On any day, thousands of Connecticut children need to be given medication while in child care centers, but many providers don’t know how to properly administer the medications, studies show. To change that equation, the Yale School of Nursing developed a curriculum and has trained 75 nurse consultants to teach child care providers on how to correctly give medication to children in their daily care. Child care providers at more than 200 sites have been trained statewide. “We have made some steady progress on this,” said Angela Crowley, a leader in crafting the curriculum and a professor and coordinator in the pediatric nurse practitioner specialty at Yale School of Nursing. “It is really exciting because we did something really innovative.”
State law requires providers who need to administer medication be trained in how to do so, but there is no uniform training method used by all providers, Crowley said.
Health insurance coverage might be more accessible and affordable in Connecticut if the state applied for certain Affordable Care Act and Medicaid waivers, according to advocates who say the options should be explored. Two waivers in particular—Affordable Care Act (ACA) Section 1332 and Medicaid Section 1115—would let the state disregard certain federal requirements, possibly lowering health care costs for some individuals, according to a policy brief commissioned by the Universal Health Care Foundation of Connecticut and the Connecticut Health Foundation. “What we need to do in Connecticut is really think about … how could we creatively, imaginatively, innovatively use waivers to expand coverage to quality care and really help improve health,” said Frances Padilla, president of Meriden-based Universal Health Care Foundation of Connecticut. “We haven’t had that conversation yet in Connecticut.”
The ACA waiver isn’t available until 2017 but the Medicaid waiver is already being used by dozens of other states to lower costs, she said. “It allows a state to get past some of the requirements of Medicaid and do some things that are innovative,” she said of the Medicaid waiver.
As we open the book on 2016, here are a few things to watch for in the field of women’s health and well-being. In no particular order, from the Office of Healthcare Prognostication—a department I just made up—comes these predictions for the new year:
1 • The use of mobile health apps, or so-called “health wearables,” will increase, according to the American College of Sports Medicine’s 10th annual survey on fitness trends. Already, the adoption of smartphone health apps has doubled in the last two years, from 16 percent in 2013 to 32 percent of consumers saying they have at least one health app on their mobile device. 2 • Beyond measuring one’s fitness, health care in general will begin a “shift into the palms of consumers’ hands,” according to PwC’s 2015 Health Research Institute’s annual report. It’s happening already in primary care and the management of some chronic diseases, though programs such as Omada Health’s online program called Prevent are pushing into fields such as behavior modification.
People who are uninsured or on Medicaid are more than twice as likely to smoke tobacco compared to those covered by other insurance, according to a national study by the Centers for Disease Control and Prevention. About 28 percent of uninsured adults and 29 percent of adults on Medicaid smoke nationwide, according to the Centers for Disease Control and Prevention (CDC), compared with just 13 percent of adults on private insurance plans and 12.5 percent on Medicare. The CDC, which examined data from the 2014 National Health Interview Survey, published the findings in November. The CDC found that cigarette-smoking rates were higher among people who live below the poverty level (26.3 percent) and people with a GED certificate (40 percent). Overall, the prevalence of cigarette smoking among adults declined from 20.9 percent to 16.8 percent from 2005 to 2014, according to the CDC.
Like all pediatricians, Dr. Lori Smith keep tabs on many aspects of her patients’ health, but until recently the Westport-based doctor didn’t always consider whether the children she sees might be going hungry. “It wasn’t something that was necessarily on our radar,” she said. While her practice treats some lower-income patients from nearby Norwalk and Bridgeport, most of the children Smith and her colleagues see come from relatively affluent families. But Smith, who has been a pediatrician for more than 16 years, and her colleagues recently began screening all patients—regardless of their household income—for food insecurity, part of a new effort doctors and advocates hope will help prevent childhood hunger. The American Academy of Pediatrics (AAP) in October recommended that pediatricians screen all patients for hunger at well visits.
People with severe mental illness die 25 years earlier than the general population and 68 percent of the mentally ill have at least one chronic physical health condition, studies show. They don’t receive the care they need because mentally ill people are often discriminated against by medical practitioners and their mental illness can make it difficult for them to be proactive about their care, according to several mental health professionals. Daniela Giordano, public policy director of National Alliance for Mental Illness of Connecticut, said the problem is often a lack of understanding of mental illness by some health care providers. Giordano said she knows of people with mental illness whose “thoughts and comments were dismissed” by medical providers who view these patients through “a different lens.”
A state project is addressing such barriers to necessary medical care faced by low-income mentally ill people. Under the program, called Behavioral Health Homes (BHH) and based in mental health facilities where people are already receiving outpatient services, staff members coordinate participants’ mental health and primary care.
Family-based day care workers can be powerful allies in the state’s battle to curb childhood obesity by influencing diets and physical activities, says new research from the University of Connecticut. Childhood obesity has emerged as one of the most serious and widespread health threats in the United States. Nationally, 17 percent of children ages 2 to 19 (about 1 in 6) are overweight or obese, according to the Centers for Disease Control and Prevention. The obesity problem is particularly acute among Hispanic children. In Connecticut, for example, 16.7 percent of Hispanic children ages 2 to 5 participating in the Women, Infants and Children (WIC) program were overweight and 18 percent were obese, compared to non-Hispanic black children (13.6 percent overweight, 14.2 percent obese) or non-Hispanic white children (14.5 percent overweight, 13.5 percent obese), according to 2011 data.
Connecticut slipped two spots, to sixth place, in an annual report on the nation’s health, with high scores on infectious disease prevention and immunizations, but relatively poor rankings on drug-related deaths and excessive drinking. The 2015 version of the longstanding America’s Health Rankings shows Connecticut remains among the top 10 healthiest states overall, behind Hawaii, Vermont, Massachusetts, Minnesota and New Hampshire, in that order. In 2014, Connecticut ranked fourth after Hawaii, Vermont and Massachusetts. The report, issued by the United Health Foundation, shows Connecticut fares well on measures such as obesity, occupational fatalities, health insurance access, and the incidence of infectious disease. It is among the 10 best-ranked states in terms of cancer deaths (seventh), premature death (third), availability of primary care physicians and dentists (sixth and fifth, respectively), and percent of children living in poverty (eighth).
Researchers at Yale University are testing whether a humorous card game can help young, black women reduce their chances of contracting HIV and AIDS—part of a new but growing trend examining whether games can spur health behavior changes. Played among three to five people, “One Night Stan” has players draw cards to establish sexual scenarios and then prompts players to discuss how they would react in those settings. The game, developed by play2PREVENT, a gaming lab within the Yale School of Medicine, is still a prototype, but designers are hoping to launch a video game version eventually and bring it to a broader audience. “It’s really about evaluating sexual situations and encounters,” said Kimberly Hieftje, a developer of the game who is an associate research scientist at Yale School of Medicine and deputy director of the play2PREVENT Lab. A growing number of developers, in Connecticut and nationally, are testing whether card, video, online and mobile games are effective tools for getting people to make healthier choices.
The Centers for Medicare and Medicaid Services has backed off a controversial plan that would have changed the way it determines Medicare coverage for advanced prosthetics - a plan critics said would have affected tens of thousands of veterans nationwide. CMS had issued a draft proposal, known as a Local Coverage Determination for Lower Limb Prostheses, that critics feared would limit access to prosthetics for amputees, including veterans. Following a public comment period that ended in August and a review of those comments, CMS on Monday announced it would not finalize the draft policy. “Both CMS and its contractors have heard concerns about access to prostheses for Medicare beneficiaries,” according to a statement provided by CMS spokeswoman Helen Mulligan. CMS said it would convene a work group in 2016 to examine the lower limb prostheses issue.