Americans are getting heavier and more sedentary, with an ever increasing prevalance of pre-diabetes and type 2 diabetes, with subsequent development of vascular and kidney disease.
A June, 2014 update from the CDC says:
9.3% (~1 in 11) of Americans have diabetes, and 1 in 3 Americans have prediabetes
Total annual cost of diabetes = $245 billion
Today I was asked why I recommend that PCPs do Wellness Visits, when the Choosing Wisely initiative of the American Board of Internal Medicine (ABIM) has recommended against “health maintenance” visits? This is a great question, so I thought I would answer in my blog.
This week, I welcome as co-authors three colleagues and dear friends who have worked with me on all 4 editions of the American College of Sports Medicine's textbook - ACSM's Exercise Management for Persons with Chronic Disease and Disabilities (aka CDD1-CDD4).
In this week's issue of JAMA, Jha and Zaslavsky discuss the issue on outcome quality reporting on physicians and health care networks, concerning the problem that lower socio-economic status (SES) members of society have poorer outcomes than those member in higher SES strata.
A recent headline in the Times of London (England) stated, “One in Three Now at Risk as Diabetes Levels Soar”. One public health official quoted in the article said "If a doctor sits you down and says 'If you carry on they way you are going, I believe within two years you will have diabetes, or heart disease, or cancer,' you will get people to sit up and take notice”. Take notice? Maybe.
In my last blog, we considered a lesson from my college calculus professor, that paths are more interesting than function graphs. Today, we’ll explore why it helps to see a patient’s health ecology as a life path rather than as a risk profile (a function graph), and how group visits can help that process.
From time-to-time, our blogs will discuss life’s paths, whether the discussion is about managing a health care practice or mentoring a patient. In today’s era of ‘big data’ it is common to graph associations and relationships that form health status, but under-appreciate the role of external forces and events that created the path to a particular health status.
Today, lets examine why it’s so important to incorporate the physical activity vital sign (PAVS), sometimes called exercise vital sign (EVS), in the patient’s medical record.
For those who are not familiar with the PAVS, it’s a product of the number of days per week that the patient does moderate-to-vigorous intensity physical activity (or exercise) times the average number of minutes spent doing it each day. Moderate-to-vigorous intensity physical activity is abbreviated as MVPA, so the formula is:
PAVS = (MVPA minutes/day) x (# of days/week)
Last week, the American College of Sports Medicine held it's annual meeting in Orlando, and it was a whiriwind of activity (as always). For at least 20 years, now, it's been far too large to take in by oneself. I first went to ACSM as a beginning post-doctoral fellow in cardiovascular physiology, when my mentor Dr. Jere Mitchell generously covered my expenses to go to the meeting in Las Vegas in 1987. My, how things have changed!
This slide show explains how to use the SHQ in your practice. It covers the basic operations, showing how to operationalize the SHQ in Annual Wellness Visits. The use in care management visits is similar process, the main difference being how the patient is recruited to complete the SHQ.
