What Do Republican Doctors Think of New Health Care Legislation? PRC David Grande in Wash Post/The Monkey Cage

In a Washington Post The Monkey Cage analysis, PRC Core Lead David Grande, MD, MPA, and Craig Pollack, MD, MHS, examine survey responses of doctors to changes on pre-existing conditions in the House bill which repeals the Affordable Care Act.  “As physicians ourselves, we understand that serious illness can strike anyone, as Jimmy Kimmel movingly pointed out. Physicians may also have firsthand experience of the barriers that many patients used to face in securing and retaining insurance coverage because of their preexisting conditions before the ACA was introduced…Even physicians who were in favor of scaling back or repealing the ACA say that scrapping protections for people with preexisting conditions is the wrong way to improve health care.”

A View from the Front Line — Physicians’ Perspectives on ACA Repeal in NEJM. David Grande, MD

David Grande, MD, MPA

In a February 2017 issue of The New England Journal of Medicine, PRC Core Lead David Grande, MD, MPH, and colleagues present findings for an updated survey on how health care providers view the repeal of the Affordable Care Act.  Findings from a 2015 survey provided the authors with a baseline upon which to measure attitude changes as providers became more experienced with the ACA.  “Given that the political and policy landscape changed dramatically over the ensuing months, and that physicians were gaining more experience with the ACA’s provisions, we performed our own survey, by mail, of PCPs from December 2016 through January 2017 to assess their perspectives on the ACA and specific policy options put forth in recent public debate. One thousand physicians, including physicians trained in internal medicine, pediatricians, geriatricians, and family practitioners, were randomly sampled from the American Medical Association (AMA) Masterfile, which contains information on AMA members as well as nonmembers. Physicians received up to two mailings and a telephone call, with an option to complete the survey online. A $2 incentive was provided in the first mailing. Overall, 426 physicians responded to the survey.”

Libraries Can Be a Health Resource for Vulnerable Populations: PRC Researchers Cannuscio, Grande, & Klusaritz

In a recent Fox News Health report, UPenn PRC Community Engagement Core Lead Carolyn Cannuscio ScD, shed light on the role modern-day libraries can play as multi-faceted community resource centers. “Some people would argue that libraries are old-fashioned, outmoded institutions that are irrelevant in the digital age,” said Cannuscio, a social epidemiologist at the University of Pennsylvania in Philadelphia. “Our work shows very clearly that libraries are vital, dynamic organizations that know their patrons well and respond creatively to community needs.”

 

Through the Healthy Library Initiative, Cannuscio and fellow PRC Researchers David Grande, MD, MPA, and Heather Klusaritz, PhD, MSW  identified ten programs aligned with the Free Library of Philadelphia which address social determinants of health within the Philadelphia community. After conducting interviews, the researchers found that libraries provided a safe space, for especially vulnerable populations which include “homeless people, people with mental illness and substance use, recent immigrants, and children and families suffering from trauma.”

 

In this new model, librarians assist with employment searches, applications for health insurance, and support other helpful programs such as classes on nutrition and youth leadership. The 54 libraries across the city of Philadelphia see 5.8 million in-person and 9.9 million online visits annually.  Cannuscio emphasizes the importance of having a space that provides shelter and services without any charge.

 

Read more about the study in Health Affairs.

 

 

Epinephrine Auto-Injector Use Among Young Adults Aided By Financial Incentives: PRC Researcher Carolyn Cannuscio

New research from UPenn PRC Community Engagement, Partnerships, & Technical Assistance Core Leads Carolyn Cannuscio, ScD, and David Grande, MD, MPA, shows that financial incentives may encourage epinephrine auto-injector use among young adults.

 

Published in the  Annals of Allergy, Asthma & Immunology. their study found that young adults ages 18- 30 who received both financial incentives and text messages appear to carry their epinephrine auto-injectors far more often than those who received only text messages. Prompt administration of epinephrine is critically important in case of anaphylaxis, a life-threatening allergic reaction that can include trouble breathing or swallowing.

 

“We were impressed by the effects of the incentives,” said lead researcher Carolyn Cannuscio, a social epidemiologist with Penn’s Center for Public Health Initiatives, faculty member at the Center for Health Incentives and Behavioral Economics (CHIBE),  and assistant professor of family medicine and community health at the Hospital of the University of Pennsylvania. “Adolescents and young adults have the highest rate of adverse events from food allergies,” with a high fatality rate, she said. When children move from elementary to middle school, school support for those with food allergies tends to drop off, according to Cannuscio, who said it’s a difficult transition to navigate.”We have learned that in very active situations, sporting events or socializing, going out to nightclubs,” said Cannuscio, “those are times when people really need to have their auto-injectors present.”

 

Read more about Cannuscio and Grande’s study here.

 

Racial Disparities in Access to Primary Care: PRC Researchers David Grande and Daniel Polsky

In the August issue of Health Affairs, UPenn PRC Researchers David Grande, MD, MPA, and Daniel Polsky, Ph.D, investigate racial disparities in spatial accessibility of primary care among different neighborhoods in the city of Philadelphia.  Noting that “areas of the city with high percentages of African Americans or Hispanics were likely to also be areas with poor primary care spatial accessibility” and that ” people who live in those areas might be forced to travel farther or wait longer, which creates additional barriers to primary care,” Grande and Polsky show similarities between their research and research on food deserts – neighborhoods which have limited access to healthy food.  This study furthers research on neighborhood health risk and how the built environment impacts the health status of different urban populations.

