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Recent Studies Demonstrate Ways to Improve Quality of Care and Reduce Costs

Thomas Gaziano

With a theme of “Noncommunicable Diseases: The Growing Burden,” the latest issue of Health Affairs features two studies co-led by BWH’s Thomas Gaziano, MD, of the Cardiovascular Division, and a team of authors.

The first study finds that cardiovascular disease screening by community health workers can be cost-effective in low resource countries. Understanding that a physician is not always available in low-resource settings, the authors demonstrated that community health workers can efficiently screen adults for cardiovascular disease in South Africa, Mexico and Guatemala. By using a paper-based or mobile phone-based screening tool that does not require blood testing, community health workers could conduct screenings in a cost-effective, or even cost-saving, manner in all three countries, compared to the usual clinic-based screening. “Our modeling indicated that screening by community health workers, combined with improved treatment rates, would increase the number of deaths averted from 15,000 to 110,000, compared to standard care,” write the authors.

The second study investigates the health and economic impacts of increasing prescription length for statins in South Africa, where the rates of statin use are among the lowest in the world.   “Almost five percent of the country’s total mortality has been attributed to high cholesterol levels, fueled in part by low levels of statin adherence,” write the authors.

They found that increasing prescription length from the standard 30 days to 60 or 90 days could save 1,694 or 2,553 lives per million adults, respectively. In addition, annual per patient costs related to cardiovascular disease would decrease by $152.41 and $210.29, respectively. “Increasing statin prescription length would both save resources and improve health outcomes in South Africa,” conclude the authors.

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First Week in Guatemala

group

I have been in Guatemala for about a week with Susan and Emma, this being their second and my third occasion to visit this very interesting country.

Guatemala is the only predominantly Mayan country. These native American people have a very diverse culture with numerous languages and are united by the national language of the Spanish conquerors. Although the culture of the native people in the United States seems to have been nearly decimated, their cousins here in Guatemala have maintained a vibrant culture. Continue reading “First Week in Guatemala”

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Ready for take off!

Tomorrow morning bright and early we take off for Guatemala! We are two families travelling together; Nora and Emma are sophomores in high school. Anna is a sophomore in college. Jamie Redgrave, MD is an endocrinologist in the Jen Center at Brigham and Women’s Hospital and also does diabetes care at Harvard University Health Services. My husband (Whit) and me round us off at six. For all but Anna, this is our second trip to Antigua. We became part of a volunteer team at Common Hope (www.commonhope.org) in April of 2012 and fell in love with the warm and welcoming people, the culture, language and landscape of the area.

Common Hope is a unique organization as the backbone of it’s workforce are it’s 25 social workers. Through home visits they support families in sending their children to school (instead of bringing them to the farms) as well as giving them opportunities to improve their housing (we built a house last year), health care (that’s where Jamie will come in as she provides continuing education to the medical providers) and mental health. Although my work at BWH is very different from theirs, our clients are challenged by many of the same psychosocial issues including domestic violence, substance use, poverty, etc. So we find much common ground.

Since the recession, Common Hope has been forced to make tough economic choices. This has resulted in the social workers and psychologists losing all funding for in-service education. While at Common Hope over the next two weeks I’ll be providing several in-service trainings on topics which include Motivational Interviewing,  Positive Psychology and Resiliency in Care Providers. Each of these will be done in such a way as to promote conversation among all of us so that I am sure to learn as much from them as I bring to the sessions.

Better change the message on my work phone and head home to pack. Adios!

Guatemalan market
Guatemalan market