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Impact of poor sleep on GPA equal to binge drinking for college students
MINNEAPOLIS – College students who do not get enough sleep experience an impact on their academic performance that is on par with binge drinking or regular marijuana use, two researchers say.
"The cultural assumption is that college is a time of bad sleep, and that all-nighters fueled by energy drinks and cheap pizza are just an inherent part of what it means to be a student," investigators J. Roxanne Prichard, Ph.D., and Monica Hartmann, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.
But they say that assumption is shortsighted and wrong. "Well-rested students perform better academically and are healthier physically and psychologically," the researchers said.
Dr. Prichard of the department of neuroscience at the University of St. Thomas, St. Paul, Minn., and Dr. Hartmann,professor of economics at the university analyzed data from the Spring 2009 NCHA (the American College Health Association National College Health Assessment), which included survey information from 72, 966 students, 63% of whom were female and 75% of whom were white.
Students who participated in the survey were asked about their physical and mental health, sexual activity, and substance use, among other issues. They also were asked whether they’ve had sleep problems or had been diagnosed with a sleep disorder or insomnia.
Using data from more than 43,000 respondents, the researchers attempted to evaluate factors that predicted academic problems, including dropping a course, earning a lower course grade, and having a lower cumulative grade point average. The researchers examined those impacts for all students but focused on freshmen, because first-year performance "has such a large effect on retention rates and thus the economic stability for the institution of higher education," the researchers said. They found that sleep timing and sleep-related problems in college students were a strong predictor of academic problems, even after they controlled for other factors that might have had an impact, including clinical depression, feeling isolated, and a diagnosis of a learning disability or chronic health issue.
Students who earned "A" grades reported experiencing fewer of the following sleep issues: early awakenings, feeling sleepy during the day, going to bed early because they could not stay awake, or having trouble falling asleep. Students with worse grades tended to report more sleep issues.
Sleep problems had about the same impact on GPA as did binge drinking and marijuana use, the authors reported. In freshmen, poor sleep was an independent predictor of whether a student would drop or withdraw from a course. The authors adjusted their analysis to account for race, gender, work hours, chronic illness, and psychiatric problems such as anxiety.
Reducing sleep problems might have had a greater impact than reducing binge drinking or marijuana use, they said. For instance, improving sleep on just 1 night a week reduced the probability that a freshman drops a course by about 15%, the authors found.
Dr. Prichard and Dr. Hartmann also tried to gauge the effect that sleep disturbances in college eventually might have on the university’s ability to keep the student and the student’s future earnings potential. They determined that a sleep screening program that identified students at risk and led to treatment would be cost effective, even for the smallest universities. "Identifying and treating students with undiagnosed sleep problems early on in a student’s career economically benefits the university through increased retention and increases the students’ lifetime earning potential," they said.
But they noted that most institutions of higher learning do not pay much attention to students’ sleep habits. Rarely is there any time or money devoted to improving sleep, and if there is, it’s much less than the amount spent to address learning disabilities, substance abuse, and contagious illness, the researchers said. They encouraged a reexamination of the resources directed toward sleep quality in this population.
Dr. Prichard and Dr. Hartmann reported no conflicts. They received no outside funding for the study.
On Twitter @aliciaault
MINNEAPOLIS – College students who do not get enough sleep experience an impact on their academic performance that is on par with binge drinking or regular marijuana use, two researchers say.
"The cultural assumption is that college is a time of bad sleep, and that all-nighters fueled by energy drinks and cheap pizza are just an inherent part of what it means to be a student," investigators J. Roxanne Prichard, Ph.D., and Monica Hartmann, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.
But they say that assumption is shortsighted and wrong. "Well-rested students perform better academically and are healthier physically and psychologically," the researchers said.
Dr. Prichard of the department of neuroscience at the University of St. Thomas, St. Paul, Minn., and Dr. Hartmann,professor of economics at the university analyzed data from the Spring 2009 NCHA (the American College Health Association National College Health Assessment), which included survey information from 72, 966 students, 63% of whom were female and 75% of whom were white.
Students who participated in the survey were asked about their physical and mental health, sexual activity, and substance use, among other issues. They also were asked whether they’ve had sleep problems or had been diagnosed with a sleep disorder or insomnia.
Using data from more than 43,000 respondents, the researchers attempted to evaluate factors that predicted academic problems, including dropping a course, earning a lower course grade, and having a lower cumulative grade point average. The researchers examined those impacts for all students but focused on freshmen, because first-year performance "has such a large effect on retention rates and thus the economic stability for the institution of higher education," the researchers said. They found that sleep timing and sleep-related problems in college students were a strong predictor of academic problems, even after they controlled for other factors that might have had an impact, including clinical depression, feeling isolated, and a diagnosis of a learning disability or chronic health issue.
Students who earned "A" grades reported experiencing fewer of the following sleep issues: early awakenings, feeling sleepy during the day, going to bed early because they could not stay awake, or having trouble falling asleep. Students with worse grades tended to report more sleep issues.
Sleep problems had about the same impact on GPA as did binge drinking and marijuana use, the authors reported. In freshmen, poor sleep was an independent predictor of whether a student would drop or withdraw from a course. The authors adjusted their analysis to account for race, gender, work hours, chronic illness, and psychiatric problems such as anxiety.
Reducing sleep problems might have had a greater impact than reducing binge drinking or marijuana use, they said. For instance, improving sleep on just 1 night a week reduced the probability that a freshman drops a course by about 15%, the authors found.
Dr. Prichard and Dr. Hartmann also tried to gauge the effect that sleep disturbances in college eventually might have on the university’s ability to keep the student and the student’s future earnings potential. They determined that a sleep screening program that identified students at risk and led to treatment would be cost effective, even for the smallest universities. "Identifying and treating students with undiagnosed sleep problems early on in a student’s career economically benefits the university through increased retention and increases the students’ lifetime earning potential," they said.
But they noted that most institutions of higher learning do not pay much attention to students’ sleep habits. Rarely is there any time or money devoted to improving sleep, and if there is, it’s much less than the amount spent to address learning disabilities, substance abuse, and contagious illness, the researchers said. They encouraged a reexamination of the resources directed toward sleep quality in this population.
Dr. Prichard and Dr. Hartmann reported no conflicts. They received no outside funding for the study.
On Twitter @aliciaault
MINNEAPOLIS – College students who do not get enough sleep experience an impact on their academic performance that is on par with binge drinking or regular marijuana use, two researchers say.
"The cultural assumption is that college is a time of bad sleep, and that all-nighters fueled by energy drinks and cheap pizza are just an inherent part of what it means to be a student," investigators J. Roxanne Prichard, Ph.D., and Monica Hartmann, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.
But they say that assumption is shortsighted and wrong. "Well-rested students perform better academically and are healthier physically and psychologically," the researchers said.
Dr. Prichard of the department of neuroscience at the University of St. Thomas, St. Paul, Minn., and Dr. Hartmann,professor of economics at the university analyzed data from the Spring 2009 NCHA (the American College Health Association National College Health Assessment), which included survey information from 72, 966 students, 63% of whom were female and 75% of whom were white.
Students who participated in the survey were asked about their physical and mental health, sexual activity, and substance use, among other issues. They also were asked whether they’ve had sleep problems or had been diagnosed with a sleep disorder or insomnia.
Using data from more than 43,000 respondents, the researchers attempted to evaluate factors that predicted academic problems, including dropping a course, earning a lower course grade, and having a lower cumulative grade point average. The researchers examined those impacts for all students but focused on freshmen, because first-year performance "has such a large effect on retention rates and thus the economic stability for the institution of higher education," the researchers said. They found that sleep timing and sleep-related problems in college students were a strong predictor of academic problems, even after they controlled for other factors that might have had an impact, including clinical depression, feeling isolated, and a diagnosis of a learning disability or chronic health issue.
Students who earned "A" grades reported experiencing fewer of the following sleep issues: early awakenings, feeling sleepy during the day, going to bed early because they could not stay awake, or having trouble falling asleep. Students with worse grades tended to report more sleep issues.
Sleep problems had about the same impact on GPA as did binge drinking and marijuana use, the authors reported. In freshmen, poor sleep was an independent predictor of whether a student would drop or withdraw from a course. The authors adjusted their analysis to account for race, gender, work hours, chronic illness, and psychiatric problems such as anxiety.
Reducing sleep problems might have had a greater impact than reducing binge drinking or marijuana use, they said. For instance, improving sleep on just 1 night a week reduced the probability that a freshman drops a course by about 15%, the authors found.
Dr. Prichard and Dr. Hartmann also tried to gauge the effect that sleep disturbances in college eventually might have on the university’s ability to keep the student and the student’s future earnings potential. They determined that a sleep screening program that identified students at risk and led to treatment would be cost effective, even for the smallest universities. "Identifying and treating students with undiagnosed sleep problems early on in a student’s career economically benefits the university through increased retention and increases the students’ lifetime earning potential," they said.
But they noted that most institutions of higher learning do not pay much attention to students’ sleep habits. Rarely is there any time or money devoted to improving sleep, and if there is, it’s much less than the amount spent to address learning disabilities, substance abuse, and contagious illness, the researchers said. They encouraged a reexamination of the resources directed toward sleep quality in this population.
Dr. Prichard and Dr. Hartmann reported no conflicts. They received no outside funding for the study.
On Twitter @aliciaault
FROM SLEEP 2014
Key clinical point: Interventions aimed at improving sleep hygiene for college students are needed.
Major finding: Insomnia and other sleep disturbances are independent risk factors for poor academic performance, on par with binge drinking or marijuana use.
Data source: An analysis of 43,000 responses to the American College Health Association National College Health survey.
Disclosures: Dr. Prichard and Dr. Hartmann reported no conflicts. They received no outside funding for the study.
AMA: Obama needs to take immediate action on VA health care
CHICAGO – The American Medical Association’s policy-making body called on President Obama to take immediate action to increase access to care for the nation’s veterans by encouraging them to use physicians outside the Veterans Affairs system.
The House of Delegates also urged state medical societies to create registries of physicians willing and able to take veterans as patients.
The action comes as Congress moves to pass legislation to help alleviate delays in the VA system that have led to long wait times for appointments. The revelation that phony wait lists were created in an attempt to cover up the delays led to the resignation of VA Secretary Eric Shinseki on May 30.
The U.S. House of Representatives on June 10 unanimously passed a bill sponsored by Rep. Jeff Miller (R-Fla.) that would allow veterans to seek care outside the VA system. A similar bipartisan bill in the U.S. Senate that is sponsored by Sen. Bernie Sanders (I-Vt.) and Sen. John McCain (R-Ariz.) may be voted on this week.
The proposal adopted by the AMA House of Delegates at its annual meeting was sponsored by delegations from Florida, Texas, New York, and California. In addition to asking President Obama to provide timely access to health care for veterans by allowing for, and paying for, care outside the VA system, it also calls on Congress to act rapidly on a long-term solution that will provide timely access to care. And, the resolution requested that the AMA issue a press release by June 12 that calls attention to its new policy on care for veterans.
