Sunday, July 1, 2007

Prescription drugs present own problems

Saving money, including those with private or government insurance, is an appealing option. Thus the new emphasis on $4 generic drugs.

There are multiple large chain stores and an increasing number of independent drug stores who offer similar programs.
However, there are multiple issues to consider carefully with your doctor and/or pharmacist before using the $4 program.

If you shop for drugs at more than one pharmacy, it is possible that the dispensing pharmacy is unaware of other medications you are taking. This could result in "double dosing" or taking drugs that are not compatible.

Using one pharmacy for all of your prescriptions allows the pharmacy staff to review your medical conditions and the medications that you are currently taking prior to filling a prescription. If your medical condition requires several different medications, the possibility for the patient or caregiver to make an error can be increased.

Reading the label on the generically dispensed pharmacy labels becomes confusing. For example: the commonly ordered drug Novasc would be labeled Amlodipine Besylate and Soma would be labeled Simvistatin.

Further, different manufacturers may color their generic products differently.

Patients often take their medications by memory — for instances taking the "small pink pill" in the morning, a "triangular pill" midday etc. Some patients either can't or won't check the bottle before taking a pill, but they depend on the familiarity of shapes and colors.

The $4 drugs are very useful and safe if the patient knows what they are taking. When in doubt, call your pharmacy.


East Stroudsburg

Pharmacy error led to premature birth, suit says

Two years ago, Antoinette Lewis' baby was born prematurely. She claims her pregnancy complication was a result of a "misfilled" prescription received at a CVS Pharmacy and is suing the company for more than $50,000.

Lewis filed her suit individually and on behalf of her new born with the Jefferson County District Court on June 25. Judge Bob Wortham, 58th Judicial District, will preside over the case.

According to the plaintiff's original petition, on June 30, 2005, Lewis was pregnant when she had a prescription filled at the CVS on Avenue A.

"Defendant through its employees, agents, and servants, misfilled the prescription. Plaintiff subsequently suffered complications due to the misfilled prescription, was forced to deliver the minor plaintiff by C-section prematurely, and both suffered injuries due to the negligence of the defendant.

The suit goes onto to say Lewis presented CVS with a prescription for an antibiotic, and instead received Vytorin.

"Defendant failed to properly administer the correct medication, the plaintiff was pregnant, and the Vytorin caused complications with the pregnancy, and subsequently caused early delivery."

Vytorin is a cholesterol-lowering medicine distributed by Merck/Schering-Plough Pharmaceuticals. The official Vytorin Web site warns that the drug should not be taken by pregnant women.

"Vytorian is a prescription tablet containing two medicines, ezetimibe and simvastatin, and isn't right for everyone, including women who are nursing or pregnant or who may become pregnant, and anyone with liver problems," the site says.

Lewis alleges the pharmacy was negligent for failing to properly fill the correct medication, failing to recognize her symptoms, and "failing to engage in recognized and acceptable practices in the medical profession to limit the likelihood and probability of infection following the treatment provided by the defendant."

"Plaintiffs allege that the defendant violated the duty of care they owed to Lewis to exercise that degree of care, skill, and diligence ordinarily possessed and used by other members of the medical profession in good standing under the same or similar circumstances," the suit said.

Lewis is suing for physical pain and suffering in the past and future, mental anguish in the past and future, lost wages, loss of earning capacity, disfigurement in the past and future, physical impairment in the past and future, and past and future medical expenses.

Lewis is demanding a trial by jury and is represented by attorney Brett S. Thomas of the Roebuck & Thomas law firm.

Case No. A179-565
By David Yates

Vaad Refuah: Improving The Quality Of Hospital Care

Question: Where do you turn for help if someone is hospitalized? Answer: Vaad Refuah.

Mrs. Shapiro spent her last days in a hospital with constant attention from her devoted family. Her children took turns sitting by her bedside, wiping her brow and cooling her parched lips with ice. When she passed away, the family at least had the satisfaction of knowing that they had done everything possible to relieve her suffering and alleviate her pain. What they didn’t realize, however, is that despite their loving vigilance, Mrs. Shapiro was not receiving adequate medical care.

