Imana imc 2015 Dr. Samadani

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Family Centered Care Current and Future Directions Ayaz Samadani MD,DCH,DTM&H,FAAFP Health care cost and to keep it affordable Rationing of medical care


Disclosure

Ayaz M Samadani MD I have NO actual or potential conflict of interest in relation to this activity. I do not have any relevant financial relationships with any commercial interests.


Affordability


Yes or No • You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much? • It is immoral to apply monetary considerations to saving lives — but is that stance tenable?


Healthcare Expenses


Health Expenditure per Capita


Healthcare Cost Share


Choices


Cost Comparison Procedure

Country

Cost in $

Laceration repair

Korea

$19.00

ER + X-ray

Mexico

$14.00

Thailand

$11.00

USA

$500.00 to $2,500.00


USA verses Elsewhere Procedure

USA

Cost of procedure

Country

Hip replacement

$33,000

$12,500

Mexico

Knee replacement

$34,000

$16,500

Singapore

CABG

$88,000

$21,000

Taiwan

Gastric bypass

$25,000

$8,200

Malaysia

Spinal fusion Fertility treatment

$41,000 $15,000

$9,500 $4,400

India Costa Rica


Having a Baby Normal delivery

CS

Hospital 1 night stay

US $9,280

US $ 14,374 to $20,000

US $3,949

Argentina $1,291 Spain $3,145 Germany $362


Getting Value for Money Measures

Cost vs Quality (Satisfaction Surveys) Infant Mortality Rate Life Expectancy


Choices What is the cost to extend life for one year


Factors Affecting Patient Outcomes


Recommendations Exercise Nutrition Prevention


Solutions Preventive Care Children Adults Women Seniors


Preventive Services for Children – Haemophilus influenzae type b – Hepatitis A – Hepatitis B – Human Papillomavirus – Inactivated Poliovirus – Influenza (Flu Shot) – Measles, Mumps, Rubella – Meningococcal – Pneumococcal – Rotavirus – Varicella – Diphtheria, Tetanus, Pertussis


Preventive Services for Children • Iron supplements for children ages 6 to 12 months at risk for anemia • Lead screening for children at risk of exposure • Medical History for all children throughout development Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. • Obesity screening and counseling • Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years. • Phenylketonuria (PKU) screening for this genetic disorder in newborns • Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk • Tuberculin testing for children at higher risk of tuberculosis


Preventive Services for Adults • Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked • Alcohol Misuse screening and counseling • Aspirin use for men and women of certain ages • Blood Pressure screening for all adults • Cholesterol screening for adults of certain ages or at higher risk • Colorectal Cancer screening for adults over 50 • Depression screening for adults


Preventive Services for Adults • Type 2 Diabetes screening for adults with high blood pressure • Diet counseling for adults at higher risk for chronic disease • HIV screening for all adults at higher risk • Obesity screening and counseling for all adults • Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk • Tobacco Use screening for all adults and cessation interventions for tobacco users • Syphilis screening for all adults at higher risk


Preventive Services for Adults • Immunization vaccines for adults--doses, recommended ages, and recommended populations vary: – Hepatitis A – Hepatitis B – Herpes Zoster – Human Papillomavirus – Influenza (Flu Shot) – Measles, Mumps, Rubella – Meningococcal – Pneumococcal – Tetanus, Diphtheria, Pertussis – Varicella


Preventive Services for Women • special needs related to the health conditions that affect their reproductive organs such as breast, uterine, and cervical cancer. • Prenatal care and delivery, while essential to the health of both mother and baby • Women are more likely to live in poverty at all ages


Preventive Services for Seniors • Tobacco Use Cessation Counseling • Screenings – Bone mass measurement – Cervical cancer screening, including Pap smear tests and pelvic exams – Cholesterol and other cardiovascular screenings – Colorectal cancer screening – Diabetes screening – Flu shot, pneumonia shot, hepatitis B shot – HIV screening for people at increased risk or who ask for the test – Mammograms – Medical nutrition therapy to help people manage diabetes or kidney disease – Prostate cancer screening


Environments


Cardiovascular Disease Screening • screening blood tests for cholesterol, lipid, and triglyceride levels every 5 years. These screening tests help detect conditions that may lead to a heart attack or stroke.


Diabetes Screening risk factors • High blood pressure (hypertension) • History of abnormal cholesterol and triglyceride levels (dyslipidemia) • Obesity • History of high blood sugar (glucose) • Overweight • Family history of diabetes (parents, brothers, sisters) • History of gestational diabetes (diabetes during pregnancy), or delivery of a baby weighing more than 9 pounds


Hepatitis B risk factors • Your risk for Hepatitis B increases if you have hemophilia, End-Stage Renal Disease (ESRD), diabetes, or certain conditions that lower your resistance to infection.


Prostate Cancer Screening • Digital rectal exam: Once every 12 months • Prostate Specific Antigen (PSA) test: Once every 12 months


Mammograms Screening • Women age 40 or older • Women between 35-39 can get one baseline mammogram


Abdominal Aortic Aneurysm Screening

• You have a family history of abdominal aortic aneurysms. • You’re a man age 65 to 75 and have smoked at least 100 cigarettes in your lifetime.


Bone Mass Measurement Bone Density Screening • A woman whose doctor determines she's estrogen deficient and at risk for osteoporosis, based on her medical history and other findings • A person whose X-rays show possible osteoporosis, osteopenia, or vertebral fractures • A person taking prednisone or steroid-type drugs or is planning to begin this treatment • A person who has been diagnosed with primary hyperparathyroidism • A person who is being monitored to see if their osteoporosis drug therapy is working


Cervical & Vaginal Cancer Screening • Once every 24 months for all women • Once every 12 months if you’re at high risk for cervical or vaginal cancer, or if you’re of childbearing age and have had an abnormal Pap test in the past 36 months


Colorectal Cancer Screening

• Barium enema every 48 months if you're 50 or over and once every 24 months if you're at high risk for colorectal cancer. • Colonoscopy: once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk for colorectal cancer, once every 120 months, or 48 months after a previous flexible sigmoidoscopy. • Fecal occult blood test: once every 12 months if you're 50 or older. • Flexible sigmoidoscopy: once every 48 months for most people 50 or older. If you aren't at high risk, test 120 months after a previous screening colonoscopy.


Colorectal Cancer

Cologuard™: multi-target stool DNA test Screening • once every 3 years for people who meet all of these conditions: – They’re between 50–85. – They show no signs or symptoms of colorectal disease including, but not limited to, lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test. – They’re at average risk for developing colorectal cancer, meaning: – They have no personal history of adenomatous polyps, colorectal cancer, inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis. – They have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.


Glaucoma Screening • You're at high risk if you have diabetes, a family history of glaucoma, are African American and 50 or older, or are Hispanic American and 65 or older.


Diet Supplements

Ayaz Samadani MD,DCH,DTM&H,FAAFP Health care cost and to keep it affordable Integrated medical care


Could a diet supplement supercharge your eyesight?


Diet


Disclosure

Ayaz M Samadani MD I have NO actual or potential conflict of interest in relation to this activity. I do not have any relevant financial relationships with any commercial interests.


Thank you Ayaz M. Samadani MD, FAAFP

DCH(London)DTM&H (Liverpool) Beaver Dam, WI 53916 USA 920-887-7731 Ayaz@samadani.com


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