Most of the delegates were in favor of the new policy.
Dr. David McKalip, a Florida neurosurgeon, said his delegation sought the policy because a solution was needed now. He said that he was already providing care to veterans, and that there was "an abundance of care" available outside the VA.
Others said they, too, were already treating veterans, either in emergency departments or in their offices. Dr. Mario Motta, a cardiologist and delegate from Massachusetts, said that he often treated veterans for acute problems and then would send them back to the VA for follow-up. But, they often end up back in his office when they can’t get in to see a cardiologist in the VA system, he said. "We need to fix this issue," said Dr. Motta.
Some delegates said that the AMA should not be trying to fix what is essentially a VA problem.
Dr. Richard Evans, a general surgeon from Dover-Foxcroft, Maine, and a veteran, said that he, too, treated many veterans. But he said that it seemed like the AMA was merely trying to take advantage of a hot topic. "I’m certain everyone in this room is supportive of veterans’ care," said Dr. Evans. But, he added, "I see no need for this resolution."
Another physician-veteran, Dr. Thomas G. Peters, an alternate delegate from Florida, said that all physicians should be willing to see veterans. But, said the Jacksonville-based transplant surgeon, "the responsibility to fix the VA should be with the VA."
The American Academy of Family Physicians also recently urged the President to enlist physicians in the community to help alleviate the backlog at the VA.
In a June 4 letter, Dr. Jeff Cain, AAFP board chair, also said the group was recommending that civilian physicians be allowed to order diagnostic tests at VA facilities, and refer to specialists at those facilities, and to allow prescriptions written by civilian physicians to be filled at VA pharmacies.
"While these policy recommendations are not a solution to all the challenges facing the VA health system, they do represent an opportunity to alleviate the current backlog and facilitate access to primary care services for thousands of veterans," Dr. Cain said in the letter.
On Twitter @aliciaault
CHICAGO – The American Medical Association’s policy-making body called on President Obama to take immediate action to increase access to care for the nation’s veterans by encouraging them to use physicians outside the Veterans Affairs system.
The House of Delegates also urged state medical societies to create registries of physicians willing and able to take veterans as patients.
The action comes as Congress moves to pass legislation to help alleviate delays in the VA system that have led to long wait times for appointments. The revelation that phony wait lists were created in an attempt to cover up the delays led to the resignation of VA Secretary Eric Shinseki on May 30.
The U.S. House of Representatives on June 10 unanimously passed a bill sponsored by Rep. Jeff Miller (R-Fla.) that would allow veterans to seek care outside the VA system. A similar bipartisan bill in the U.S. Senate that is sponsored by Sen. Bernie Sanders (I-Vt.) and Sen. John McCain (R-Ariz.) may be voted on this week.
The proposal adopted by the AMA House of Delegates at its annual meeting was sponsored by delegations from Florida, Texas, New York, and California. In addition to asking President Obama to provide timely access to health care for veterans by allowing for, and paying for, care outside the VA system, it also calls on Congress to act rapidly on a long-term solution that will provide timely access to care. And, the resolution requested that the AMA issue a press release by June 12 that calls attention to its new policy on care for veterans.
Most of the delegates were in favor of the new policy.
Dr. David McKalip, a Florida neurosurgeon, said his delegation sought the policy because a solution was needed now. He said that he was already providing care to veterans, and that there was "an abundance of care" available outside the VA.
Others said they, too, were already treating veterans, either in emergency departments or in their offices. Dr. Mario Motta, a cardiologist and delegate from Massachusetts, said that he often treated veterans for acute problems and then would send them back to the VA for follow-up. But, they often end up back in his office when they can’t get in to see a cardiologist in the VA system, he said. "We need to fix this issue," said Dr. Motta.
Some delegates said that the AMA should not be trying to fix what is essentially a VA problem.
Dr. Richard Evans, a general surgeon from Dover-Foxcroft, Maine, and a veteran, said that he, too, treated many veterans. But he said that it seemed like the AMA was merely trying to take advantage of a hot topic. "I’m certain everyone in this room is supportive of veterans’ care," said Dr. Evans. But, he added, "I see no need for this resolution."
Another physician-veteran, Dr. Thomas G. Peters, an alternate delegate from Florida, said that all physicians should be willing to see veterans. But, said the Jacksonville-based transplant surgeon, "the responsibility to fix the VA should be with the VA."
The American Academy of Family Physicians also recently urged the President to enlist physicians in the community to help alleviate the backlog at the VA.
In a June 4 letter, Dr. Jeff Cain, AAFP board chair, also said the group was recommending that civilian physicians be allowed to order diagnostic tests at VA facilities, and refer to specialists at those facilities, and to allow prescriptions written by civilian physicians to be filled at VA pharmacies.
"While these policy recommendations are not a solution to all the challenges facing the VA health system, they do represent an opportunity to alleviate the current backlog and facilitate access to primary care services for thousands of veterans," Dr. Cain said in the letter.
On Twitter @aliciaault
CHICAGO – The American Medical Association’s policy-making body called on President Obama to take immediate action to increase access to care for the nation’s veterans by encouraging them to use physicians outside the Veterans Affairs system.
The House of Delegates also urged state medical societies to create registries of physicians willing and able to take veterans as patients.
The action comes as Congress moves to pass legislation to help alleviate delays in the VA system that have led to long wait times for appointments. The revelation that phony wait lists were created in an attempt to cover up the delays led to the resignation of VA Secretary Eric Shinseki on May 30.
The U.S. House of Representatives on June 10 unanimously passed a bill sponsored by Rep. Jeff Miller (R-Fla.) that would allow veterans to seek care outside the VA system. A similar bipartisan bill in the U.S. Senate that is sponsored by Sen. Bernie Sanders (I-Vt.) and Sen. John McCain (R-Ariz.) may be voted on this week.
The proposal adopted by the AMA House of Delegates at its annual meeting was sponsored by delegations from Florida, Texas, New York, and California. In addition to asking President Obama to provide timely access to health care for veterans by allowing for, and paying for, care outside the VA system, it also calls on Congress to act rapidly on a long-term solution that will provide timely access to care. And, the resolution requested that the AMA issue a press release by June 12 that calls attention to its new policy on care for veterans.
Most of the delegates were in favor of the new policy.
Dr. David McKalip, a Florida neurosurgeon, said his delegation sought the policy because a solution was needed now. He said that he was already providing care to veterans, and that there was "an abundance of care" available outside the VA.
Others said they, too, were already treating veterans, either in emergency departments or in their offices. Dr. Mario Motta, a cardiologist and delegate from Massachusetts, said that he often treated veterans for acute problems and then would send them back to the VA for follow-up. But, they often end up back in his office when they can’t get in to see a cardiologist in the VA system, he said. "We need to fix this issue," said Dr. Motta.
Some delegates said that the AMA should not be trying to fix what is essentially a VA problem.
Dr. Richard Evans, a general surgeon from Dover-Foxcroft, Maine, and a veteran, said that he, too, treated many veterans. But he said that it seemed like the AMA was merely trying to take advantage of a hot topic. "I’m certain everyone in this room is supportive of veterans’ care," said Dr. Evans. But, he added, "I see no need for this resolution."
Another physician-veteran, Dr. Thomas G. Peters, an alternate delegate from Florida, said that all physicians should be willing to see veterans. But, said the Jacksonville-based transplant surgeon, "the responsibility to fix the VA should be with the VA."
The American Academy of Family Physicians also recently urged the President to enlist physicians in the community to help alleviate the backlog at the VA.
In a June 4 letter, Dr. Jeff Cain, AAFP board chair, also said the group was recommending that civilian physicians be allowed to order diagnostic tests at VA facilities, and refer to specialists at those facilities, and to allow prescriptions written by civilian physicians to be filled at VA pharmacies.
"While these policy recommendations are not a solution to all the challenges facing the VA health system, they do represent an opportunity to alleviate the current backlog and facilitate access to primary care services for thousands of veterans," Dr. Cain said in the letter.
On Twitter @aliciaault
AT THE AMA HOD MEETING
AMA calls for background checks for all gun purchases
CHICAGO – The American Medical Association said it will back legislation to require criminal background checks for all gun sales, whether they are public or private.
The House of Delegates voted at its annual meeting to approve the new policy position as a public health issue. The debate and vote took place June 10, the same day as an Oregon school shooting where a high school student and the shooter died.
The resolution to support background checks was brought forward by the Illinois delegation to the House.
Dr. Maryanne C. Bombaugh, an alternate delegate with the Massachusetts Medical Society, introduced an amendment to extend background checks to all gun transfers, as well.
Dr. Bombaugh, an ob.gyn. in Falmouth, Mass., said that adding transfers would help close many loopholes that private sellers use to skirt background checks.
But some delegates said that might be impossible to enforce, and might interfere with transfers among family members. Louisiana delegate Dr. Vincent Culotta said that he had been given a gun by his father to use for hunting when he was younger, and that he did not think that type of transfer should be subject to a background check.
Another delegate, a psychiatrist, said that background checks on transfers could potentially stop family members from taking possession of guns that relatives might use in suicide attempts.
But others said they supported more scrutiny of transfers. One delegate said it might prevent one person from buying a gun for someone else who could not pass a background check.
Another suggested that requiring checks on transfers – even for family members – made sense, just as transferring ownership of a vehicle required a check that the recipient possessed a driver’s license.
On Twitter @aliciaault
CHICAGO – The American Medical Association said it will back legislation to require criminal background checks for all gun sales, whether they are public or private.
The House of Delegates voted at its annual meeting to approve the new policy position as a public health issue. The debate and vote took place June 10, the same day as an Oregon school shooting where a high school student and the shooter died.
The resolution to support background checks was brought forward by the Illinois delegation to the House.
Dr. Maryanne C. Bombaugh, an alternate delegate with the Massachusetts Medical Society, introduced an amendment to extend background checks to all gun transfers, as well.
Dr. Bombaugh, an ob.gyn. in Falmouth, Mass., said that adding transfers would help close many loopholes that private sellers use to skirt background checks.
But some delegates said that might be impossible to enforce, and might interfere with transfers among family members. Louisiana delegate Dr. Vincent Culotta said that he had been given a gun by his father to use for hunting when he was younger, and that he did not think that type of transfer should be subject to a background check.
Another delegate, a psychiatrist, said that background checks on transfers could potentially stop family members from taking possession of guns that relatives might use in suicide attempts.
But others said they supported more scrutiny of transfers. One delegate said it might prevent one person from buying a gun for someone else who could not pass a background check.
Another suggested that requiring checks on transfers – even for family members – made sense, just as transferring ownership of a vehicle required a check that the recipient possessed a driver’s license.
On Twitter @aliciaault
CHICAGO – The American Medical Association said it will back legislation to require criminal background checks for all gun sales, whether they are public or private.
