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Wednesday, January 16, 2008 6:00 PM
Newscast: Lead Story - Older Americans Not Getting Screened

(opening music)

Rand: This is Healthcare 411 for the week of January 16, 2008.

Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

Debra: I’m Debra James.

Rand: And I’m Rand Gardner .

Debra: Coming up.

Rand: In the News and Numbers, an AHRQ survey shows less than 50 percent of Americans over 50 years old have had colonoscopy to screen for colon cancer.

Debra: The U.S. Preventive Services Task Force recommends against screening for carotid artery stenosis in people without symptoms, saying the harms outweigh the benefits.

Rand: And AHRQ Director, Dr. Carolyn Clancy talks to consumers about ways to play it safe with prescription medications in her special segment on Navigating the Health Care System.

Debra: More after this message from AHRQ.


[Begin PSA: Tips to Preven Medical Errors]

Man: Okay, here’s your ham on rye, extra mayo.

Woman: Uh, I ordered the turkey on whole wheat with mustard!

Narrator: Messing up your sandwich order is one thing, but messing up your medical care is another. Medical errors are one of the nation’s leading causes of death and injury. But you can help avoid errors by being more involved in your health care. Get the fact sheet, 20 Tips to Prevent Medical Errors, by visiting ahrq.gov/consumer. A message from the U.S. Agency for Healthcare Research and Quality.

[End PSA]


Debra: Now the numbers.


Debra: AHRQ survey results show many older Americans have never had a colonoscopy. This medical test allows a doctor to look inside a patient’s colon using a flexible scope. It is one of several common screenings for colon cancer - the second leading cause of cancer deaths. The U.S. Preventive Services Task Force recommends all people age 50 and over get screened for colon cancer. But the survey showed 47 percent of whites and 55 percent of blacks aren’t getting colonoscopies. And Hispanics are the least likeliest to get this type of screening. Nearly 67 percent of Hispanics age 50 and older say they’ve never had a colonoscopy. Older Americans without insurance also say that they aren’t getting this vital screening test. More than three-fourths or about 77 percent of uninsured adults aged 50 to 64 say they, too, have never had a colonoscopy screening. This data is from AHRQ’s Medical Expenditure Panel Survey.

Rand: Taking care of yourself means doing those things that we know help people live better or longer. Screening for disease is one of the ways we use to prevent health problems later. The idea is by finding a disease earlier, we can treat if better and prevent getting sick later. But sometimes this approach doesn’t work and might even make you worse off. In other words, the harms of screening sometimes outweigh the benefits. Dr. Russell Harris of the U.S. Preventive Services Task Force is with us to talk about screening for carotid artery stenosis, a narrowing of the blood vessel in the neck that takes blood to your brain. Welcome, Dr. Harris.

Dr. Harris: Thank you.

Rand: First, please tell us why a person would want to screen for carotid artery stenosis.

Dr. Harris: That’s a good question. When you’re screening for some condition, you should always ask what you’re trying to prevent. In this case, we’re trying to prevent people from having strokes. There is a problem, though, because most strokes don’t come from carotid artery stenosis. They come from high blood pressure and blockage of the arteries up in the brain itself, not in the carotid artery which is down in the neck. But some strokes do come from carotid artery stenosis. Those are the ones we are trying to prevent with screening.

Rand: So how would you screen people for carotid artery stenosis?

Dr. Harris: The test itself is easy the simple ultrasound, doesn’t hurt at all. The problem is that the test is not completely accurate, so in people with an abnormal ultrasound, you need to do a second test to see if you really do have carotid artery stenosis.

Rand: But what about this second test?

Dr. Harris: That’s where things get tricky. The second test involves sticking a needle into the artery and shooting dye through it while you are taking pictures. And occasionally this second test actually causes a stroke the very thing we are trying to prevent.

Rand: But what if the second test shows you really do have carotid artery stenosis? Could you have a treatment that might prevent a stroke?

Dr. Harris: Yes, well that’s the hope. Treatment is a surgery called carotid endarterectomy. And it sometimes does prevent strokes. But it also sometimes causes strokes.

Rand: So overall, does screening prevent more strokes than it causes?

Dr. Harris: Well that’s the real question. In the case of people who have never before had a stroke or a threatened stroke, overall screening probably causes more strokes than it prevents. That’s why the U.S. Preventive Services Task Force recommended against screening for carotid artery stenosis.

Rand: If not screening, what does the Task Force recommend that people do to prevent stroke?

Dr. Harris: Well the good news is that there are several things that can be done to prevent stroke. The most important is getting your blood pressure and cholesterol checked and being sure with your doctor that they’re under good control. Those are things that the US Preventive Services Task Force strongly recommends.

Rand: And finally, what is the Task Force and what is its mission?