The chevra kadisha, while washing the body, discovered that yet another patient had passed away with Stage III or IV bedsores. These are deep, black craters usually in the sacrum, back or ankles where the skin, muscles, or bone have been eaten away. Mrs. Shapiro, along with 1 million other Americans, half of whom are over 70, was suffering from excruciating, but largely avoidable, decubitus (bed sores). Elderly patients who are confined to bed are at the highest risk due to their thinner skin and weaker circulation and immune systems. Had this family been aware of this potential problem, they would have made a simple request to the nurses to turn her every two hours and check her body for early signs of bedsores to prevent this painful complication.

Bedsores, unfortunately, are not the only problems that call for extra attention from the families of patients who are staying in a health care facility. At least one study shows that 5-6% of all patients acquire nosocomial infections in hospitals each year. These infections are usually highly resistant virulent strains. It is within the patient’s rights and responsibility to ask respectfully if the health care worker has washed his or her hands. There are also times when a family should discreetly ask that the patient be moved due to the danger of cross infection from a roommate. In addition, errors in prescription drugs for hospitalized patients have recently soared. If the patient was not informed that his doctor changed his medication, he should immediately request confirmation. The number of unnecessary surgeries and the resulting greater need for second opinions also warrants consideration.

How are the family members, who are already over-strained, worried, and tired, able to assume this role of guarding the patient from medical error without knowing the ‘ins and outs’ of the hospital process? To address this problem, a team of rabbonim, askonim, medical professionals and volunteer workers has created a patient advocacy group, Vaad Refuah. Vaad Refuah does not give medical advice. They only guide the patient and his family through the maze of health care bureaucracy in order to increase the quality of health care for all patients.

Mrs. Krausz, who supervises 14 volunteers who are on call through Vaad Refuah’s helpline, offers the following advice to all patients and their families:

Appoint a friend or family member to be a spokesperson to liaise with the hospital staff. Even a patient who can take responsibility for his own health care still needs a spokesperson to act as his advocate.

The spokesperson is invited to contact the Vaad Refuah helpline about how to avoid preventable complications and how to effectively intervene with hospital staff.

With polite respect, the spokesperson should try to resolve all care problems with the local nursing or care-giving workers.

Medical problems should be discussed with the doctor who is managing the case. In those instances where there is no managing doctor, the spokesperson should communicate with all the appropriate doctors who are involved in the case.

If any problems arise, the spokesperson should be in touch with Vaad Refuah. For Lutheran, NY Methodist, Long Island College, and Maimonides hospital, Vaad Refuah has established communication channels where, if necessary, they will intercede to help acquire the appropriate cooperation from the hospital. For patients in other hospitals, Vaad Refuah can advise the spokesman how to talk to the hospital and, where possible, the Vaad may be able to facilitate communication.

The Vaad will maintain a database of problems encountered in each hospital. The information collected will be provided to the management of each hospital to assist in effectuating needed improvement. Unclean conditions, employee neglect of duties, and other violations should all be reported to the Vaad. (Forms can be obtained at

Positive feedback, either general or relating to the actions of specific staff, should be reported to the Vaad, who will pass praise along to the hospitals. This will create a culture of caring in which the efforts of conscientious staff will be made known. Conversely, the Vaad will apply pressure on the hospitals to change by publicizing negative data when necessary.

All information given to the Vaad is kept in strict confidence. There is no need to fear retaliation from hospital employees.

The Vaad has thus far made several major changes in local Brooklyn hospitals. They have convinced hospital management to improve emergency room procedures, establish more hand washing stations, implement stricter hand washing compliance, improve the staff/patient ratio, provide more diligence in turning patients, and computerize bed availability tracking. Future plans include expanding the Vaad’s computerized patient satisfaction program to more hospitals, introducing more medical prevention practices, and educating the community and health workers about the most effective methods of communication.

The Vaad performs these services through its network of volunteers in order to help our local communities secure the best possible health care. For more information or to join the volunteer staff, call 1-877-REFUAH, 1-877-973-3824 or visit www.vaad

Vaad Refuah Meets Maimonides Trustees. On June 24, an historic conference took place in Borough Park between the Rabbinical board of Vaad Refuah and the Trustees of Maimonides Medical Center to tackle healthcare concerns facing the Borough Park/Flatbush/Bensonhurst communities.