The House of Delegates voted at its annual meeting to approve the new policy position as a public health issue. The debate and vote took place June 10, the same day as an Oregon school shooting where a high school student and the shooter died.
The resolution to support background checks was brought forward by the Illinois delegation to the House.
Dr. Maryanne C. Bombaugh, an alternate delegate with the Massachusetts Medical Society, introduced an amendment to extend background checks to all gun transfers, as well.
Dr. Bombaugh, an ob.gyn. in Falmouth, Mass., said that adding transfers would help close many loopholes that private sellers use to skirt background checks.
But some delegates said that might be impossible to enforce, and might interfere with transfers among family members. Louisiana delegate Dr. Vincent Culotta said that he had been given a gun by his father to use for hunting when he was younger, and that he did not think that type of transfer should be subject to a background check.
Another delegate, a psychiatrist, said that background checks on transfers could potentially stop family members from taking possession of guns that relatives might use in suicide attempts.
But others said they supported more scrutiny of transfers. One delegate said it might prevent one person from buying a gun for someone else who could not pass a background check.
Another suggested that requiring checks on transfers – even for family members – made sense, just as transferring ownership of a vehicle required a check that the recipient possessed a driver’s license.
On Twitter @aliciaault
AT THE AMA HOD MEETING
Advocates, House members press for involuntary treatment
WASHINGTON – People with serious mental illness need more attention, including involuntary treatment, advocates said at a hearing to push a wide-ranging bill that addresses issues around the hardest-to-reach patients.
The bill, H.R. 3717, was introduced in December by Rep. Tim Murphy, (R-Penn.), a clinical psychologist and chairman of the Oversight and Investigations Subcommittee of the Energy & Commerce Committee.
Rep. Murphy said people with serious and persistent mental illness – including severe bipolar disorder and schizophrenia – are not being well served.
An almost-2-year investigation by the subcommittee "reveals that the current mental health system does not respond until after a crisis has already occurred because we do not empower parents, patients, clinicians, and law enforcement to stop it from happening," he said at the hearing.
He cited a recent list of those with severe mental illness who had undertreated or untreated disease, including Elliot Rodger, who killed 6 people and himself in Isla Vista, Calif.; Adam Lanza, who, in 2012, killed 20 children, 6 adults, his mother, and himself in Newtown, Conn.; and Aaron Alexis, who went on a shooting spree in September 2013 at the Navy Yard in Washington and killed 12 people, then killed himself.
Treatment might help prevent violent episodes, Rep. Murphy said. In the subcommittee report, Rep. Murphy and his staff noted that the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that in 2009, 40% of adults with serious mental illness reported not receiving any treatment. It takes an average of 110 weeks between the onset of symptoms and an individual’s entering into treatment, according to the letter.
Rep. Murphy’s bill – the Helping Families in Mental Health Crisis Act – seeks to create a new infrastructure to focus on serious mental illness. It also takes issue with how SAMHSA is being administered and how it decides on grantees.
A new assistant secretary for mental health and substance use disorders would oversee the SAMHSA administrator, and establish a National Mental Health Policy Laboratory to more closely supervise SAMHSA grantees and make sure that they undertook evidence-based projects. New telepsychiatry and primary care physician training grants would be provided to states to promote the use of telehealth. The bill would allow caregivers to get access to protected health information, when the patient’s provider reasonably believes it is necessary for that information to be made available to protect the individual’s health, safety, or welfare or the safety of one or more other individuals – even it the patient has not consented to disclosure.
After the bill was introduced last year, the American Psychiatric Association wrote a letter to Rep. Murphy praising the comprehensive nature of the package and its emphasis on providing evidence-based services.
At the hearing, Edward F. Kelly III, the father of an adult son with schizophrenia, said HIPAA had prevented him and his wife from getting information on their son’s treatment, hospitalizations, releases, encounters with the legal system, and whereabouts.
He chided organizations that he said were advocating against involuntary treatment of people with severe mental illness. Mr. Kelly urged Congress to support Rep. Murphy’s bill.
"Don’t fear the threats of unconstitutionality. Don’t fear the threats of lawsuits," he said.
Mr. Kelly urged Congress to support assisted outpatient treatment, known as AOT. D.J. Jaffe, founder of Mental Illness Policy Org., said that AOT – which allows courts to order patients into outpatient treatment in the community – reduces violence, incarceration, and homelessness. Many of those with severe mental illness are not aware that they need help, he said. "They are never going to volunteer for treatment," Mr. Jaffe said. "We have to recognize this reality."
AOT is "an off-ramp before jail," he said. "It’s like putting a fence at the edge of the cliff, rather than an ambulance at the bottom."
Rep. Murphy’s bill has 87 cosponsors. There is no companion bill in the Senate.
On Twitter @aliciaault
WASHINGTON – People with serious mental illness need more attention, including involuntary treatment, advocates said at a hearing to push a wide-ranging bill that addresses issues around the hardest-to-reach patients.
The bill, H.R. 3717, was introduced in December by Rep. Tim Murphy, (R-Penn.), a clinical psychologist and chairman of the Oversight and Investigations Subcommittee of the Energy & Commerce Committee.
Rep. Murphy said people with serious and persistent mental illness – including severe bipolar disorder and schizophrenia – are not being well served.
An almost-2-year investigation by the subcommittee "reveals that the current mental health system does not respond until after a crisis has already occurred because we do not empower parents, patients, clinicians, and law enforcement to stop it from happening," he said at the hearing.
He cited a recent list of those with severe mental illness who had undertreated or untreated disease, including Elliot Rodger, who killed 6 people and himself in Isla Vista, Calif.; Adam Lanza, who, in 2012, killed 20 children, 6 adults, his mother, and himself in Newtown, Conn.; and Aaron Alexis, who went on a shooting spree in September 2013 at the Navy Yard in Washington and killed 12 people, then killed himself.
Treatment might help prevent violent episodes, Rep. Murphy said. In the subcommittee report, Rep. Murphy and his staff noted that the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that in 2009, 40% of adults with serious mental illness reported not receiving any treatment. It takes an average of 110 weeks between the onset of symptoms and an individual’s entering into treatment, according to the letter.
Rep. Murphy’s bill – the Helping Families in Mental Health Crisis Act – seeks to create a new infrastructure to focus on serious mental illness. It also takes issue with how SAMHSA is being administered and how it decides on grantees.
A new assistant secretary for mental health and substance use disorders would oversee the SAMHSA administrator, and establish a National Mental Health Policy Laboratory to more closely supervise SAMHSA grantees and make sure that they undertook evidence-based projects. New telepsychiatry and primary care physician training grants would be provided to states to promote the use of telehealth. The bill would allow caregivers to get access to protected health information, when the patient’s provider reasonably believes it is necessary for that information to be made available to protect the individual’s health, safety, or welfare or the safety of one or more other individuals – even it the patient has not consented to disclosure.
After the bill was introduced last year, the American Psychiatric Association wrote a letter to Rep. Murphy praising the comprehensive nature of the package and its emphasis on providing evidence-based services.
At the hearing, Edward F. Kelly III, the father of an adult son with schizophrenia, said HIPAA had prevented him and his wife from getting information on their son’s treatment, hospitalizations, releases, encounters with the legal system, and whereabouts.
He chided organizations that he said were advocating against involuntary treatment of people with severe mental illness. Mr. Kelly urged Congress to support Rep. Murphy’s bill.
"Don’t fear the threats of unconstitutionality. Don’t fear the threats of lawsuits," he said.
Mr. Kelly urged Congress to support assisted outpatient treatment, known as AOT. D.J. Jaffe, founder of Mental Illness Policy Org., said that AOT – which allows courts to order patients into outpatient treatment in the community – reduces violence, incarceration, and homelessness. Many of those with severe mental illness are not aware that they need help, he said. "They are never going to volunteer for treatment," Mr. Jaffe said. "We have to recognize this reality."
AOT is "an off-ramp before jail," he said. "It’s like putting a fence at the edge of the cliff, rather than an ambulance at the bottom."
Rep. Murphy’s bill has 87 cosponsors. There is no companion bill in the Senate.
On Twitter @aliciaault
WASHINGTON – People with serious mental illness need more attention, including involuntary treatment, advocates said at a hearing to push a wide-ranging bill that addresses issues around the hardest-to-reach patients.
The bill, H.R. 3717, was introduced in December by Rep. Tim Murphy, (R-Penn.), a clinical psychologist and chairman of the Oversight and Investigations Subcommittee of the Energy & Commerce Committee.
Rep. Murphy said people with serious and persistent mental illness – including severe bipolar disorder and schizophrenia – are not being well served.
An almost-2-year investigation by the subcommittee "reveals that the current mental health system does not respond until after a crisis has already occurred because we do not empower parents, patients, clinicians, and law enforcement to stop it from happening," he said at the hearing.
He cited a recent list of those with severe mental illness who had undertreated or untreated disease, including Elliot Rodger, who killed 6 people and himself in Isla Vista, Calif.; Adam Lanza, who, in 2012, killed 20 children, 6 adults, his mother, and himself in Newtown, Conn.; and Aaron Alexis, who went on a shooting spree in September 2013 at the Navy Yard in Washington and killed 12 people, then killed himself.
Treatment might help prevent violent episodes, Rep. Murphy said. In the subcommittee report, Rep. Murphy and his staff noted that the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that in 2009, 40% of adults with serious mental illness reported not receiving any treatment. It takes an average of 110 weeks between the onset of symptoms and an individual’s entering into treatment, according to the letter.
Rep. Murphy’s bill – the Helping Families in Mental Health Crisis Act – seeks to create a new infrastructure to focus on serious mental illness. It also takes issue with how SAMHSA is being administered and how it decides on grantees.
A new assistant secretary for mental health and substance use disorders would oversee the SAMHSA administrator, and establish a National Mental Health Policy Laboratory to more closely supervise SAMHSA grantees and make sure that they undertook evidence-based projects. New telepsychiatry and primary care physician training grants would be provided to states to promote the use of telehealth. The bill would allow caregivers to get access to protected health information, when the patient’s provider reasonably believes it is necessary for that information to be made available to protect the individual’s health, safety, or welfare or the safety of one or more other individuals – even it the patient has not consented to disclosure.
After the bill was introduced last year, the American Psychiatric Association wrote a letter to Rep. Murphy praising the comprehensive nature of the package and its emphasis on providing evidence-based services.
At the hearing, Edward F. Kelly III, the father of an adult son with schizophrenia, said HIPAA had prevented him and his wife from getting information on their son’s treatment, hospitalizations, releases, encounters with the legal system, and whereabouts.
He chided organizations that he said were advocating against involuntary treatment of people with severe mental illness. Mr. Kelly urged Congress to support Rep. Murphy’s bill.
"Don’t fear the threats of unconstitutionality. Don’t fear the threats of lawsuits," he said.
