Disease Management Update
Volume V, No. 3
May 15, 2008

Dear Healthcare Intelligence Network Client,

As May 6th marked World Asthma Day, an event organized by Global Initiative for Asthma (GINA) to improve asthma awareness and care around the world, this week's Disease Management Update describes how adolescents' deliberate misuse of inhalers is leading to even greater problems. In addition, researchers from the University of Pittsburgh School of Medicine are on their way to developing more effective drugs for treating asthma and allergic disorders.

Your colleague in the business of healthcare,
Laura M. Greene
Editor, Disease Management Update

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at: http://www.hin.com/dmdesktop/diseasemanagement.html

Table of Contents

  1. Teens Misuse Asthma Inhalers
  2. Disease Management Q&A: Approaching Addictive Case Management
  3. HealthSounds Podcast: Utilizing Medical Homes to Create a Patient-centered Approach to Managing Chronic Conditions
  4. Immune System Pathway Identified to Fight Asthma, Allergens
  5. Survey of the Month: Patient Registries
  6. Waging War on the Cost of Healthcare

1. Teens Misuse Asthma Inhalers

Nearly one out of four teens who use an asthma inhaler say their intent is to get high. Findings from a new University of Michigan (U-M) study identified high levels of asthma inhaler misuse among anti-social youths, who displayed higher levels of distress and were more likely to abuse other substances.

The researchers conducted a survey assessing substance use, psychiatric symptoms and anti-social behaviors among 723 adolescents in 32 residential treatment facilities. About 27 percent of youths who had been prescribed an inhaler used it excessively. In addition, one-third of all youths in the sample had used an asthma inhaler without a prescription.

Asthma inhaler misusers were more psychiatrically distressed and prone to suicidal thoughts and attempts than youths who did not misuse their inhalers to get high, the study shows. Many inhaler abusers reported positive feelings of euphoria, relaxation and increased confidence during or immediately following inhaler use. Adverse reactions noted included increased dizziness, headaches, rapid heartbeat, anxiety, irritability and confusion.

"Our findings indicate that inhaler misuse for the purposes of becoming intoxicated is both widespread and may justifiably be regarded as a form of substance abuse in many cases," said Brian Perron, an assistant professor in the School of Social Work and the study's lead author.

To learn more about this study, please visit:

2. Disease Management Q&A: Approaching Addictive Case Management

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Dr. Richard Citrin, vice president of integrated care management for Corphealth Inc.

Question: As a diabetic nurse educator, I find most behavioral change occurs in the addictive patient. I ask them to look at their disease processes, take some personal responsibility and try to set some goals. Is this DM approach similar to case management by addiction case managers?

Response: (Dr. Richard Citrin) That’s interesting, because people don’t tend to think of the denial process in alcohol and drug dependence as similar to the denial process that occurs for people in DM programs. I suspect addictive case managers use similar approaches, but there are important distinctions. If you deal with addictive patients you have to treat them from a different behavioral perspective. The disease of alcoholism and drug dependence has a significant denial component to it. You want to get those addicted individuals involved in treatment beyond education. If we consider denial in a larger perspective, behavioral modification becomes difficult on the practitioner end if the addicted individual does not perceive, or refuses to see, the problem. It is hard to impact that member’s perspective in terms of alcohol/drug dependence and its relation to health. I am unsure how a health perception model would address that particular approach and how you could change behavior from the member perspective as opposed to our perception of how the member should change.

This health perception approach is the way to tie in the members’ sense of personal health. If they experience poor health separate from their diabetes and cite disease symptoms that impact ability to function successfully, that may be a step toward addressing the core problems. As a case manager, you’ll find that issues like drug dependence and alcoholism are tough to crack in behavior modification programs.

For more details on addiction, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. HealthSounds Podcast: Utilizing Medical Homes to Create a Patient-centered Approach to Managing Chronic Conditions

In this week's disease management podcast, Elizabeth Reardon, a consultant with Commonwealth Medicine in Massachusetts, explains how patients' families and communities have clear-cut responsibilities in the patient-centered "medical home" model. Healthcare organizations can draw parallels from Ed Wagner's chronic care model and learn from the groundbreaking work pediatricians have done to assure continuity of care for children with special healthcare needs. She suggested tactics and resources for drawing families and communities into the medical home model.

To listen to this complimentary HIN podcast, please visit:

4. Immune System Pathway Identified to Fight Asthma, Allergens

Researchers from the University of Pittsburgh School of Medicine (UPSM) have identified genetic components of dendritic cells that are key to asthma and allergy-related immune response malfunction. Targeting these elements could result in more effective drugs to treat allergic disorders and asthma.

Dendritic cells are vital to immune response in that they recognize, capture and introduce threatening organisms to T lymphocytes — other immune cells that secrete potent proteins called cytokines that surround and destroy the invaders. However, the Pittsburgh team’s study goes further to illuminate a pathway that allergens use to act directly on dendritic cells to propel differentiation into the T lymphocytes that fight back.

“We now have identified a molecule, c-Kit, that is central to the process of allergic response,” said Anuradha Ray, Ph.D., co-corresponding author and professor of medicine and immunology in the Division of Pulmonary, Allergy and Critical Care Medicine, UPSM. “We show that genes encoding for c-Kit and the cytokine interleukin 6 (IL-6) are significantly activated when allergens are present, but c-Kit is the very first molecule that gets triggered.”

To view more of this study's findings, please visit:

5. Survey of the Month: Patient Registries

Many healthcare organizations use patient registries to create a realistic view of clinical practice, patient outcomes, safety and comparative effectiveness and to support evidence development and decision-making. Complete our online survey on patient registries by May 31, and you'll receive a free summary of the results.

To participate in this survey and receive its results, please visit: http://www.surveymonkey.com/s.aspx?sm=5OTbdp3eEaksGtQNlOyqyA_3d_3d

6. Waging War on Cost of Chronic Disease

This white paper discusses the prevalence of chronic diseases, points out key elements necessary in a successful disease management program, and outlines the Beyond Disease Management program. Also highlights outcomes experienced by American Health clients: drastic reductions in members’ overall ER visits, hospitalizations and absenteeism, and disease-specific clinical outcomes.

To download this complimentary white paper, please visit:
Please forward this news announcement to your colleagues who might find it useful.
Contact HIN: For more information on the products and services available through the Healthcare Intelligence Network, contact us at (888) 446-3530 / (732) 528-4468, fax (732) 292-3073 or email us at info@hin.com.
All contents of this message Copyright 2008