The roster of esteemed attendees included: Rabbi Yisroel Tzvi Brody, Manchester Dayan; Rabbi David Eichenstein, Burshtyner Rebbe; Rabbi Shloime Gross, Belzer Dayan; Rabbi Shraga Hager, Kosover Rebbe; Rabbi Yakov Horowitz, Rav Telshe Minyan, Rosh Hayeshivah, Beis Meir; Rabbi Yechiel Kaufman, Rav D’khal Anshe Sefard; Rabbi Yakov Perlow, Novominsker Rebbe; Rabbi Yisroel Reisman, Rav Agudath Yisroel Madison Branch, Rosh Yeshivah Torah V’daas; Rabbi Yechiel Mechel Steinmetz, Skverer Dayan; and Rabbi Chaim Yakov Tauber, Bobover Dayan. The other participants were board members of Vaad Refuah, along with community representatives on the Maimonides Medical Center Board of Trustees including Abraham Biderman, Moshe Hellman, Andrew Kohen, Chaim Leshkowitz, Peter Rebenwurzel, Alfred Schonberger and Rabbi Aaron Twersky.

Concerned with the quality of healthcare our families receive at local hospitals as well as the need for the various community organizations to work together to ensure the best possible service within halachic parameters, the rabbonim initiated this meeting as a follow-up to a prior meeting held between the Vaad Rabbinical Board and Hatzoloh representatives. At the conference, attendees were updated on the efforts the Vaad has made to date on infection control, respiratory care patients, wound-care and decubiti (bed sores/pressure sores).

The Vaad has a close working relationship with the Bikur Cholims of Borough Park, Flatbush and Bensonhurst. It also meets regularly with Hatzoloh, sharing information of common concern and coordinating activities to maximize community efforts for the improvement in the quality of healthcare service delivery.

While the Vaad has made great strides in assisting individual patients and their families by helping them navigate hospital bureaucracy, advocating on their behalf and intervening to expedite their needs, effecting systemic changes is significantly more laborious and requires the close cooperation and assistance from the Hospital Board of Trustees.

The community representatives on the Maimonides Medical Center Board of Trustees expressed their eagerness to assist in this effort by collaborating with the Vaad in assuring that the Maimonides Administration continues to pay proper attention to community concerns, responds promptly to issues raised by the various community organizations, and implements needed changes in a timely fashion. The Vaad highly commended Maimonides Medical Center Board of Trustees for their commitment to partner in this vital mission.

Computerized Doctors' Orders Reduce Medication Errors

Doctors are famous for sloppy scribbling -- and handwritten prescriptions lead to thousands of medication errors each year. Electronics to the rescue: U.S. hospitals that switched to computerized physician order entry systems saw a 66 percent drop in prescription errors, according to a new review of studies.
Illegible handwriting and transcription errors are responsible for as much as 61 percent of medication errors in hospitals. A simple mistake such as putting the decimal point in the wrong place can have serious consequences because a patient's dosage could be 10 times the recommended amount.

Drugs with similar names are another common source of error, such as the pain medication Celebrex and the antidepressant Celexa, or the tranquilizer Zyprexa and the antihistamine Zyrtec.

"These medication errors are very painful for doctors, as well as the patients. Nobody wants to make a mistake," said Tatyana Shamliyan, lead review author and a research associate at the University of Minnesota School of Public Health.

The University of Minnesota researchers looked at 12 studies that compared medication errors with handwritten and computerized prescriptions from in-hospital doctors. Nearly a quarter of all hospital patients experience medication errors, a rate that has increased from 5 percent in 1992, according to the study.

Medication errors include prescribing the wrong drug or incorrect dosage or administering a drug at the wrong time or not at all. "Most errors typically go undetected unless they led to an adverse event," said review co-author Robert Kane.