Mr. Kelly urged Congress to support assisted outpatient treatment, known as AOT. D.J. Jaffe, founder of Mental Illness Policy Org., said that AOT – which allows courts to order patients into outpatient treatment in the community – reduces violence, incarceration, and homelessness. Many of those with severe mental illness are not aware that they need help, he said. "They are never going to volunteer for treatment," Mr. Jaffe said. "We have to recognize this reality."
AOT is "an off-ramp before jail," he said. "It’s like putting a fence at the edge of the cliff, rather than an ambulance at the bottom."
Rep. Murphy’s bill has 87 cosponsors. There is no companion bill in the Senate.
On Twitter @aliciaault
EXPERT ANALYSIS AT AN ENERGY & COMMERCE SUBCOMMITTEE HEARING
Teens who sleep less at risk for greater insulin resistance
MINNEAPOLIS – Teens who do not sleep enough may be at risk for gaining weight and increased insulin resistance.
That’s the conclusion of a small pilot study conducted by Dr. Dorit Koren and her colleagues at the University of Chicago.
There is already considerable epidemiologic data that lack of sleep is a risk factor for obesity in children and young adults, said Dr. Koren who is with the departments of pediatrics and medicine in the pediatric endocrinology department at the University of Chicago.
There have been studies examining the risk of type 2 diabetes with sleep deprivation in adults, but there has been no population-based data in children examining the risk of type 2 diabetes in children and adolescents – and that’s important because they are not just small adults, she said.
Adolescents tend to be more insulin resistant because of the pubertal growth spurt, and they have a different sleep architecture than do adults, as they tend to be late to bed and late to rise, said Dr. Koren.
Previous studies looking at glucose homeostasis in adolescents have mostly looked at fasting rather than dynamic measures of glucose homeostasis and that is a limitation because fasting measures reflect primarily hepatic insulin sensitivity, she said. Most studies also were conducted in a sleep lab, which is not a natural environment.
She and her colleagues wanted to study adolescents at home and also gauge postprandial glucose metabolism. They enrolled 10 adolescents, aged 13-18 years. A total of 70% were black and 30% were non-Hispanic white. Just under half were male. They were mostly overweight, as measured by body mass index, although some were very lean, and some were very obese, said Dr. Koren.
The patients were first given an overnight polysomnogram, and then told to measure sleep at home through an actigraphy device, and sleep diaries. The actigraphy helped back up the diaries, which are known to be "remarkably inaccurate" among adolescents, said Dr. Koren. They kept track of their sleep for 2 weeks.
The teens then returned for a second visit to the clinic. The researchers analyzed the average bedtime and waking time, and then asked them to restrict their sleep by going to bed an hour later. After returning again, the new measures after sleep restriction were compared with the earlier measures.
There was a strong correlation between weight and sleep duration, with longer sleep associated with less weight. They also saw a trend toward a greater waist circumference in adolescents who slept less.
There was a significant negative association between sleep duration and the 90-minute oral glucose tolerance test, with a P = .036. Restricted sleep also led to greater insulin resistance as measured by the homeostasis model assessment of insulin resistance (P = .091), and the whole-body insulin sensitivity index (P = .091).
Dr. Koren and her colleagues also performed linear regression analyses, controlling for either waist circumference or weight. Sleep deprivation was still the most significant factor as measured on the 90-minute glucose tolerance test and by the whole-body insulin sensitivity index.
"The model suggests that these relationships between home sleep deprivation and insulin resistance or hyperglycemia are independent of obesity, generalized or central," said Dr. Koren.
She cited the example of a 15-year-old female subject, who was lean. Her sleep went from 8.7 hours at baseline to 7.9 hours with the restriction. Her glucose values did not change significantly between baseline and restriction, but her insulin levels were noticeably higher in the sleep-restricted state, said Dr. Koren. Those levels rose an hour into the 90-minute tolerance test, which suggests that she was insulin resistant and needed to secrete more insulin to maintain glycemia.
Dr. Koren and her colleagues hope to replicate the study in a larger cohort.
Dr. Koren reported no relevant financial conflicts.
On Twitter @aliciaault
MINNEAPOLIS – Teens who do not sleep enough may be at risk for gaining weight and increased insulin resistance.
That’s the conclusion of a small pilot study conducted by Dr. Dorit Koren and her colleagues at the University of Chicago.
There is already considerable epidemiologic data that lack of sleep is a risk factor for obesity in children and young adults, said Dr. Koren who is with the departments of pediatrics and medicine in the pediatric endocrinology department at the University of Chicago.
There have been studies examining the risk of type 2 diabetes with sleep deprivation in adults, but there has been no population-based data in children examining the risk of type 2 diabetes in children and adolescents – and that’s important because they are not just small adults, she said.
Adolescents tend to be more insulin resistant because of the pubertal growth spurt, and they have a different sleep architecture than do adults, as they tend to be late to bed and late to rise, said Dr. Koren.
Previous studies looking at glucose homeostasis in adolescents have mostly looked at fasting rather than dynamic measures of glucose homeostasis and that is a limitation because fasting measures reflect primarily hepatic insulin sensitivity, she said. Most studies also were conducted in a sleep lab, which is not a natural environment.
She and her colleagues wanted to study adolescents at home and also gauge postprandial glucose metabolism. They enrolled 10 adolescents, aged 13-18 years. A total of 70% were black and 30% were non-Hispanic white. Just under half were male. They were mostly overweight, as measured by body mass index, although some were very lean, and some were very obese, said Dr. Koren.
The patients were first given an overnight polysomnogram, and then told to measure sleep at home through an actigraphy device, and sleep diaries. The actigraphy helped back up the diaries, which are known to be "remarkably inaccurate" among adolescents, said Dr. Koren. They kept track of their sleep for 2 weeks.
The teens then returned for a second visit to the clinic. The researchers analyzed the average bedtime and waking time, and then asked them to restrict their sleep by going to bed an hour later. After returning again, the new measures after sleep restriction were compared with the earlier measures.
There was a strong correlation between weight and sleep duration, with longer sleep associated with less weight. They also saw a trend toward a greater waist circumference in adolescents who slept less.
There was a significant negative association between sleep duration and the 90-minute oral glucose tolerance test, with a P = .036. Restricted sleep also led to greater insulin resistance as measured by the homeostasis model assessment of insulin resistance (P = .091), and the whole-body insulin sensitivity index (P = .091).
Dr. Koren and her colleagues also performed linear regression analyses, controlling for either waist circumference or weight. Sleep deprivation was still the most significant factor as measured on the 90-minute glucose tolerance test and by the whole-body insulin sensitivity index.
"The model suggests that these relationships between home sleep deprivation and insulin resistance or hyperglycemia are independent of obesity, generalized or central," said Dr. Koren.
She cited the example of a 15-year-old female subject, who was lean. Her sleep went from 8.7 hours at baseline to 7.9 hours with the restriction. Her glucose values did not change significantly between baseline and restriction, but her insulin levels were noticeably higher in the sleep-restricted state, said Dr. Koren. Those levels rose an hour into the 90-minute tolerance test, which suggests that she was insulin resistant and needed to secrete more insulin to maintain glycemia.
Dr. Koren and her colleagues hope to replicate the study in a larger cohort.
Dr. Koren reported no relevant financial conflicts.
On Twitter @aliciaault
MINNEAPOLIS – Teens who do not sleep enough may be at risk for gaining weight and increased insulin resistance.
That’s the conclusion of a small pilot study conducted by Dr. Dorit Koren and her colleagues at the University of Chicago.
There is already considerable epidemiologic data that lack of sleep is a risk factor for obesity in children and young adults, said Dr. Koren who is with the departments of pediatrics and medicine in the pediatric endocrinology department at the University of Chicago.
There have been studies examining the risk of type 2 diabetes with sleep deprivation in adults, but there has been no population-based data in children examining the risk of type 2 diabetes in children and adolescents – and that’s important because they are not just small adults, she said.
Adolescents tend to be more insulin resistant because of the pubertal growth spurt, and they have a different sleep architecture than do adults, as they tend to be late to bed and late to rise, said Dr. Koren.
Previous studies looking at glucose homeostasis in adolescents have mostly looked at fasting rather than dynamic measures of glucose homeostasis and that is a limitation because fasting measures reflect primarily hepatic insulin sensitivity, she said. Most studies also were conducted in a sleep lab, which is not a natural environment.
She and her colleagues wanted to study adolescents at home and also gauge postprandial glucose metabolism. They enrolled 10 adolescents, aged 13-18 years. A total of 70% were black and 30% were non-Hispanic white. Just under half were male. They were mostly overweight, as measured by body mass index, although some were very lean, and some were very obese, said Dr. Koren.
The patients were first given an overnight polysomnogram, and then told to measure sleep at home through an actigraphy device, and sleep diaries. The actigraphy helped back up the diaries, which are known to be "remarkably inaccurate" among adolescents, said Dr. Koren. They kept track of their sleep for 2 weeks.
The teens then returned for a second visit to the clinic. The researchers analyzed the average bedtime and waking time, and then asked them to restrict their sleep by going to bed an hour later. After returning again, the new measures after sleep restriction were compared with the earlier measures.
There was a strong correlation between weight and sleep duration, with longer sleep associated with less weight. They also saw a trend toward a greater waist circumference in adolescents who slept less.
There was a significant negative association between sleep duration and the 90-minute oral glucose tolerance test, with a P = .036. Restricted sleep also led to greater insulin resistance as measured by the homeostasis model assessment of insulin resistance (P = .091), and the whole-body insulin sensitivity index (P = .091).
Dr. Koren and her colleagues also performed linear regression analyses, controlling for either waist circumference or weight. Sleep deprivation was still the most significant factor as measured on the 90-minute glucose tolerance test and by the whole-body insulin sensitivity index.
"The model suggests that these relationships between home sleep deprivation and insulin resistance or hyperglycemia are independent of obesity, generalized or central," said Dr. Koren.
She cited the example of a 15-year-old female subject, who was lean. Her sleep went from 8.7 hours at baseline to 7.9 hours with the restriction. Her glucose values did not change significantly between baseline and restriction, but her insulin levels were noticeably higher in the sleep-restricted state, said Dr. Koren. Those levels rose an hour into the 90-minute tolerance test, which suggests that she was insulin resistant and needed to secrete more insulin to maintain glycemia.
Dr. Koren and her colleagues hope to replicate the study in a larger cohort.
Dr. Koren reported no relevant financial conflicts.
On Twitter @aliciaault
FROM SLEEP 2014
Key clinical point: Sleep restriction can lead to obesity and insulin resistance.
Major finding: Teens who underslept by an hour a night were more likely to be heavier, have a larger weight circumference, and to have greater insulin resistance.
Data source: A 10-patient pilot study of home sleep.
Disclosures: The study was supported by a National Institutes of Health grant. Dr. Koren reported no conflicts.
Sleep society: Screen for apnea at first Medicare visit
MINNEAPOLIS – The American Academy of Sleep Medicine is pushing to have a simple sleep apnea questionnaire included in the initial Welcome to Medicare preventive care visit.