 

 

 

The Complexities of Shopping for Health Care: PRC Researcher David Grande

In philly.com’s Health Cents blog, PRC Researcher David Grande, MD, MPA, looks at the complexities of shopping for health care. Grande shares his own family’s experience of trying to make the right – and affordable – decisions in an urgent care crisis to exemplify how difficult it is to collect information about medical expenses and choices, especially from insurance providers.

David Grande and Carolyn Cannuscio review “Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients Into Consumers”

UPenn PRC Community Engagement, Partnerships, and Technical Assistance Core Leads, David Grande, MD, and Carolyn Cannuscio, ScD, reviewed “Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients Into Consumers” by Nancy Tomes in the April 2016 issue of Health Affairs.

Noting that “Tomes illustrates the long and storied path to our current reality, characterized by trends such as medicine as business, retail models of health care delivery, widespread direct-to-consumer advertising of prescription drugs, and the rapid growth of high-deductible health plans marketed as “consumer-directed health care,”  Grande and Cannuscio credit Tomes with identifying the dueling values of science, professionalism, entrepreneurial aspiration, and patient engagement.  “This book, which will intrigue students and scholars of health care systems and health systems management, charts the emergence of consumerism in health care beginning in the early twentieth century.”

 

Read the complete review here.

 

 

UPenn PRC Core Leads Cannuscio & Grande Help Move Free Library Health Literacy Initiative Forward

UPenn PRC Community Engagement, Partnerships, and Technical Assistance Core Leads Carolyn Cannuscio and David Grande are part of the University of Pennsylvania team supporting a health-focused partnership with the Free Library of Philadelphia. The Penn team just completed a community needs assessment in South Philadelphia, the neighborhood where a new community health and literacy center will open in Spring 2016. Their work focuses on how the Free Library addresses the social determinants of health, including the development of a training program to help librarians become community health specialists who guide library patrons to resources and programs that benefit health and wellbeing.

Pictured left to right: Anna Morgan (Robert Wood Johnson Foundation Clinical Scholar), Carolyn Cannuscio (Assistant Professor, Family Medicine and Community Health), Adina Lieberman (Program Manager, Family Medicine and Community Health), Amy Graves (Research Assistant, Center for Public Health Initiatives (CPHI)), and Roxanne Dupuis (Research Program Manager, CPHI).

http://www.philly.com/philly/health/20140919_Joint_library__health_and_rec_center_coming_to_S__Phila_.html

http://www.chop.edu/news/chop-and-city-philadelphia-break-ground-health-and-literacy-center#.Voq-CVJjx41

Behavioral Economics Intervention For Food Allergies

Adolescents and young adults with food allergies are at increased risk of adverse events, including death from anaphylaxis. Epinephrine is the cornerstone of emergency response, yet few individuals with serious food allergies consistently carry their emergency medication. Behavioral economics offers promising, previously untapped opportunities for behavior change in this arena.

Carolyn C. Cannuscio, ScD, and David Grande, MD, were part of a team of researchers who tested the effectiveness of modest financial incentives in promoting the carrying of epinephrine and to evaluate the acceptability of text messaging for delivering reminders and key health messages to young adults with food allergies.

The study raises important questions for future work; first, because epinephrine carriage rates were depressingly low, underscoring the urgency for further behavioral research to understand and improve food allergy management practices. And second, text messaging alone might be a highly feasible, relatively low-cost intervention model.  Advocacy groups and device manufacturers—who have a vested interest in encouraging adherence—could be potential allies in implementing and testing future interventions such as the one evaluated in the present study.

In conclusion, this study’s findings are a promising step for young adults with food allergies, suggesting opportunities for minimizing morbidity and mortality in this high-risk group.

Read the article here.

Cannuscio C, Dupuis R, Graves A, Seymour J, Kounaves S, Strupp E, Leri D, Frasso R, Grande D, Meisel Z. A behavioral economics intervention to encourage epinephrine-carrying among food-allergic adults: a randomized controlled trial. Annals of Allergy, Asthma & Immunology. Sept 2015, 115:3, 234-240.

 

Issues for Expanding Role of Community Health Workers

Community Health Workers in Post-Reform U.S. Health Care

Shreya Kangovi, M.D., M.S., founding executive of the Penn Center for Community Health Workers, and David Grande, M.D., M.P.A., Co-Director for the PRC’s Community Engagement, Partnerships & Technical Assistance Core, wrote in last week’s published issue of New England Journal of Medicine. First, they wrote about the need for more community health workers. Kangovi and Grande highlight the need for community health workers to assist patients in navigating health systems.

Secondly, Kangovi and Grande address several implementation issues that come with the potential increase of CHWs, including the need to establish a working network between CHWs and healthcare providers rather than CHWs working for standalone companies or programs. In addition, it will be important for CHWs’ tendency to shift focus from “disease education” to providing assistance with specific insurance implementation issues. David Grande says that “addressing historical implementation barriers will allow programs to maximize this opportunity.”

Read the article published on June 15, 2015, here.