In addition to improving patient safety, computerized systems make life easier for pharmacists. "They don't have to decipher the chicken scratch," said Karl Gumpper, director of the pharmacy informatics and technology section of the American Society of Health-System Pharmacists, based in Bethesda, Md. Pharmacists frequently have to call the prescribing doctor or interview the patient because of problems in deciphering handwriting.

Currently, only about 9 percent of hospitals have computerized prescription systems. Some hospitals have stand-alone systems, while others have computerized prescriptions as part of an electronic medical record system.

Each year, more health systems implement computerized order entry systems and more will do so as electronic medical records become more common. "It's a growth industry," Kane said.

A small handful of institutions, including Brigham and Women's Hospital in Boston and Vanderbilt University Medical Center in Nashville, have been leaders in integrating computerized prescriptions, experts say.

It takes 12 to 36 months to implement computerized prescribing system, Gumpper said. Currently, no industry standard system exists. Some hospitals use systems created in-house, while others use commercial products created by companies such as Epic Systems, based in Verona, Wis. or McKesson Corp., based in San Francisco.

Some systems guide doctors through the prescription process, asking questions that might help avoid errors. Some even use voice recognition.

There are two reasons why more hospitals have not switched to electronic prescription systems, says Arthur Levin, director of the Center for Medical Consumers in New York. First, "Physicians, like most of us, don't like change," he said. In addition, electronic prescription systems are costly and difficult to integrate into the complex, sometimes-chaotic hospital structure.

Regardless, in hospitals with a computerized prescription system, the number of medication errors dropped, especially among adult patients. However, the rate of one type of error --prescribing the wrong drug -- did not decrease, and in five studies, the number of adverse events from drug errors did not decrease.

Each year, more than one-half million patients sustain injuries or die in hospitals from adverse events, according to the study.

In hospitals with a higher number of medication errors -- more than 12 percent -- computerized systems made the biggest improvement, the researchers found.

Medical schools in the United States rarely address penmanship. It is the same in Russia, says Shamilyan, who studied there. However, at least one medical school in the United States, Indiana University in Indianapolis, teaches penmanship to students in hopes of avoiding errors.

As nearly every industry becomes more computerized, Levin says the doctor's prescription pad should go the way of scarification used in the 19th century for bloodletting. "Written and verbal orders should be a no-no," he said.

Reference; Shamliyan TA, et al. Review of the evidence: impact of computerized physician order entry system (CPOE) on medication errors. Health Services Research online, 2007.

Note: This story has been adapted from a news release issued by Center for the Advancement of Health.

Call Kurtis: Medical Board Investigation

An 82-page report shows the medical board is still failing to protect all of us from doctors who abuse alcohol and drugs.

Linda, Becky, Tina, Ken-- just some of the faces of people who believe they're living the consequences. If you looked beneath the clothes of some patients you would see something horrifying. They blame damages on a doctor who battled a dangerous addiction, and on the state's significant errors.

We know of more than 30-patients who say plastic surgeon Dr. Brian West made medical mistakes while treating them. The medical board knew Dr. West had a drinking problem, and had two drunk driving convictions. The first, after crashing his car in 2000 on the way to the hospital to treat a patient. The state had the power to take away his license to practice.

Instead, they let him enroll in the medical board's alcohol diversion program, a secret program where they're supposed to keep an eye on substance abusing doctors with random alcohol and drug tests in an effort to protect patients.

We learned, the state wasn't giving doctors those tests as often as required, and the testing was done on days doctors could anticipate. In November, with the Dr. West case in front of him, the head of the medical board admitted his agency failed.

While in the program, Dr. West cut into Becky Anderson so many times, she never looked or felt the same. Tina Minasian ended up with permanent scars from a body tuck that went wrong. Ken Mickulecky says his late wife Sharon was left with a massive flesh eating infection that kept her from getting the cancer treatment she needed.

“He put his finger without a glove in my wife's wound. When he came into examine her, she said smells like he's got alcohol on his breath. I said, no, doctors wouldn't do that,” said Ken.
Back in November Medical Board Executive Director Dave Thornton admitted the diversion program's problems of the past, but claimed they have been fixed.

“If your doctor is an alcoholic, and is in the program, he's not gaming the system. The system is working now the way it’s supposed to be working and the way it should have been working all of these years,” said Thornton.