Including such a screening tool would help identify obstructive sleep apnea (OSA) when patients first join the Medicare program and thus improve the odds of diagnosing and treating the condition, said Dr. Timothy Morgenthaler, president of the AASM. Getting a handle on OSA could also reduce the potential that the beneficiary will develop related chronic conditions, and that will help Medicare curb expenditures, he said.
An estimated 20% of current Medicare beneficiaries have OSA. That number is expected to grow with the rising obesity rates, he said. Untreated OSA can increase the risk of hypertension, heart disease, type 2 diabetes, and stroke, said Dr. Morgenthaler, who is professor of medicine at the Mayo Clinic in Rochester, Minn.
The AASM has been lobbying Congress to include a validated OSA screen in the initial Medicare visit and found sponsors in Rep. Michael Burgess (R-Tex.) and Rep. Bobby Rush (D-Ill.). The two congressmen introduced a bill (H.R. 4695) that would do just that on May 21.
"This important legislation addresses the barriers that prevent new Medicare beneficiaries from receiving what we know to be required sleep apnea services," Dr. Morgenthaler said at the annual meeting of the Associated Professional Sleep Societies.
Rep. Erik Paulsen (R-Minn.), who recently signed on to the bill as a cosponsor, told AASM attendees that adding an OSA screen to the initial Medicare visit would help increase detection of disease, raise patient awareness, and "improve health care quality and reduce costs to the Medicare program," over the long term.
The AASM is asking its members to back the legislation and educate local lawmakers and patients through the group’s Seniors Sleep Campaign.
The association also wants to make it easier for board-certified sleep medicine specialists to care for Medicare patients from start to finish. Currently, antikickback laws prevent sleep specialists and sleep centers from directly providing therapeutic durable medical equipment to Medicare patients, said Dr. Morgenthaler.
The AASM has developed model language for an exception to that statute, which it hopes legislators or regulators will approve, he said. It would allow board-certified specialists to provide the continuum of care from start to finish, including durable medical equipment such as continuous positive airway pressure devices.
Eliminating the current fragmented system of care would eliminate waste, simplify the work flow, and improve the quality of care and reduce costs, said Dr. Morgenthaler.
On Twitter @aliciaault
MINNEAPOLIS – The American Academy of Sleep Medicine is pushing to have a simple sleep apnea questionnaire included in the initial Welcome to Medicare preventive care visit.
Including such a screening tool would help identify obstructive sleep apnea (OSA) when patients first join the Medicare program and thus improve the odds of diagnosing and treating the condition, said Dr. Timothy Morgenthaler, president of the AASM. Getting a handle on OSA could also reduce the potential that the beneficiary will develop related chronic conditions, and that will help Medicare curb expenditures, he said.
An estimated 20% of current Medicare beneficiaries have OSA. That number is expected to grow with the rising obesity rates, he said. Untreated OSA can increase the risk of hypertension, heart disease, type 2 diabetes, and stroke, said Dr. Morgenthaler, who is professor of medicine at the Mayo Clinic in Rochester, Minn.
The AASM has been lobbying Congress to include a validated OSA screen in the initial Medicare visit and found sponsors in Rep. Michael Burgess (R-Tex.) and Rep. Bobby Rush (D-Ill.). The two congressmen introduced a bill (H.R. 4695) that would do just that on May 21.
"This important legislation addresses the barriers that prevent new Medicare beneficiaries from receiving what we know to be required sleep apnea services," Dr. Morgenthaler said at the annual meeting of the Associated Professional Sleep Societies.
Rep. Erik Paulsen (R-Minn.), who recently signed on to the bill as a cosponsor, told AASM attendees that adding an OSA screen to the initial Medicare visit would help increase detection of disease, raise patient awareness, and "improve health care quality and reduce costs to the Medicare program," over the long term.
The AASM is asking its members to back the legislation and educate local lawmakers and patients through the group’s Seniors Sleep Campaign.
The association also wants to make it easier for board-certified sleep medicine specialists to care for Medicare patients from start to finish. Currently, antikickback laws prevent sleep specialists and sleep centers from directly providing therapeutic durable medical equipment to Medicare patients, said Dr. Morgenthaler.
The AASM has developed model language for an exception to that statute, which it hopes legislators or regulators will approve, he said. It would allow board-certified specialists to provide the continuum of care from start to finish, including durable medical equipment such as continuous positive airway pressure devices.
Eliminating the current fragmented system of care would eliminate waste, simplify the work flow, and improve the quality of care and reduce costs, said Dr. Morgenthaler.
On Twitter @aliciaault
MINNEAPOLIS – The American Academy of Sleep Medicine is pushing to have a simple sleep apnea questionnaire included in the initial Welcome to Medicare preventive care visit.
Including such a screening tool would help identify obstructive sleep apnea (OSA) when patients first join the Medicare program and thus improve the odds of diagnosing and treating the condition, said Dr. Timothy Morgenthaler, president of the AASM. Getting a handle on OSA could also reduce the potential that the beneficiary will develop related chronic conditions, and that will help Medicare curb expenditures, he said.
An estimated 20% of current Medicare beneficiaries have OSA. That number is expected to grow with the rising obesity rates, he said. Untreated OSA can increase the risk of hypertension, heart disease, type 2 diabetes, and stroke, said Dr. Morgenthaler, who is professor of medicine at the Mayo Clinic in Rochester, Minn.
The AASM has been lobbying Congress to include a validated OSA screen in the initial Medicare visit and found sponsors in Rep. Michael Burgess (R-Tex.) and Rep. Bobby Rush (D-Ill.). The two congressmen introduced a bill (H.R. 4695) that would do just that on May 21.
"This important legislation addresses the barriers that prevent new Medicare beneficiaries from receiving what we know to be required sleep apnea services," Dr. Morgenthaler said at the annual meeting of the Associated Professional Sleep Societies.
Rep. Erik Paulsen (R-Minn.), who recently signed on to the bill as a cosponsor, told AASM attendees that adding an OSA screen to the initial Medicare visit would help increase detection of disease, raise patient awareness, and "improve health care quality and reduce costs to the Medicare program," over the long term.
The AASM is asking its members to back the legislation and educate local lawmakers and patients through the group’s Seniors Sleep Campaign.
The association also wants to make it easier for board-certified sleep medicine specialists to care for Medicare patients from start to finish. Currently, antikickback laws prevent sleep specialists and sleep centers from directly providing therapeutic durable medical equipment to Medicare patients, said Dr. Morgenthaler.
The AASM has developed model language for an exception to that statute, which it hopes legislators or regulators will approve, he said. It would allow board-certified specialists to provide the continuum of care from start to finish, including durable medical equipment such as continuous positive airway pressure devices.
Eliminating the current fragmented system of care would eliminate waste, simplify the work flow, and improve the quality of care and reduce costs, said Dr. Morgenthaler.
On Twitter @aliciaault
AT SLEEP 2014
Suicide more likely after midnight
MINNEAPOLIS – Suicide may be more likely after midnight and in particular between 2 a.m. and 3 a.m., according to new research.
"This appears to be the first data to suggest that circadian factors may contribute to suicidality, and help explain why insomnia is also a risk factor for suicidal ideation and behavior," said Michael L. Perlis, Ph.D., of the department of psychiatry and director of the Penn behavioral sleep medicine program at the University of Pennsylvania, Philadelphia.
Dr. Perlis said that it has long been known that insomnia may lead to a certain despair; he found a reference to it in the Lancet in 1914. The anecdotal report said, "The rector of a parish having written the following letter, was found dead in a pool with a bullet wound in the head: ‘Another sleepless night; no real sleep for weeks. Oh, my poor brain, I cannot bear the lengthy, dark hours of the night.’ "
Previous studies have shown that completed suicides rise starting in the morning, and then peak in the afternoon, with trends being lowest from midnight to 4 a.m., Dr. Perlis said at the annual meeting of the Associated Professional Sleep Societies.
He and his colleagues at Penn and the Philadelphia Veteran Affairs Medical Center, also in Philadelphia, decided to take a different look at the data – instead of arraying completed suicides as a percent per hour, they examined the odds of completed suicide by clock hour, accounting for the proportion of the population awake at each hour.
They hypothesized that people with insomnia may be at higher risk for suicidal ideation and behavior because of their chaotic and dysfunctional thoughts and nightmares, in which small problems appear much larger. Further, people who are depressed and suicidal also have higher rates of insomnia.
They looked at 35,332 suicides reported to the National Violent Death Reporting System at the Centers for Disease Control and Prevention. The data come from 18 states and was compiled from 2002 to 2010. The reports included the time of the fatal injury.
A total of 81% (28,704) of the suicides were in men and 84% (29,771) were in non-Hispanic whites. Suicide was highest among 35-44-year-olds and 45-54-year-olds, at about 20% for each age group.
The researchers used existing data on the number of Americans awake at any given hour and plotted the suicides by 1-hour increments.
At 7 a.m., the mean suicide rate was just under 2%. But at midnight, it was 8.3%; at 2 a.m., it was 16%, and at 3 a.m. it was 15%. Rates continued to drop from there, to a little over 2% at 6 a.m.
"Frankly, it makes all the sense in the world that completed suicides would occur more frequently at night," Dr. Perlis said in an interview. At that time, there is an absence of social constraints and social supports, a despair that comes from sleeplessness and easier access to alcohol, substances, and weapons, he said. Impulse control also may be lower (Sleep 2014;vol.237:abstract supplement,abst. 0768)
It is also "likely that being awake at night, when one is biologically prepared to be asleep, may be a risk factor in and of itself," Dr. Perlis said.
As far as why suicides peaked between 2 a.m. and 3 a.m. in their study, Dr. Perlis said that it may be that it’s the time of day "where the pressure to sleep is greatest and as a result this is the time when executive function is most impaired."
Dr. Perlis said that the study, "suggests that interventions for insomnia and nightmares may serve to reduce the risk for completed suicide and likely will also reduce suicidal ideation and behavior."
Short term interventions can include medications and other medical strategies. But Dr. Perlis recommends cognitive-behavioral therapy that targets insomnia and nightmares for longer-term treatment. The Philadelphia Veterans Affairs began system-wide training in CBT for insomnia and nightmares 4 years ago, he said.
The research was supported by the University of Pennsylvania and the National Institutes of Health. Dr. Perlis and his colleagues reported no conflicts.
On Twitter @aliciaault
MINNEAPOLIS – Suicide may be more likely after midnight and in particular between 2 a.m. and 3 a.m., according to new research.
"This appears to be the first data to suggest that circadian factors may contribute to suicidality, and help explain why insomnia is also a risk factor for suicidal ideation and behavior," said Michael L. Perlis, Ph.D., of the department of psychiatry and director of the Penn behavioral sleep medicine program at the University of Pennsylvania, Philadelphia.
