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December 9, 2010 Volume VII, No. 22

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Quitting smoking can help to improve mental health by reducing symptoms of depression, according to a study highlighted in this week's issue. Learn more about this study as well as another population at risk for depression.

What are the three main influences of high blood pressure? Find the answer in this week's issue.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Depression Risk & Menopause
  2. High Blood Pressure Influences
  3. Physician Practice Redesign
  4. Engaging Clients and Sustaining Motivation
  5. Conditions Tied to Readmissions
  6. Targeting Depression Through DM
  7. Quitting Smoking & Mental Health
  8. Reducing Hospital Readmissions in 2010

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Please send comments, questions and replies to jpapay@hin.com.

Publisher:
Melanie Matthews, mmatthews@hin.com

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Young Women with Menopause-like Condition at Risk for Depression

Young women with the menopause-like condition primary ovarian insufficiency (POI) are much more likely than other women to experience depression at some point during their lives, according to a study from the National Institutes of Health. The finding suggests that all women diagnosed with the condition should be evaluated for depression. Depression is a serious medical illness affecting the brain. Symptoms include persistent feelings of sadness, difficulty sleeping or over sleeping, energy loss and feelings of worthlessness. POI results in a menopause-like condition years before normal menopause begins — sometimes as early as the teens or twenties. Women with POI stop producing normal amounts of reproductive hormones, develop hot flashes and typically become infertile.

Over a period of nearly five years, the researchers asked 174 women with POI to respond to a standard set of interview questions on past or current incidents of major, minor or long-term depression. The women also were asked when they were diagnosed with POI and when they first noticed the pattern of irregular menstrual cycles believed to signal the onset of POI. It was found that 67 percent either were currently clinically depressed or had been depressed at least one time in their lives. The researchers noted that this proportion was more than twice the rate of depression found by a national survey of women in the general population.

The study was unable to determine why women with POI are more likely than other women to experience depression. The investigators cited results of a previous study, which had suggested that depression might trigger physical changes that ultimately lead women to develop POI. However, in the current study, more than 73 percent of women with POI first experienced depressive symptoms after developing the irregular menstrual cycles believed to be an indicator of impending POI. The findings also did not support the hypothesis that most women with POI become depressed after they are told of their diagnosis, when they learn that they will likely be infertile. In the current study, more than 68 percent of patients with POI who had depression had become depressed after the onset of irregular menstrual cycles but before receiving the diagnosis of POI.

In a previous study, researchers found that women entering natural menopause at an appropriate age are at greater risk of depression late in the menopause transition, when estrogen levels are particularly low. The authors also noted that studies of women undergoing natural menopause have found that estrogen supplements relieve symptoms of depression in some women. The authors added that it is possible that estrogen supplements might relieve symptoms of depression in women with POI.

"Because of the strong association with depression, results indicate all women diagnosed with POI should be thoroughly evaluated for depression," said Lawrence M. Nelson, MD, co-senior author of the study and head of the Integrative and Reproductive Medicine Group at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "Simply asking patients if they are depressed is not sufficient. Primary care physicians should evaluate their patients with a diagnostic screening test to determine if treatment or referral to a mental health specialist for further evaluation is needed."

To learn more about this research, please visit:
http://www.nih.gov/news/health/nov2010/nichd-30.htm

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Gender, Race, Place of Residence Influence High Blood Pressure Incidence

High blood pressure may help to explain why deaths from heart disease and stroke vary according to geography, race and gender, researchers reported in Hypertension: Journal of the American Heart Association. Between 1968 and 2006, deaths from heart disease and stroke fell an impressive 65 percent, but everyone didn’t share equally in the positive trend, said the researchers. Cardiovascular deaths are still higher in the southeastern United States, in blacks compared with whites, and in men compared with women.

The researchers examined data from the Coronary Artery Risk Development in Young Adults (CARDIA) study that followed young people from Birmingham, Ala., Chicago, Ill., Minneapolis, Minn. and Oakland, Calif. from the time they were 18-30 years old. Each center began the study with groups similar to each other for race, sex and age. Among 3,436 participants who didn’t have high blood pressure when the research began, and were followed for 20 years (when average age was 45), hypertension was diagnosed in:

  • 37.6 percent of black women; 34.5 percent of black men; 21.4 percent of white men and 12.3 percent of white women.
  • 33.6 percent of Birmingham residents; 27.4 percent in Oakland; 23.4 percent in Chicago and 19 percent in Minneapolis.
After adjusting for multiple risk factors, living in Birmingham significantly increased the chance that a person would develop high blood pressure. More research is needed to understand the geographic and racial differences in high blood pressure documented in this study as well as the potential biological, environmental and genetic mechanisms, said the researchers. “In the meantime, people at higher risk can benefit from close monitoring of their blood pressure and paying attention to risk factors such as obesity and physical activity,” according to the researchers.