Fast forward to a state audit that was just released. The audit states that what he says is not true. Although there have been some improvements, many doctors in diversion are still given drug and alcohol tests on days they can anticipate.

The report shows during the audit 13 doctors failed their tests. Yet, only three of them were immediately removed from practice.

“These are doctors who retain their license to practice medicine who are allowed to practice medicine, are chemically dependent. This board is supposed to be monitoring doctors, it doesn't,” said Julie D'angelo Felmeth, who has audited the program twice.

D'angelo Felmeth says there have been five audits in 27 years and each one shows the same exact issues with diversion-- A program she says has no room for error.

“They've had decades to fix these problems, which have been repeatedly identified for them and the problems and the programs have never been a priority to the medical board,” said D'angelo Felmeth.

In fact, a member of the board's executive committee even admitted it during a meeting last week. The problematic program caught the attention of state lawmakers in 2005 who passed a law stating the diversion program needs to be fixed by July of next year, or it'll go away.

Earlier this year State Senator Mark Ridley-Thomas, the head of the legislative committee that oversees the medical board, drafted a bill to keep the diversion program going for an additional two years.

“Ultimately saving doctors is better than disposing of them,” said Senator Ridley-Thomas.

We showed him our investigation, and he admitted what the state allowed to happen here is upsetting.

“It should be long before you get there, this problem is dealt with,” said Senator Ridley-Thomas.

He points out, his bill to extend the program was drafted before the latest audit, but instead of killing his legislation he says he'll beef it up, to hold the medical board accountable.

“Shape up this program, or it will not longer exist,” said Senator Ridley-Thomas.

That message went out two years ago, and the program still has major problems putting patients at risk.

“Let me simply say there's a new sheriff in town. And the chair of this committee will push for accountability, and that's essentially what we're doing now,” said Senator Ridley-Thomas.

Knowing this is the fifth audit in 27 years, and all of the same concerns keep coming up. Audit after audit some might question why should this program be extended for another two years.

“That's a legitimate question. This is a program under strict scrutiny. Either they perform as intended, or there is no defense for continuation. It requires a significant time on task to straighten some of these things out,” said Senator Ridley-Thomas.

That bill is still being talked about at the capitol. It has to pass the State Senate and Assembly by September, or the program is set to go away next July. It's supported by the medical board and the California Medical Association, which historically contributes a large amount of money to the campaigns of state lawmakers.

At the Beverly Hills Surgical Institute in Long Beach, Dr. West still practices, and has always refused to comment on this issue. The state has a case against him for what happened to several patients. It will be the fall before a judge decides if he should lose his license.
by Kurtis Ming

Physician order entry system reduces error

The incidence of medication errors can be reduced by implementing a computerized physician order entry (CPOE) system, according to a review of several studies conducted by researchers at the University of Minnesota.

The review, recently published in the online journal Health Services Research, analyzed 12 studies conducted between 1990 and 2005 that compared the number of handwritten and computerized medication errors made by hospital physicians. Medication errors, which include prescribing the wrong drug, ordering an inaccurate dosage, or administering a drug at the wrong time, dropped by as much as 66 percent in United States hospitals that switched to a CPOE system. Illegible handwriting and transcription errors account for more than 60 percent of medication errors.

Patient safety is our final goal, said Tatyana Shamliyan, lead review author and a research associate at the University of Minnesota School of Public Health.Evidence from these studies show that computerized systems can reduce mistakes, but unfortunately less than 50 percent of hospitals have implemented these systems. There is a lot of work to be done in the future.

The rate of medication errors experienced by hospitals has skyrocketed from only 5 percent in 1992 to nearly 25 percent today. The review found that of these hospitals, CPOE systems were most beneficial when the rate of medication errors was more than 12 percent.

The Institute of Medicine has already identified medication errors as a major threat to patient safety and has endorsed electronic prescribing of medication as an effective method in correcting the problem.Medication errors are a central aspect of improving hospital safety. CPOE can help that process, says Robert Kane, M.D., review co-author.