Dr. Harris: The US Preventive Services Task Force is the leading independent panel of experts in prevention. Its task is to conduct impartial assessments of the scientific evidence about a broad range of clinical preventive services, including screening, counseling, and preventive medications. The Task Force’s recommendations are widely respected as the best ones to follow.

Rand: Dr. Harris, thanks for joining us.

Dr. Harris: It was my pleasure.

Rand: Up next, Dr. Clancy offers tips for Navigating the Health Care System.


Debra: If you’ve ever had a problem remembering the names of your medications, you’re not alone. But it’s dangerous not to know what medications you’re taking because it puts you at added risk for problems with mixing medicines. In this segment on Navigating the Healthcare System, AHRQ Director Dr. Carolyn Clancy talks about how to make sure that you get the right medicine and that you understand how to use it correctly. Welcome, Dr. Clancy.

Dr. Clancy: Thank you.

Debra: Dr. Clancy, please tell us why it’s so important for people to be active and informed consumers - especially when it comes to their medications.

Dr. Clancy: Being involved in your health care is one of the most important things you can do. For example, if your doctor wrote you a prescription for the pain reliever Darvon, would you notice if you got Diovan, a medicine for high blood pressure, by mistake? Unless you check the prescription that your doctor wrote to make sure it matches what’s in the pill bottle you receive from the pharmacy, chances are good that you wouldn’t notice you received the wrong medicine. And these two drugs are just two examples of many medicines whose names look and sound alike.

Debra: What is being done about these potential problems?

Dr. Clancy: The good news is that pharmacies, hospitals and other health care organizations are developing lists so that they can identify these drugs and take steps ahead of time to make sure that doctors are especially careful to print in block letters or use electronic prescribing to reduce the risk of errors from sound-alike drugs. And drug companies are working to reduce the number of medicines with similar-sounding names. But patients need to also take an active role in their health care by asking questions if something doesn’t seem right.

Debra: So what do you recommend patients do to be safer about medications?

Dr. Clancy: AHRQ has developed a consumer checklist about medication safety. So the following are five simple tips you can follow when it comes to your medications: The first is bring a list or a bag with all your medicines when you go to your doctor’s office, the pharmacy, or the hospital. This list or bag should include all prescription and over-the-counter medicines, vitamins, and any herbal supplements that you use. If your doctor prescribes a new medicine, ask if it’s safe to use with your other medicines. And remind your doctor and pharmacist if you are allergic to any medicines. The second tip is to ask questions about your medicines and make sure you understand the answers. Choose a pharmacist and doctor you feel comfortable talking with about your health and medicines. Take a relative or friend with you to ask questions and remind you about the answers later and make sure you write down the answers. The third tip is to make sure your medicine is what the doctor ordered. Does the medicine seem different than what your doctor wrote on the prescription or does it look different than what you expected? Does a refill look like it is a different shape, color, or size than when you had it before? If something seems wrong, ask the pharmacist to double-check it. Most medication errors are first found by patients. The fourth tip is to ask how to use the medicine correctly. Read the directions on the label and other information you get with your medicine. Have the pharmacist or doctor explain anything to you that you do not understand. Are there other medicines, foods, or activities such as driving, drinking alcohol, or using tobacco that you should avoid while using the medicine? Ask if you need lab tests to check how the medicine is working or to make sure it doesn’t cause harmful side effects. The fifth tip is ask about possible side effects. Side effects can occur with many medicines. Ask your doctor or pharmacist what side effects to expect and which ones are serious. Some side effects may bother you but will get better after you’ve been using the medicine for a while. Call your doctor right away if you have a serious side effect or if a side effect does not get better. You may need a change in the medicine or the dose of the same medicine. And finally, don’t take other people’s medicines. Many times it seems like a very good idea: a spouse or relative had the exactly the same symptoms you did, and they just happen to have a few pills lying around, and quite a few people do this. It is usually a bad idea because you can’t know ahead of time if it’s going to adversely interact with medicines you already take.

Debra: So it sounds like people need to be active in their health care, every aspect, including medications.

Dr. Clancy: Absolutely. Whether you have a brief illness or an ongoing medical condition, medicines are designed to help you heal and to make you feel better. And you get the best results from the medications when you take the right ones for your condition - and take them safely.

Debra: Thanks for being here, Dr. Clancy.

Dr. Clancy: My pleasure.

Debra: AHRQ’s medication safety checklist is called "Check Your Medicines," and it’s available online at ahrq.gov/consumer/checkmeds.htm


Rand: That’s it for this week. For more information on these and other health-related stories and topics go to www.ahrq.gov.

Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. For Rand Gardner, I’m Debra James. Please join us for the next edition of Healthcare 411.

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