Dr. Perlis said that it has long been known that insomnia may lead to a certain despair; he found a reference to it in the Lancet in 1914. The anecdotal report said, "The rector of a parish having written the following letter, was found dead in a pool with a bullet wound in the head: ‘Another sleepless night; no real sleep for weeks. Oh, my poor brain, I cannot bear the lengthy, dark hours of the night.’ "
Previous studies have shown that completed suicides rise starting in the morning, and then peak in the afternoon, with trends being lowest from midnight to 4 a.m., Dr. Perlis said at the annual meeting of the Associated Professional Sleep Societies.
He and his colleagues at Penn and the Philadelphia Veteran Affairs Medical Center, also in Philadelphia, decided to take a different look at the data – instead of arraying completed suicides as a percent per hour, they examined the odds of completed suicide by clock hour, accounting for the proportion of the population awake at each hour.
They hypothesized that people with insomnia may be at higher risk for suicidal ideation and behavior because of their chaotic and dysfunctional thoughts and nightmares, in which small problems appear much larger. Further, people who are depressed and suicidal also have higher rates of insomnia.
They looked at 35,332 suicides reported to the National Violent Death Reporting System at the Centers for Disease Control and Prevention. The data come from 18 states and was compiled from 2002 to 2010. The reports included the time of the fatal injury.
A total of 81% (28,704) of the suicides were in men and 84% (29,771) were in non-Hispanic whites. Suicide was highest among 35-44-year-olds and 45-54-year-olds, at about 20% for each age group.
The researchers used existing data on the number of Americans awake at any given hour and plotted the suicides by 1-hour increments.
At 7 a.m., the mean suicide rate was just under 2%. But at midnight, it was 8.3%; at 2 a.m., it was 16%, and at 3 a.m. it was 15%. Rates continued to drop from there, to a little over 2% at 6 a.m.
"Frankly, it makes all the sense in the world that completed suicides would occur more frequently at night," Dr. Perlis said in an interview. At that time, there is an absence of social constraints and social supports, a despair that comes from sleeplessness and easier access to alcohol, substances, and weapons, he said. Impulse control also may be lower (Sleep 2014;vol.237:abstract supplement,abst. 0768)
It is also "likely that being awake at night, when one is biologically prepared to be asleep, may be a risk factor in and of itself," Dr. Perlis said.
As far as why suicides peaked between 2 a.m. and 3 a.m. in their study, Dr. Perlis said that it may be that it’s the time of day "where the pressure to sleep is greatest and as a result this is the time when executive function is most impaired."
Dr. Perlis said that the study, "suggests that interventions for insomnia and nightmares may serve to reduce the risk for completed suicide and likely will also reduce suicidal ideation and behavior."
Short term interventions can include medications and other medical strategies. But Dr. Perlis recommends cognitive-behavioral therapy that targets insomnia and nightmares for longer-term treatment. The Philadelphia Veterans Affairs began system-wide training in CBT for insomnia and nightmares 4 years ago, he said.
The research was supported by the University of Pennsylvania and the National Institutes of Health. Dr. Perlis and his colleagues reported no conflicts.
On Twitter @aliciaault
MINNEAPOLIS – Suicide may be more likely after midnight and in particular between 2 a.m. and 3 a.m., according to new research.
"This appears to be the first data to suggest that circadian factors may contribute to suicidality, and help explain why insomnia is also a risk factor for suicidal ideation and behavior," said Michael L. Perlis, Ph.D., of the department of psychiatry and director of the Penn behavioral sleep medicine program at the University of Pennsylvania, Philadelphia.
Dr. Perlis said that it has long been known that insomnia may lead to a certain despair; he found a reference to it in the Lancet in 1914. The anecdotal report said, "The rector of a parish having written the following letter, was found dead in a pool with a bullet wound in the head: ‘Another sleepless night; no real sleep for weeks. Oh, my poor brain, I cannot bear the lengthy, dark hours of the night.’ "
Previous studies have shown that completed suicides rise starting in the morning, and then peak in the afternoon, with trends being lowest from midnight to 4 a.m., Dr. Perlis said at the annual meeting of the Associated Professional Sleep Societies.
He and his colleagues at Penn and the Philadelphia Veteran Affairs Medical Center, also in Philadelphia, decided to take a different look at the data – instead of arraying completed suicides as a percent per hour, they examined the odds of completed suicide by clock hour, accounting for the proportion of the population awake at each hour.
They hypothesized that people with insomnia may be at higher risk for suicidal ideation and behavior because of their chaotic and dysfunctional thoughts and nightmares, in which small problems appear much larger. Further, people who are depressed and suicidal also have higher rates of insomnia.
They looked at 35,332 suicides reported to the National Violent Death Reporting System at the Centers for Disease Control and Prevention. The data come from 18 states and was compiled from 2002 to 2010. The reports included the time of the fatal injury.
A total of 81% (28,704) of the suicides were in men and 84% (29,771) were in non-Hispanic whites. Suicide was highest among 35-44-year-olds and 45-54-year-olds, at about 20% for each age group.
The researchers used existing data on the number of Americans awake at any given hour and plotted the suicides by 1-hour increments.
At 7 a.m., the mean suicide rate was just under 2%. But at midnight, it was 8.3%; at 2 a.m., it was 16%, and at 3 a.m. it was 15%. Rates continued to drop from there, to a little over 2% at 6 a.m.
"Frankly, it makes all the sense in the world that completed suicides would occur more frequently at night," Dr. Perlis said in an interview. At that time, there is an absence of social constraints and social supports, a despair that comes from sleeplessness and easier access to alcohol, substances, and weapons, he said. Impulse control also may be lower (Sleep 2014;vol.237:abstract supplement,abst. 0768)
It is also "likely that being awake at night, when one is biologically prepared to be asleep, may be a risk factor in and of itself," Dr. Perlis said.
As far as why suicides peaked between 2 a.m. and 3 a.m. in their study, Dr. Perlis said that it may be that it’s the time of day "where the pressure to sleep is greatest and as a result this is the time when executive function is most impaired."
Dr. Perlis said that the study, "suggests that interventions for insomnia and nightmares may serve to reduce the risk for completed suicide and likely will also reduce suicidal ideation and behavior."
Short term interventions can include medications and other medical strategies. But Dr. Perlis recommends cognitive-behavioral therapy that targets insomnia and nightmares for longer-term treatment. The Philadelphia Veterans Affairs began system-wide training in CBT for insomnia and nightmares 4 years ago, he said.
The research was supported by the University of Pennsylvania and the National Institutes of Health. Dr. Perlis and his colleagues reported no conflicts.
On Twitter @aliciaault
FROM SLEEP 2014
Key clinical point: Nighttime wakefulness is a risk factor for suicide.
Major finding: Suicides rose after midnight, peaking at a mean 16% at 2 a.m.
Data source: The authors analyzed surveillance data on 35,332 completed suicides from the CDC’s National Violent Death Reporting System.
Disclosures: The research was supported by the University of Pennsylvania and the National Institutes of Health. Dr. Perlis and his colleagues reported no conflicts.
CPAP adherence improves with partner support
MINNEAPOLIS – People with obstructive sleep apnea who have spouses or supportive partners tend to use their continuous positive airway pressure devices for longer periods of time.
That’s according to a study to be presented at the annual meeting of the Associated Professional Sleep Societies on June 2 by researchers at the University of Pittsburgh School of Nursing and at National Jewish Health in Denver.
The findings indicate that patients who live alone or do not have a supportive family might benefit from a group setting during the initial use of the CPAP. New, single users could also be paired off with peer "buddies" who can share experience and offer advice, according to principal investigator Faith Luyster, Ph.D.
Dr. Luyster performed a subanalysis of patients enrolled in a larger randomized, controlled trial conducted by Mark Aloia, Ph.D., associate professor of medicine at National Jewish Health, when he was a resident at Brown University in Providence, R.I. That larger study enrolled patients with obstructive sleep apnea (OSA) to determine whether motivational interviewing or intensive education might increase the use of continuous positive airway pressure (CPAP).
Data were analyzed from 253 patients (100 women and 153 men), just starting CPAP. At the start of the study, 185 were part of a couple and 68 were never married; divorced or separated; or widowed. The quality of the relationship was assessed at baseline using the 12-item General Functioning subscale of the McMaster Family Assessment Device.
Study participants used a four-point Likert scale – rating the 12 statements as "strongly agree", "agree," "disagree," and "strongly disagree" to answer statements that included: "In times of crisis we can turn to each other for support;" "We can express feelings to each other;" and "We confide in each other." A high score is associated with poor relationship quality.
CPAP use was recorded by the device itself.
At 3 months, single patients had average CPAP use of 3.3 hours plus or minus 2.5 hours per night, and coupled patients had 4.3 hours plus or minus 2.6 hours per night (P less than .01). Patients who had a higher relationship quality also had better adherence (P less than .05).
"Ideally, physicians want patients to wear [the CPAP mask] all night," said Dr. Luyster. There are "some data to suggest that wearing it 6 to 7 hours a night can improve cognitive functioning and daytime sleepiness."
Having a supportive partner or family member can help, especially in the beginning of CPAP use. The mask may need to be adjusted, and the user needs to get acclimated to sleeping with a mask. "It’s very helpful for patients to have cheerleaders," who can encourage and assist them, remind them to use the device, and help them to clean the CPAP device daily.
And it helps to have someone who’s accepting of the patient when wearing the CPAP mask. In focus groups, men were very concerned about how they would look to their partners, said Dr. Luyster. Women were more concerned that everyone was sleeping well again.
The authors reported no financial conflicts. The study was funded by the National Heart, Lung and Blood Institute.
[email protected]
On Twitter @aliciaault
MINNEAPOLIS – People with obstructive sleep apnea who have spouses or supportive partners tend to use their continuous positive airway pressure devices for longer periods of time.
That’s according to a study to be presented at the annual meeting of the Associated Professional Sleep Societies on June 2 by researchers at the University of Pittsburgh School of Nursing and at National Jewish Health in Denver.
The findings indicate that patients who live alone or do not have a supportive family might benefit from a group setting during the initial use of the CPAP. New, single users could also be paired off with peer "buddies" who can share experience and offer advice, according to principal investigator Faith Luyster, Ph.D.
Dr. Luyster performed a subanalysis of patients enrolled in a larger randomized, controlled trial conducted by Mark Aloia, Ph.D., associate professor of medicine at National Jewish Health, when he was a resident at Brown University in Providence, R.I. That larger study enrolled patients with obstructive sleep apnea (OSA) to determine whether motivational interviewing or intensive education might increase the use of continuous positive airway pressure (CPAP).
Data were analyzed from 253 patients (100 women and 153 men), just starting CPAP. At the start of the study, 185 were part of a couple and 68 were never married; divorced or separated; or widowed. The quality of the relationship was assessed at baseline using the 12-item General Functioning subscale of the McMaster Family Assessment Device.
Study participants used a four-point Likert scale – rating the 12 statements as "strongly agree", "agree," "disagree," and "strongly disagree" to answer statements that included: "In times of crisis we can turn to each other for support;" "We can express feelings to each other;" and "We confide in each other." A high score is associated with poor relationship quality.
