ED Visits by Elderly Increase
The number of emergency department visits among elderly persons could almost double from 6 million in 2003 to just under 12 million by 2013, according to an analysis using National Hospital Ambulatory Medical Care Survey data from 1993–2003. The overall rate of admission in those patients aged 65–74 years increased 34% during the study period (Ann. Emerg. Med. 2007 [doi:10. 1016/j.annemerg med. 2007.09. 011]). The visit rate for elderly blacks rose 90% during that time but did not increase significantly for whites or other races. Researchers used admission rate and number of medications administered (one, two, or three) to gauge the acuity of the visit and found the absolute admission rate increased as did the number of visits in which three or more medications were given, suggesting “older Americans are having more true emergencies, rather than using the ED for convenience.” Ignoring these trends will result in a “serious increase in the problem of ED crowding,” they warned.
Center Takes on Nursing Shortage
A new think tank will address the burgeoning nursing shortage and its impact on the quality of patient care. To achieve this goal, the Center to Champion Nursing in America will focus on increasing funding for nursing education, expanding nurse representation on hospital boards, and informing policy makers and the public about the profession. The shortage is projected to hit 1.1 million by 2020, according to a statement from the Robert Wood Johnson Foundation, which gave the AARP a grant for establishing the center. A study in 2005 by the foundation and Harvard School of Public Health, Boston, found that 60% of Americans considered a shortage of nurses a major factor in poor care in hospitals, two-thirds cited nurses' working conditions as reasons for poor-quality care, and 80% said nursing quality affected their choice of hospital. “If we are going to improve the quality of hospital and nursing care, we need to find ways to fill the pipeline,” said Dr. Risa Lavizzo-Mourey, RWJF president and CEO.
DEA Accused of Electronic Stalling
The Drug Enforcement Administration, which investigates and prosecutes crimes involving illicit use of controlled substances, has been criticized for stalling implementation of a national electronic prescribing system for controlled substances. Sen. Sheldon Whitehouse (D-RI), speaking at a Senate Judiciary Committee hearing on e-prescribing, cited the DEA's tardiness in developing regulations for such a system and its reluctance to commit to a deadline for completing the regulations as the main reasons. Currently, doctors write prescriptions for controlled substances but can prescribe noncontrolled substances electronically, but most doctors use a “pen-and-paper regime” for all prescriptions, said Sen. Whitehouse, who argued that e-prescribing for all medications could save as much as $20 billion a year. Joseph T. Rannazzisi, a deputy assistant administrator for the DEA, told the committee that the agency is concerned an electronic system would be susceptible to abuse.
Access Reduced by Cost
Forty million Americans can't get access to needed health care, and 20% said the main reason was because they could not afford the services, according to a report issued in December by the Centers for Disease Control and Prevention. Health, United States, 2007, is a compilation of pertinent data gathered by the CDC's National Center for Health Statistics. In 2005, 1 in 10 people between the ages of 18 and 64 years reported they had not been able to get prescription drugs in the past year because of the cost. Another 10% said they had delayed necessary medical care because of costs. The report also found 30% of 18- to 24-year-olds were uninsured, and another 30% of that group did not have a usual source of medical care. In 45- to 64-year-olds, 10% did not have a usual source of care.
FDA Can't Fulfill Mission
Three members of the Food and Drug Administration's Science Board issued a damning report on the state of the agency, saying that it “suffers from serious scientific deficiencies and is not positioned to meet current or emerging regulatory responsibilities.” The authors wrote that the agency has become weak and unable to fulfill its mission because of the increasing number of demands and an inability to respond because of a lack of resources, meaning that “American lives are at risk,” adding that the agency can't fulfill its mission “without substantial and sustained additional appropriations.” The report was written by Gail Cassell, Ph.D., vice president of scientific affairs at Eli Lilly & Co.; Dr. Allen D. Roses, the Jefferson Pilot Corp. Professor of Neurobiology and Genetics at Duke University, Durham, N.C.; and Dr. Barbara J. McNeil, head of the health care policy department at Harvard Medical School, Boston.