had the highest rate (64%), followed by Denmark (61%). Lithuania (13% rate) and Russia (11% rate) were at the bottom of the list. Authors note that the rate of institutional trust and personal satisfaction tends to be similar in nearly all countries, and that the US is an "outlier."
Authors of the study write that the lack of trust in the medical institution puts doctors at risk of losing political clout as the future of US health care is shaped.
"If the medical profession and its leaders cannot raise the level of public trust," they write, "they're likely to find that many policy decisions affecting patient care will be made by others, without consideration of their perspective."
Authors suggest that public trust could be improved "if the medical profession and its leaders deliberately take visible stands favoring policies that would improve the nation's health and health care, even if doing so might be disadvantageous to some physicians."
Other findings in the study related to Americans' perceptions:
Americans' steadily increasing rate of walking and biking is definitely good news—but that healthy shift needs to be accompanied by more attention to safety, according to a new initiative from the US Department of Transportation (DOT).
This fall, the DOT launched "Safer People, Safer Streets (.pdf)," an effort to curb a recent uptick in the rate of fatalities among bicyclists and pedestrians, which accounted for 16% of all traffic-related fatalities in 2012.
The initiative will begin with a survey of pedestrian and bicyclists "gaps" across the country—places where safety is compromised by lack of sidewalks or other safety infrastructure. With gaps identified, DOT and its agencies will work with state, local, and private industry partners to help create so-called "road diets" that are more attentive to safe space allocation for pedestrians and bicyclists.
The initiative will also include public education campaigns on safety, according to DOT.
Encouraging healthy, active lifestyles is central to the physical therapy profession's ability to transform society. Keep up with the latest resources at APTA's Prevention, Wellness, and Disease Management webpage.
A Bulgarian man whose spinal cord was completely severed has regained limited mobility and feeling in his lower extremities after a surgical procedure that used nerve-supporting cells taken from his nose. Once completely paralyzed in both legs, he can now walk with a walker and drive a car.
According to an article in the Guardian, Darek Fidyka is believed to be the first person to recover from a complete severing of the spinal cord, an injury he sustained in a knife attack in 2010.
Polish surgeons accomplished the recovery by transplanting olfactory ensheathing cells (OECs) from Fidyka's nose into the severed ends of his spinal cord. The cells connected and allowed nerve impulses to once again travel through the entire spinal cord. The technique was developed by the University College of London's Institute of Neurology.
Although Fidyka's recovery is not complete, 1 of the authors of a study on the procedure published in Cell Transplantationdescribed the technique as one that "opened the door to a treatment of spinal cord injury which will get patients out of wheelchairs," according to an article in the Washington Post.
In the wake of 2 Dallas nurses contracting Ebola from the first person to die of the disease in the US, the US Centers for Disease Control and Prevention (CDC) has issued "tightened" guidance for health care workers interacting with infected patients. The announcement was one of several Ebola-related developments occurring recently.
The new guidelines focus on better training, more extensive personal protective equipment (PPE), and more rigorous monitoring of donning and doffing. The enhanced recommendations are informed by practices at Emory University Hospital, Nebraska Medical Center, and the National Institutes of Health Clinical Center—facilities that have had success in handling patients with the disease. The CDC reports that the guidelines are similar to those developed by Doctors Without Borders.
A story in Modern Healthcare (free access with one-time registration) quotes CDC Director Thomas Frieden as describing Ebola care as "hard," saying that "the way care is given in this country is riskier than in Africa. There's more hands-on nursing care, and there are more high-risk procedures."
CDC is recommending all of the same PPE included in the August 1, 2014, guidance, with the addition of coveralls, disposable hoods, and full-face shields instead of goggles. Also recommended:
The CDC warns, however, that "focusing only on PPE gives a false sense of security of safe care and worker safety," and urges extensive training and practice, as well as a careful monitoring process as health care workers put on and take off PPE.
Other recent Ebola-related developments:
The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) is seeking members with diverse clinical expertise to serve on the Accreditation Services Committee, a group of trained experts who review applications and visit physical therapist education program sites undergoing accreditation.
Members interested in being considered to serve on the committee should complete the application on the ABPTRFE website by November 30, 2014. The Accreditation Services Council will make appointments in December 2014. Notification about appointments will be sent in January 2015.
Appointed members must be available for training at APTA headquarters in Alexandria, Virginia, on March 2, 2015. APTA will reimburse all travel expenses for this meeting.
Sure, if you're reading this you probably get to put "PT" or "PTA" after your name. And maybe you can even add "DPT" or "PhD." But—and be honest here—can you tack on the word "adventurer" after those designations?
Stanley Paris can. And he's getting ready to kick that particular part of his qualifications into high gear.
Stanley Paris, PT, PhD, adventurer, has announced that he will make another attempt to set the age and speed record for solo circumnavigation of the globe by sailboat as a way to raise awareness for the Foundation for Physical Therapy (Foundation) and physical therapy research in general. The adventure is set to begin in early November in St Augustine, Florida. Last year's attempt raised more than $250,000 for the Foundation.
Paris made his first attempt to break the age record of 56 years and the speed record of 150 days in early December 2013, but he suffered equipment failure that prevented him from completing the voyage. Since that time, both records have been broken, with the speed record now set at 137 days, and the age record now 70. If he's successful, Paris will beat the new age record by 7 years.
"I am looking forward to taking on this challenge once again and using this opportunity to raise awareness for the Foundation," said Paris in a Foundation news release (pdf). "We need more research that demonstrates the value of physical therapy, and the Foundation is doing just that."
Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, praised Paris's commitment and generosity and said that his efforts are "important in the Foundation's determination to support research that helps physical therapists improve the quality of life."
Paris will once again sail in his 63-foot yacht, the Kiwi Spirit, a craft that will run solely on wind and solar energy. If successful, Paris will also become the first person to circumnavigate in a completely "green" way—or at least the first person to do so in a really, really long time.
Paris will document his journey, post videos, and provide other information on his Facebook page, www.facebook.com/uofstaugsolo. Visit the Foundation's website to find out how to contribute to physical therapy research.
Healthy People 2020, a US Department of Health and Human Services initiative that establishes goals for improving the health of all Americans, is being updated and needs your input.
The program, which provides a set of 10-year national objectives, has issued proposed new objectives in the areas of arthritis, osteoporosis, and chronic back conditions; early and middle childhood; heart disease and stroke; maternal, infant, and child health; and tobacco use. The objectives include issues around hypertension, chronic pain, and attention deficit-hyperactivity disorder. Participants may review and comment on the proposed objectives.
APTA is a member of the Healthy People Consortium, and will gather comments from member experts to develop a formal response from the association.
Plan on submitting individual comments? Be sure to identify yourself as a PT sharing your own perspectives to avoid confusion with the official APTA response.
The US Office of Special Education and Rehabilitative Services (OSERS) has announced funding opportunities for nonprofits and institutes of higher learning that train individuals to work with children with disabilities, and physical therapy is among the training areas that could qualify for the awards. An estimated 26 awards averaging $237,500 will be made.
The funding is intended to help address state-identified needs for personnel preparation in special education, early intervention, related services, and regular education to work with children with disabilities. Special attention is being focused on ways to ensure that personnel have the necessary skills and knowledge using scientifically based research and experience.
Some of the "Personnel Development to Improve Services and Results for Children with Disabilities—Personnel Preparation in Special Education, Early Intervention, and Related Services" grants will be awarded to projects associated with preexisting education programs in special education, early intervention, or a related field; however, grants may also be awarded to projects associated with various assistant programs—among them physical therapist assistant programs. Primary focus areas include projects that prepare related services personnel, such as physical therapists (PTs), to serve children, infants, and toddlers with disabilities. OSERS intends to fund 8 awards under this focus area.
Other award areas include projects related to preparation for professions in "related" services that include physical therapy.
For details, requirements, and application instructions, refer to the program posting on the Federal Register (pdf).
"Transformative" changes mandated by the Affordable Care Act (ACA) and a slowly recovering economy have contributed to a Medicaid system in which most states are expanding eligibility, adopting delivery system reforms, and increasing community and home-based services, according to a new study from Kaiser Commission on Medicaid and the Uninsured.
The Kaiser report surveyed Medicaid directors in all 50 states and the District of Columbia to gather information on program changes implemented in the 2014 fiscal year or planned for the next year. Authors of the study write that these years "will stand out as a time of significant change and transformation." Among the findings:
While the Kaiser report shows more variation in how states are adjusting provider rates, authors note that generally "more states implemented provider rate increases across most major provider types … inpatient hospital rates being the exception."
"States are expanding their reliance on managed care but also implementing new innovative delivery systems and care coordination arrangements, some of which are new options made available by the ACA," according to the authors. In turn, this expansion could be putting some programs to the test, with most directors "report[ing] staffing and resource constraints in the face of the magnitude of the changes occurring in the program today."
Keep up with Medicaid as it continues to evolve: check out APTA's Medicaid webpage for resources, including a members-only guide titled "Making Sense of Health Care Reform: Medicaid Expansion."
The American Medical Association's (AMA) latest ratings of health insurance competitiveness across the United States finds that in 17 states, a single health insurer commands 50% or more of the market in each state, and that in 45 states 2 insurers have captured over half or more of each state’s share.
The AMA's Competition in Health Insurance: A Comprehensive Study of US Markets (summary available for free) uses commercial enrollment data from 2012 to create lists of the country's most and least competitive states for insurance companies, and to assess competitiveness in 388 metropolitan areas.
The 10 least-competitive states are, in order, Alabama, Hawaii, Michigan, Delaware, Louisiana, South Carolina, Alaska, Illinois, Nebraska, and North Dakota. States that have the most competitive markets are, in order, Oregon, Wisconsin, Pennsylvania, New York, Colorado, Missouri, Washington, Ohio, California, and Florida.
The AMA analysis of metropolitan areas found a "significant absence" of competition in 72% of the areas studied, and identified a single insurer as capturing 50% or more of the market share in 41% of the areas.
Overall, Wellpoint Inc was found to be the largest insurer in most markets, with a "commanding position" in more than 20% of metropolitan areas—more than double the number of the next 2 largest insurers, Health Care Services Corporation and UnitedHealth Group.
Carmen Elliott, senior director of payment and practice management at APTA, thinks the shrinking competitiveness contributes to a larger picture of insurers looking to reduce costs and control utilization.
"The lack of competition is a reality," she said. "At the same time, insurers are trying to keep costs down by doing things like narrowing the network of providers covered by the system, increasing copays and deductibles, and implementing utilization management programs. The insurers argue that some of these efforts, like the shift of a greater payment burden to patients, will make consumers more accountable around health care costs and lifestyle choices, but the real challenge is to reduce costs while ensuring high-quality care. That can be a difficult balance."
Keep up with the insurance industry as it continues to evolve. Check out the APTA Private Insurance webpage to find resources including toolkits, videos, podcasts and FAQs on topics ranging from payment methodologies to patient and client advocacy.
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