Morbidly obese individuals who had weight loss surgery are seeking treatment for eating disorders years after their procedure, prompting concerns among some experts about the assessment process used to identify surgical candidates. “They are terrified of gaining the weight back,” said Dr. Sara Niego, medical director of the Eating Disorders Program at Hartford Hospital’s Institute of Living, who has treated patients with anorexia, bulimia and binge eating disorder years after weight loss surgery. The lack of a national “gold standard” to psychologically assess prospective patients has led Connecticut mental health professionals to call for standardized criteria to identify those who are at risk before and after surgery. They worry some patients with mental health problems may slip through the cracks because each hospital and insurance company has different psychological screening requirements. “Unfortunately, there is no consensus in the field regarding what constitutes a psychological evaluation or what would prohibit an individual from obtaining surgery from a psychological standpoint,” said Kimberly Daniels, a clinical psychologist with the Center for Weight Loss Surgery at Middlesex Hospital.
Thousands of Connecticut adults and children – some as young as 10 – struggle with eating disorders with many suffering secretly because the life-threatening psychiatric condition has gone undiagnosed and untreated, experts in the field report. “We used to see eating disorders start at 13 or 14. Now we frequently see 10- and 11-year olds,” said Dr. Diane Mickley, founder and director of the Wilkins Center for Eating Disorders in Greenwich, which has treated females and males for three decades. Mickley is a founder and past president of the National Eating Disorders Association (NEDA). “We’re concerned that there are many boys and girls flying under the radar who could be struggling with eating disorders that aren’t diagnosed or treated,” said Craig Brown, a founder and chief executive officer for Center for Discovery, which since 2011 has opened two adolescent residential treatment centers in Fairfield County for youth ages 11 to 17.
The use of nationally certified medical homes to coordinate the care of Connecticut’s Medicaid patients has led to improved quality, a 2 percent cut in per person costs, and a 32 percent increase in the number of participating providers during an 18-month period. The news comes as the state moves forward with plans to jumpstart the medical home movement in Connecticut with an expanded “Glide Path” program that would assist all practices – not just those that accept Medicaid patients – working to become medical homes. The program, still under development, would require practices to meet national standards. The state initiative has shed light on the challenges facing Connecticut’s medical homes, including the costs of implementing an electronic medical record and care coordination strategies. Experts say medical homes can improve quality, cut costs and reduce health inequities among all patients, not only those in the state’s Medicaid program.
Although smoking rates in Connecticut decreased between 1996 and 2012, striking disparities persist among counties, according to new research from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. The widest gap existed between Windham County, a rural area with the state’s highest overall smoking rate (15.6 percent), and Fairfield County, one of the wealthiest regions in the country, which had the state’s lowest smoking rate (9.5 percent). About twelve percent of the state’s population smoked cigarettes in 2012. “You’ll find lots of variations among counties even within small states like Connecticut that have successfully lowered smoking rates compared to other states in the nation,” said Ali Mokdad, professor of global health at IHME and one of the study’s authors. The IHME study looked at smoking prevalence – the percentage of the population that smokes – between 1996 and 2012.
A unique campaign spearheaded by Yale School of Medicine students to encourage uninsured young adults to sign up for health coverage by the federal March 31 deadline has galvanized student groups across Connecticut and the country. The Students for a Better Healthcare System (SBHS) campaign has reached more than 600 residents of all ages and health care providers through dozens of presentations at schools, churches, physician practices, medical clinics and other greater New Haven sites. The University of Connecticut School of Medicine has joined the effort to reach Hartford area residents and 33 schools nationwide have expressed interest in bringing the campaign to their local communities. “The most important thing we can do right now is help people sign up for health insurance through the Affordable Care Act,” said Matthew Meizlish, a SBHS co-founder who just completed his term as co-president of Yale’s chapter of the American Medical Student Association. “Our goal is to expand access to health care and to engage our communities in building a better health care system.”
Consumers have until March 31 to sign up for coverage to avoid a tax penalty.
Hypertension rates among women in all eight Connecticut counties increased from 2001 to 2009, with disparities widening for African American women compared to whites and Hispanics, according to a C-HIT analysis of data from the Institute for Health Metrics and Evaluation at the University of Washington. In fact, nearly one out of every two African American women living in Connecticut suffers from hypertension, a life-threatening condition that can lead to heart attack, stroke and kidney disease, research shows. The rising trend in hypertension coincides with increasing adult obesity rates in Connecticut and the nation, as stepped up efforts focusing on wellness — from Michelle Obama’s national physical activity campaign “Let’s Move!” to serving healthier meals at local public schools — look to stem the tide in future generations. The state findings on hypertension mirror national statistics showing black women with the highest rates. In Connecticut, health experts pointed to a mix of genetic, socioeconomic, and cultural factors as contributing to hypertension among black women.
Connecticut was among 41 states nationwide to earn a failing grade from health advocates for lacking public information about the quality of care provided by doctors. “Consumers should be able to find out if their local primary care physician is delivering good quality care without having to go through hoops,” said Francois de Brantes, executive director of the Health Care Incentives Improvement Institute in Newtown, which published the report. “Connecticut has no public reporting of physician quality.”
Only two states, Minnesota and Washington, received an ‘A.’ California received a ‘C’ and the remaining states earned a ‘D’ or ‘F.’
Mark Schaefer, the state’s new director of Healthcare Innovation, wasn’t surprised by the findings. “It’s widely recognized that consumers in the health care market don’t have accessible and reliable information about the cost of treatments across settings and the quality of providers at the clinical level,” he said. “Like most states, this is something Connecticut is working on.”
Connecticut has made significant gains to create a system that better identifies and treats children suffering from traumatic stress in the year since the tragedy at Sandy Hook Elementary School. But ensuring children have equal access to mental health services regardless of where they live or their insurance status remains elusive. “The impact of trauma on children is a public health issue. It’s happening all over the state and it’s not just high-profile events such as Sandy Hook,” said Robert Franks, vice president of the Child Health and Development Institute, noting that 25,000 children per year experience significant traumatic events. “Children are exposed to all sorts of trauma in their homes and communities every day.
Undocumented immigrants are expected to make up a larger share of Connecticut’s uninsured population next year, putting new financial pressures on safety-net hospitals that provide emergency care to everyone, state and national health experts predict. The Affordable Care Act (ACA) provides coverage options for legal immigrants, but those in the U.S. illegally cannot apply for Medicaid, even if they are poor, or buy coverage at Access Health CT (the new insurance marketplace), even if they have cash. That means illegal residents without coverage will continue turning to local emergency departments for care at a time when Connecticut hospitals face the loss of millions of dollars in federal and state subsidies to help defray the cost of uncompensated care. “This is a global problem that isn’t going away. This population (of undocumented residents) is not being addressed by any state or federal initiatives.
Cheila Serrano knows educating Hispanics who are uninsured and underinsured about the new options available at Access Health CT – the health insurance marketplace that opens for business today – presents a unique set of problems.
But with one in every four Hispanics lacking coverage, Serrano, a program director at Junta for Progressive Action in New Haven, is up for the challenge. Connecticut’s Hispanics represent the fastest-growing, youngest and poorest segment of the state’s population. Estimates of Connecticut’s uninsured vary. Approximately 344,000 people lack health insurance in Connecticut and 65 percent of the state’s uninsured are minorities, according to data being used by Access Health. Estimates released by the U.S. Census Bureau in September, however, put the uninsured at 284,000.