Beauty Health for Life

Playing whacamole

"Immunizations cause autism." 

"Health care blogging will never lead any serious beer money."

"Disease management coaching focuses exclusively on just one disease."

These are three falsehoods that bubble up in the unlikeliest of places, including cable news outlets, replying to the DMCB spouses asking "and what did you do today?" and webinars, webcasts and other educational meetings about population health and disease management.

While the Disease Management Care Blog finds all three vexing, the most irksome is the canard that the commercial health coaching service providers purposely limit their programs to just one chronic condition, like diabetes, weight loss or readmission prevention.

While that may have been the case in the earliest versions of disease management, that narrow approach was dropped years ago. Thats because patients typically seek advice for a wide range of overlapping concerns and the good nurses hired by the vendors will respond to them.  The vendors also understand that their shared risk and performance guarantees depend on claims expense that is driven by the synergies of multiple co-morbidities. 

While a purchaser, insurer or accountable provider organization may start out with a focus on a population defined by a single condition - such as diabetes mellitus - that doesnt mean their protocols and care plans wont span the continuum of care and include hypertension, tobacco abuse, depression, housing, chatting about the grandkid and responding to concerns whether this will be finally be NBA superstar LeBron James year.

And the published literature supports the DMCBs contention that modern population health management is multifaceted.  Examples include this seven-condition program for dually eligible Medicaid beneficiaries in Georgia, this Midwest employer-sponsored program that enrolled persons with multiple care needs and this physician-focused program that used pay-for-performance to improve measures across multiple conditions.  Check out some vendor web sites and youll see erences to "whole person health," the "interrelated aspects of social, emotional, and physical health" and "a holistic view of member health across internal and external care management initiatives."

That being said, the DMCB knows that perception and reality can be two different things. Given the whac-a-mole persistence of the "single disease" myth, the DMCB says the population health management community may benefit clarifying the broadness as well as the depth of their offerings as they continue to build their brand.

Image from Wikipedia

Using cholesterol-lowering statins may be associated with musculoskeletal conditions, arthropathies (joint diseases) and injuries, according to a report published Online First by JAMA Internal Medicine, a JAMA Network publication.

While statins effectively lower cardiovascular illnesses and death, the full spectrum of statin musculoskeletal adverse events (AEs) is unknown. Statin-associated musculoskeletal AEs include a wide variety of clinical presentations, including muscle weakness, muscle cramps and tendinous (tendon) diseases, the authors write in the study background.

Ishak Mansi, M.D., of the VA North Texas Health Care System, Dallas, and colleagues utilized data from a military health care system to determine whether statins were associated with musculoskeletal conditions based on statin use during the 2005 fiscal year. Patients were divided into two groups: statin users for at least 90 days and nonusers. A total of 46,249 patients met the study criteria and of those, researchers propensity score-matched (a statistical approach that mathematically matches the characteristics of patients in two or more groups) 6,967 statin users with 6,967 nonusers.

"Musculoskeletal conditions, arthropathies, injuries and pain are more common among statin users than among similar nonusers. The full spectrum of statins musculoskeletal adverse events may not be fully explored, and further studies are warranted, especially in physically active individuals," the authors notes.

Statin users had a higher odds ratio (OR) for musculoskeletal disease diagnosis group 1 (all musculoskeletal diseases: OR, 1.19), for musculoskeletal disease diagnosis group 1b (dislocation/strain/sprain: OR, 1.13) and for musculoskeletal diagnosis group 2 (musculoskeletal pain: OR, 1.09), but not for musculoskeletal disease diagnosis group 1a (osteoarthritis/arthropathy: OR,1.07), according to study results for the propensity score-matched pairs.

To our knowledge, this is the first study, using propensity score matching, to show that statin use is associated with an increased likelihood of diagnoses of musculoskeletal conditions, arthropathies and injuries. In our primary analysis, we did not find a statistically significant association between statin use and arthropathy; however, this association was statistically significant in all other analyses," the authors conclude. "These findings are concerning because starting statin therapy at a young age for primary prevention of cardiovascular diseases has been widely advocated."