To learn more about this research, please visit:
http://www.newsroom.heart.org/index.php?s=43&item=1213

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Redesigning the Physician Practice for Improved Efficiency and Increased Revenue

In the face of healthcare reform and new models of care delivery such as the patient-centered medical home, primary care physicians don't have to fly solo anymore, advises Dr. David Eitrheim, a family physician with the Mayo Clinic Health System in Wisconsin. Dr. Eitrheim describes how his practice's team-based approach has changed the nature of the patient visit as well as the nurses' workload, and provides the secret to a productive patient visit.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#135

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Engaging Clients and Sustaining Motivation

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Karen Lawson, MD, program director for the health coaching track at the Center for Spirituality and Healing, University of Minnesota.

Question: How do you engage your clients and keep them motivated to change their behavior?

Response: It’s important to recognize the incentive and where the motivation is coming from because it’s not the coach’s job to get them to change or to get them motivated. It’s a matter of trying to facilitate an individual doing what they want for themselves. You wouldn’t have a client unless they’d been assigned or sent to you by an outside entity, who wouldn’t have some desire to work in some direction of change themselves. That is one of the conflicts that arises: If someone’s being told that they need to participate in a program because of a work indication or a third-party payor, and they have no desire to be there themselves, you can’t motivate them. You can’t give a patient motivation that they don’t have.

For more information on behavior change and engagement, please visit:
http://store.hin.com/product.asp?itemid=3900

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

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There are other free email newsletters available from HIN!

Medical Home Monitor tracks the construction of medical homes around the country and their impact on healthcare access, quality, utilization and cost. As providers and payors reframe care delivery, this twice monthly e-newsletter will cover the pilots, practice transformations, tools and technology that will guide healthcare organizations toward clinical excellence.

To sign up for our free email newsletters, please visit:
http://www.hin.com/freenews2.html

Top Conditions Tied to Readmissions

Responding organizations face many challenges related to the reduction of hospital readmissions. We wanted to see which health conditions are targeted by programs to reduce hospital readmissions.

Click here to view the chart.

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Targeting Depression Through DM

Nearly 6 percent of men and almost 10 percent of women worldwide will experience a depressive episode in any given year, and in America alone, approximately 18.8 million adults have depression. In an e-survey from the Healthcare Intelligence Network (HIN), 250 healthcare professionals shared how their organizations are targeting depression in their DM initiatives.

To download this complimentary white paper, please visit:
http://www.hin.com/library/registerdepdm.html

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Quitting Smoking Improves Mental, Physical Health

Quitting smoking is certainly healthy for the body, but doctors and scientists haven’t been sure whether quitting makes people happier, especially since conventional wisdom says many smokers use cigarettes to ease anxiety and depression. In a new study from Brown University, researchers tracked the symptoms of depression in people who were trying to quit and found that they were never happier than when they were being successful. Based on their results, the authors recommend that smokers embrace quitting as a step toward improving mental as well as physical health.

Researchers studied a group of 236 men and women seeking to quit smoking, who also happened to be heavy social drinkers. They received nicotine patches and counseling on quitting and then agreed to a quit date; some also were given specific advice to reduce drinking. Participants took a standardized test of symptoms of depression a week before the quit date and then two, eight, 16 and 28 weeks after that date. All but 29 participants exhibited one of four different quitting behaviors: 99 subjects never abstained, 44 were only abstinent at the two-week assessment, 33 managed to remain smoke-free at the two- and eight-week checkups, and 33 managed to stay off cigarettes for the entire study length.

The most illustrative — and somewhat tragic — subjects were the ones who only quit temporarily. Their moods were clearly brightest at the checkups when they were abstinent. After going back to smoking, their mood darkened, in some cases to higher levels of sadness than before. The strong correlation in time between increased happiness and abstinence is a tell-tale sign that the two go hand-in-hand, said the researchers. Subjects who never quit remained the unhappiest of all throughout the study. The ones who quit and stuck with abstinence were the happiest to begin with and remained at the same strong level of happiness throughout.

According to the researchers, the results can be generalized to most people, even though the smokers in this study also drank at relatively high levels. One reason is that the results correlate well with a study completed in 2002 of smokers who all had had past episodes of depression but who did not necessarily drink. Another is that the changes in happiness measured in this study did not correlate in time with a reduction in drinking, only with a reduction — and resumption — of smoking. “If people quit smoking, their depressive symptoms go down and if they relapse, their mood goes back to where they were,” said the researchers. “An effective antidepressant should look like that.”

To learn more about this research, please visit:
http://news.brown.edu/pressreleases/2010/12/smoking

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Reducing Hospital Readmissions in 2010

Spurred on by incentives from public and private payors, healthcare organizations are working hard to reduce avoidable rehospitalizations, especially among Medicare patients. Describe your organization's efforts to reduce hospital readmissions by taking HIN's second annual Reducing Hospital Readmissions Benchmark Survey. Respond by December 31 and receive an e-summary of the results once the survey is completed.

To participate in this survey and receive its results, please visit:
http://www.surveymonkey.com/s/rehospitalizations

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