CPAP use was recorded by the device itself.
At 3 months, single patients had average CPAP use of 3.3 hours plus or minus 2.5 hours per night, and coupled patients had 4.3 hours plus or minus 2.6 hours per night (P less than .01). Patients who had a higher relationship quality also had better adherence (P less than .05).
"Ideally, physicians want patients to wear [the CPAP mask] all night," said Dr. Luyster. There are "some data to suggest that wearing it 6 to 7 hours a night can improve cognitive functioning and daytime sleepiness."
Having a supportive partner or family member can help, especially in the beginning of CPAP use. The mask may need to be adjusted, and the user needs to get acclimated to sleeping with a mask. "It’s very helpful for patients to have cheerleaders," who can encourage and assist them, remind them to use the device, and help them to clean the CPAP device daily.
And it helps to have someone who’s accepting of the patient when wearing the CPAP mask. In focus groups, men were very concerned about how they would look to their partners, said Dr. Luyster. Women were more concerned that everyone was sleeping well again.
The authors reported no financial conflicts. The study was funded by the National Heart, Lung and Blood Institute.
[email protected]
On Twitter @aliciaault
MINNEAPOLIS – People with obstructive sleep apnea who have spouses or supportive partners tend to use their continuous positive airway pressure devices for longer periods of time.
That’s according to a study to be presented at the annual meeting of the Associated Professional Sleep Societies on June 2 by researchers at the University of Pittsburgh School of Nursing and at National Jewish Health in Denver.
The findings indicate that patients who live alone or do not have a supportive family might benefit from a group setting during the initial use of the CPAP. New, single users could also be paired off with peer "buddies" who can share experience and offer advice, according to principal investigator Faith Luyster, Ph.D.
Dr. Luyster performed a subanalysis of patients enrolled in a larger randomized, controlled trial conducted by Mark Aloia, Ph.D., associate professor of medicine at National Jewish Health, when he was a resident at Brown University in Providence, R.I. That larger study enrolled patients with obstructive sleep apnea (OSA) to determine whether motivational interviewing or intensive education might increase the use of continuous positive airway pressure (CPAP).
Data were analyzed from 253 patients (100 women and 153 men), just starting CPAP. At the start of the study, 185 were part of a couple and 68 were never married; divorced or separated; or widowed. The quality of the relationship was assessed at baseline using the 12-item General Functioning subscale of the McMaster Family Assessment Device.
Study participants used a four-point Likert scale – rating the 12 statements as "strongly agree", "agree," "disagree," and "strongly disagree" to answer statements that included: "In times of crisis we can turn to each other for support;" "We can express feelings to each other;" and "We confide in each other." A high score is associated with poor relationship quality.
CPAP use was recorded by the device itself.
At 3 months, single patients had average CPAP use of 3.3 hours plus or minus 2.5 hours per night, and coupled patients had 4.3 hours plus or minus 2.6 hours per night (P less than .01). Patients who had a higher relationship quality also had better adherence (P less than .05).
"Ideally, physicians want patients to wear [the CPAP mask] all night," said Dr. Luyster. There are "some data to suggest that wearing it 6 to 7 hours a night can improve cognitive functioning and daytime sleepiness."
Having a supportive partner or family member can help, especially in the beginning of CPAP use. The mask may need to be adjusted, and the user needs to get acclimated to sleeping with a mask. "It’s very helpful for patients to have cheerleaders," who can encourage and assist them, remind them to use the device, and help them to clean the CPAP device daily.
And it helps to have someone who’s accepting of the patient when wearing the CPAP mask. In focus groups, men were very concerned about how they would look to their partners, said Dr. Luyster. Women were more concerned that everyone was sleeping well again.
The authors reported no financial conflicts. The study was funded by the National Heart, Lung and Blood Institute.
[email protected]
On Twitter @aliciaault
FROM SLEEP 2014
Key clinical point: Coupled patients have better CPAP adherence.
Major finding: CPAP use was about an hour longer in coupled patients than in single patients, and adherence was related to relationship quality.
Data source: An analysis of 253 patients from a randomized, controlled trial.
Disclosures: The authors reported no financial conflicts. The study was funded by the National Heart, Lung and Blood Institute.
FDA approves blood test for membranous glomerulonephritis
The Food and Drug Administration has approved a noninvasive test to determine whether a chronic kidney disease is caused by an autoimmune disease or another cause such as infection.
The EUROIMMUN Anti- PLA2R IFA blood test detects an antibody that is specific to primary membranous glomerulonephritis (pMGN). MGN, a chronic kidney disease, damages the glomeruli; it can lead to kidney failure and transplant. Symptoms include swelling, hypercholesterolemia, hypertension, and an increased predisposition to blood clots.
The condition mostly affects white men. It occurs in 2 of every 10,000 people and is more common after age 40, according to the National Library of Medicine. Risk factors include cancers, especially lung and colon cancer; exposure to toxins, including gold and mercury; infections, including hepatitis B, malaria, syphilis, and endocarditis; certain medications, including penicillamine, trimethadione, and skin-lightening creams; and systemic lupus erythematosus, rheumatoid arthritis, Graves’ disease, and other autoimmune disorders.
"Treatment of MGN depends on the underlying cause of the disease," said Alberto Gutierrez, Ph.D., director of the Office of In Vitro Diagnostics and Radiological Health at the FDA’s Center for Devices and Radiological Health, in a statement. "This test can help patients get a timely diagnosis for their MGN and aid with earlier treatment."
Test manufacturer EUROIMMUN US submitted data that compared 275 blood samples from patients with presumed pMGN, with 285 samples from patients diagnosed with other kidney diseases including secondary MGN (sMGN) and autoimmune diseases. The test detected pMGN in 77% of the presumed pMGN samples, and gave a false-positive result in less than 1% of the other samples.
The diagnostic test helped distinguish pMGN from sMGN in most of the patients.
The FDA said that the test should not be used alone to diagnose pMGN, but that patients’ symptoms and other laboratory test results should also be considered. A kidney biopsy is required for confirmation, according to the FDA.
On Twitter @aliciaault
The Food and Drug Administration has approved a noninvasive test to determine whether a chronic kidney disease is caused by an autoimmune disease or another cause such as infection.
The EUROIMMUN Anti- PLA2R IFA blood test detects an antibody that is specific to primary membranous glomerulonephritis (pMGN). MGN, a chronic kidney disease, damages the glomeruli; it can lead to kidney failure and transplant. Symptoms include swelling, hypercholesterolemia, hypertension, and an increased predisposition to blood clots.
The condition mostly affects white men. It occurs in 2 of every 10,000 people and is more common after age 40, according to the National Library of Medicine. Risk factors include cancers, especially lung and colon cancer; exposure to toxins, including gold and mercury; infections, including hepatitis B, malaria, syphilis, and endocarditis; certain medications, including penicillamine, trimethadione, and skin-lightening creams; and systemic lupus erythematosus, rheumatoid arthritis, Graves’ disease, and other autoimmune disorders.
"Treatment of MGN depends on the underlying cause of the disease," said Alberto Gutierrez, Ph.D., director of the Office of In Vitro Diagnostics and Radiological Health at the FDA’s Center for Devices and Radiological Health, in a statement. "This test can help patients get a timely diagnosis for their MGN and aid with earlier treatment."
Test manufacturer EUROIMMUN US submitted data that compared 275 blood samples from patients with presumed pMGN, with 285 samples from patients diagnosed with other kidney diseases including secondary MGN (sMGN) and autoimmune diseases. The test detected pMGN in 77% of the presumed pMGN samples, and gave a false-positive result in less than 1% of the other samples.
The diagnostic test helped distinguish pMGN from sMGN in most of the patients.
The FDA said that the test should not be used alone to diagnose pMGN, but that patients’ symptoms and other laboratory test results should also be considered. A kidney biopsy is required for confirmation, according to the FDA.
On Twitter @aliciaault
The Food and Drug Administration has approved a noninvasive test to determine whether a chronic kidney disease is caused by an autoimmune disease or another cause such as infection.
The EUROIMMUN Anti- PLA2R IFA blood test detects an antibody that is specific to primary membranous glomerulonephritis (pMGN). MGN, a chronic kidney disease, damages the glomeruli; it can lead to kidney failure and transplant. Symptoms include swelling, hypercholesterolemia, hypertension, and an increased predisposition to blood clots.
The condition mostly affects white men. It occurs in 2 of every 10,000 people and is more common after age 40, according to the National Library of Medicine. Risk factors include cancers, especially lung and colon cancer; exposure to toxins, including gold and mercury; infections, including hepatitis B, malaria, syphilis, and endocarditis; certain medications, including penicillamine, trimethadione, and skin-lightening creams; and systemic lupus erythematosus, rheumatoid arthritis, Graves’ disease, and other autoimmune disorders.
"Treatment of MGN depends on the underlying cause of the disease," said Alberto Gutierrez, Ph.D., director of the Office of In Vitro Diagnostics and Radiological Health at the FDA’s Center for Devices and Radiological Health, in a statement. "This test can help patients get a timely diagnosis for their MGN and aid with earlier treatment."
Test manufacturer EUROIMMUN US submitted data that compared 275 blood samples from patients with presumed pMGN, with 285 samples from patients diagnosed with other kidney diseases including secondary MGN (sMGN) and autoimmune diseases. The test detected pMGN in 77% of the presumed pMGN samples, and gave a false-positive result in less than 1% of the other samples.
The diagnostic test helped distinguish pMGN from sMGN in most of the patients.
The FDA said that the test should not be used alone to diagnose pMGN, but that patients’ symptoms and other laboratory test results should also be considered. A kidney biopsy is required for confirmation, according to the FDA.
On Twitter @aliciaault
Kaiser survey: Many women skipping preventive care
WASHINGTON – A just-released survey conducted last fall shows that low-income women with private insurance or Medicaid were often foregoing preventive care and use of contraceptives, in part due to cost, but also because of a lack of awareness of benefits that were already available under the Affordable Care Act.
The Kaiser Family Foundation conducted the survey of some 3,000 women aged 15-64 years by telephone – in English and Spanish – from September to November 2013. The goal was to get a baseline picture of women’s health care before the ACA was fully implemented in January.
"It’s important to know where we are today, to have a baseline" with which to compare outcomes in the future, after more women have insurance and broader access to benefits, Alina Salganicoff, vice president and director of women’s health policy for the Kaiser Family Foundation, said at a briefing*.
At the time of the survey, many preventive benefits had already been available to a large number of women since 2012. Under the ACA, health plans that had changed since the law went into effect in 2010 were required to cover services such as mammograms, Pap smears, counseling on domestic and interpersonal violence and sexually transmitted infections (STIs), and contraception. Medicaid also has been covering those preventive benefits.
Among the women surveyed, 51% had employer-provided insurance, 9% were on Medicaid, 7% had individual coverage, 6% were on a parent’s policy, 6% were covered by another government program, and 18% were uninsured. When stratified by income, women who were under 200% of the poverty line were more likely to be uninsured (40%) or on Medicaid (21%).
More than a quarter overall (26%) said they’d delayed care in the past year because of cost, and about 20% said they had skipped recommended tests or treatments, or not filled prescriptions. Twenty-eight percent said they had trouble paying medical bills. All of these rates are higher than in a comparable sample of men surveyed by Kaiser.
When it came to knowledge about preventive services, 60% said they knew insurers were required to cover the cost of at least one preventive visit a year with no out-of-pocket costs, and a slightly smaller number were aware that the plans were also required to provide preventive services free of copays, deductibles, or other charges.
About 88% of women with private insurance said they’d had a recent checkup with a doctor, compared with 81% of those with Medicaid. Not surprisingly, fewer uninsured women had a recent checkup – only about 60%. Only about 40% of women said they’d talked with a health provider about a mental health issue. Mental health services are considered an essential benefit under the ACA, but it’s not clear yet what exactly will be covered.
Most women (73%) reported that their usual source of care was a doctor or an HMO; 13% received care in a clinic, but 3% reported the emergency room as their usual source of care.
For screening tests that are covered, rates of use were high for hypertension (92%) but extremely low for colonoscopy – only 39% of all women reported having had the exam at the appropriate interval, with rates dipping to 35% for blacks and 34% for Hispanics.
Women with private insurance were more likely to have visited an ob.gyn. in the past year – at about 70%, compared with 58% of those on Medicaid, and 43% of the uninsured.
Physician counseling varied by insurance status and ethnicity. Clinicians were more likely to discuss sexual history, HIV, and STIs with women on Medicaid, and black and Hispanic women. Of women on Medicaid, 52% said their provider had talked about HIV, compared with only 29% of those with private insurance. The uninsured had the lowest rate of counseling on any of those topics.
Only about 40% of women were tested for an STI, and among those women, half assumed that the test was a routine part of an ob.gyn. exam. It is not, so rates of testing are probably even lower than those being reported by the survey respondents, said Usha Ranji, associate director for women’s health policy at Kaiser, who was also an author of the survey.
Even though contraceptives are required to be covered by most health plans, 20% of those surveyed said they were not using any contraception. In part, that may be because condoms were reported as the primary method for all women, but especially for those under age 25, and for black women. Condoms are not reimbursed by any plan.
Among women who did use contraception, 32% said it was fully covered by insurance, 31% said it was partially covered, 10% said it was covered by Medicaid, and 18% said they did not have coverage.
The survey was conducted among a nationally representative random digit dial telephone sample, and a shorter companion survey with a nationally representative sample of 700 men aged 18-64 years was conducted at the same time. The margin of sampling error was plus or minus 3 percentage points for the full sample of women and plus or minus 4 percentage points for men.
[email protected]
On Twitter @aliciaault
*Correction, 7/9/2014: An earlier version of this article misstated Alina Salganicoff's name.
WASHINGTON – A just-released survey conducted last fall shows that low-income women with private insurance or Medicaid were often foregoing preventive care and use of contraceptives, in part due to cost, but also because of a lack of awareness of benefits that were already available under the Affordable Care Act.
The Kaiser Family Foundation conducted the survey of some 3,000 women aged 15-64 years by telephone – in English and Spanish – from September to November 2013. The goal was to get a baseline picture of women’s health care before the ACA was fully implemented in January.
"It’s important to know where we are today, to have a baseline" with which to compare outcomes in the future, after more women have insurance and broader access to benefits, Alina Salganicoff, vice president and director of women’s health policy for the Kaiser Family Foundation, said at a briefing*.
At the time of the survey, many preventive benefits had already been available to a large number of women since 2012. Under the ACA, health plans that had changed since the law went into effect in 2010 were required to cover services such as mammograms, Pap smears, counseling on domestic and interpersonal violence and sexually transmitted infections (STIs), and contraception. Medicaid also has been covering those preventive benefits.
Among the women surveyed, 51% had employer-provided insurance, 9% were on Medicaid, 7% had individual coverage, 6% were on a parent’s policy, 6% were covered by another government program, and 18% were uninsured. When stratified by income, women who were under 200% of the poverty line were more likely to be uninsured (40%) or on Medicaid (21%).
More than a quarter overall (26%) said they’d delayed care in the past year because of cost, and about 20% said they had skipped recommended tests or treatments, or not filled prescriptions. Twenty-eight percent said they had trouble paying medical bills. All of these rates are higher than in a comparable sample of men surveyed by Kaiser.
When it came to knowledge about preventive services, 60% said they knew insurers were required to cover the cost of at least one preventive visit a year with no out-of-pocket costs, and a slightly smaller number were aware that the plans were also required to provide preventive services free of copays, deductibles, or other charges.
About 88% of women with private insurance said they’d had a recent checkup with a doctor, compared with 81% of those with Medicaid. Not surprisingly, fewer uninsured women had a recent checkup – only about 60%. Only about 40% of women said they’d talked with a health provider about a mental health issue. Mental health services are considered an essential benefit under the ACA, but it’s not clear yet what exactly will be covered.
Most women (73%) reported that their usual source of care was a doctor or an HMO; 13% received care in a clinic, but 3% reported the emergency room as their usual source of care.
For screening tests that are covered, rates of use were high for hypertension (92%) but extremely low for colonoscopy – only 39% of all women reported having had the exam at the appropriate interval, with rates dipping to 35% for blacks and 34% for Hispanics.
Women with private insurance were more likely to have visited an ob.gyn. in the past year – at about 70%, compared with 58% of those on Medicaid, and 43% of the uninsured.
Physician counseling varied by insurance status and ethnicity. Clinicians were more likely to discuss sexual history, HIV, and STIs with women on Medicaid, and black and Hispanic women. Of women on Medicaid, 52% said their provider had talked about HIV, compared with only 29% of those with private insurance. The uninsured had the lowest rate of counseling on any of those topics.
Only about 40% of women were tested for an STI, and among those women, half assumed that the test was a routine part of an ob.gyn. exam. It is not, so rates of testing are probably even lower than those being reported by the survey respondents, said Usha Ranji, associate director for women’s health policy at Kaiser, who was also an author of the survey.
Even though contraceptives are required to be covered by most health plans, 20% of those surveyed said they were not using any contraception. In part, that may be because condoms were reported as the primary method for all women, but especially for those under age 25, and for black women. Condoms are not reimbursed by any plan.
Among women who did use contraception, 32% said it was fully covered by insurance, 31% said it was partially covered, 10% said it was covered by Medicaid, and 18% said they did not have coverage.
The survey was conducted among a nationally representative random digit dial telephone sample, and a shorter companion survey with a nationally representative sample of 700 men aged 18-64 years was conducted at the same time. The margin of sampling error was plus or minus 3 percentage points for the full sample of women and plus or minus 4 percentage points for men.
[email protected]
On Twitter @aliciaault
*Correction, 7/9/2014: An earlier version of this article misstated Alina Salganicoff's name.
WASHINGTON – A just-released survey conducted last fall shows that low-income women with private insurance or Medicaid were often foregoing preventive care and use of contraceptives, in part due to cost, but also because of a lack of awareness of benefits that were already available under the Affordable Care Act.
The Kaiser Family Foundation conducted the survey of some 3,000 women aged 15-64 years by telephone – in English and Spanish – from September to November 2013. The goal was to get a baseline picture of women’s health care before the ACA was fully implemented in January.
"It’s important to know where we are today, to have a baseline" with which to compare outcomes in the future, after more women have insurance and broader access to benefits, Alina Salganicoff, vice president and director of women’s health policy for the Kaiser Family Foundation, said at a briefing*.
At the time of the survey, many preventive benefits had already been available to a large number of women since 2012. Under the ACA, health plans that had changed since the law went into effect in 2010 were required to cover services such as mammograms, Pap smears, counseling on domestic and interpersonal violence and sexually transmitted infections (STIs), and contraception. Medicaid also has been covering those preventive benefits.
Among the women surveyed, 51% had employer-provided insurance, 9% were on Medicaid, 7% had individual coverage, 6% were on a parent’s policy, 6% were covered by another government program, and 18% were uninsured. When stratified by income, women who were under 200% of the poverty line were more likely to be uninsured (40%) or on Medicaid (21%).
More than a quarter overall (26%) said they’d delayed care in the past year because of cost, and about 20% said they had skipped recommended tests or treatments, or not filled prescriptions. Twenty-eight percent said they had trouble paying medical bills. All of these rates are higher than in a comparable sample of men surveyed by Kaiser.
When it came to knowledge about preventive services, 60% said they knew insurers were required to cover the cost of at least one preventive visit a year with no out-of-pocket costs, and a slightly smaller number were aware that the plans were also required to provide preventive services free of copays, deductibles, or other charges.
About 88% of women with private insurance said they’d had a recent checkup with a doctor, compared with 81% of those with Medicaid. Not surprisingly, fewer uninsured women had a recent checkup – only about 60%. Only about 40% of women said they’d talked with a health provider about a mental health issue. Mental health services are considered an essential benefit under the ACA, but it’s not clear yet what exactly will be covered.
Most women (73%) reported that their usual source of care was a doctor or an HMO; 13% received care in a clinic, but 3% reported the emergency room as their usual source of care.
For screening tests that are covered, rates of use were high for hypertension (92%) but extremely low for colonoscopy – only 39% of all women reported having had the exam at the appropriate interval, with rates dipping to 35% for blacks and 34% for Hispanics.
Women with private insurance were more likely to have visited an ob.gyn. in the past year – at about 70%, compared with 58% of those on Medicaid, and 43% of the uninsured.
Physician counseling varied by insurance status and ethnicity. Clinicians were more likely to discuss sexual history, HIV, and STIs with women on Medicaid, and black and Hispanic women. Of women on Medicaid, 52% said their provider had talked about HIV, compared with only 29% of those with private insurance. The uninsured had the lowest rate of counseling on any of those topics.
Only about 40% of women were tested for an STI, and among those women, half assumed that the test was a routine part of an ob.gyn. exam. It is not, so rates of testing are probably even lower than those being reported by the survey respondents, said Usha Ranji, associate director for women’s health policy at Kaiser, who was also an author of the survey.
Even though contraceptives are required to be covered by most health plans, 20% of those surveyed said they were not using any contraception. In part, that may be because condoms were reported as the primary method for all women, but especially for those under age 25, and for black women. Condoms are not reimbursed by any plan.
Among women who did use contraception, 32% said it was fully covered by insurance, 31% said it was partially covered, 10% said it was covered by Medicaid, and 18% said they did not have coverage.
The survey was conducted among a nationally representative random digit dial telephone sample, and a shorter companion survey with a nationally representative sample of 700 men aged 18-64 years was conducted at the same time. The margin of sampling error was plus or minus 3 percentage points for the full sample of women and plus or minus 4 percentage points for men.
[email protected]
On Twitter @aliciaault
*Correction, 7/9/2014: An earlier version of this article misstated Alina Salganicoff's name.