Hospitals would be short-sighted not to use it. Kane also notes that CPOE systems can be combined with existing computerized medical records, creating a central location for physicians to efficiently enter and view past and present patient prescriptions and medical history.

While the review found that the number of medication errors dropped as a whole, the incidence of one type of error, prescribing the wrong drug, did not decrease. In five of the twelve studies, the number of adverse events from drugs errors did not decrease. More than one-half million patients suffer injuries or death from adverse events, causing up to $5.6 million annually per hospital, according to the review.

When Minority Patients Have Insurance And A Medical Home, Their Health Care Improves

Providing minority patients a "medical home" in which they have a regular doctor or health professional who oversees and coordinates their care would help eliminate racial and ethnic health disparities and promote more health care equity, says a new report from The Commonwealth Fund. The report, based on a 2006 survey of more than 2,830 adults, shows that linking minority patients with a health care setting that offers timely, well-organized care where they can routinely seek physicians and medical advice can help them better manage chronic conditions and obtain critical preventive care services.
According to the report, Closing the Divide: How Medical Homes Promote Equity in Health Care, in 2006 nearly one-half of Hispanics and more than one of four African Americans were uninsured at some point during the year. In contrast, 21 percent of whites and 18 percent of Asian Americans lacked coverage. In addition to being the groups most likely to go without health insurance, African Americans and Hispanics are least likely to have a regular doctor or source of care. While health insurance coverage is an important determinant of whether people can obtain essential care, the authors say insurance alone cannot eliminate racial and ethnic disparities in health.

"Insurance coverage helps people gain access to health care, but the next thing you have to ask is 'access to what?'" says lead co-author Anne Beal, M.D., senior program officer at the Commonwealth Fund. "We found many disparities in care; however, disparities are not immutable. This survey shows if you can provide both insurance and access to a true medical home, racial and ethnic differences in getting needed medical care are often eliminated," she adds.

According to the report, patients have a medical home when they:

* Have a regular provider or place of care
* Report no difficulty contacting a provider by phone
* Report no difficulty getting advice or medical care when needed on weekends or evenings
* Always or often find office visits well-organized and efficiently run

Although there are many places that are already functioning as models of such care, what most limited a health setting from being designated a medical home in this survey was the ability to dispense medical advice or care after hours or on weekends, according to the report. Only two-thirds of adults who have a regular provider or source of care report that it is easy to get care or medical advice after hours. Among all groups surveyed, Hispanics have the hardest time seeking care or advice after hours, and they are least likely to have a medical home.

The survey shows that, when they have a medical home, the vast majority of adults of all races say they can always get the care they need when they need it. Nearly three-quarters of adults with a medical home report getting the care they need compared with only 52 percent of those with a regular provider that is not a medical home and 38 percent of adults without any regular source of provider.

Key survey findings on the role of a medical home in eliminating health care disparities:

* Racial/Ethnic Disparities Are Still Common.
* African Americans and Hispanics are less likely to be insured, and less likely to have a regular doctor or source of care.
* Hispanics are least likely to have a medical home; only 15 percent of Hispanics report having a medical home compared with 28 percent of whites, 34 percent of African Americans and 26 percent of Asian Americans.

Preventive Care Is More Routine.

* Minority adults with a medical home experienced no disparities in receiving preventive care reminders, which significantly improve rates of routine screening for conditions such as heart disease and cancer. For example, eight of 10 adults who received a preventive reminder had their cholesterol checked in the past five years compared with half of adults who did not get a reminder.
* Two-thirds (65%) of adults who have a medical home receive preventive reminders, according to the survey.

Chronic Care is Better Managed.

* Adults with a medical home are better prepared to manage chronic conditions such as diabetes or hypertension. Only 23 percent of adults with a medical home report their doctor or doctor's office did not give them a plan to manage their care at home compared with 65 percent who have no regular source of care.
* Forty-two percent of hypertensive adults with a medical home report that they check their blood pressure and it is well controlled compared with 25 percent of those without a medical home.

Having Health Insurance Matters.

* More than half of insured adults received a reminder from a doctor's office to schedule preventive visits compared with only 36 percent of uninsured adults; when African American and Hispanic patients are insured, they are just as likely as white adults to receive reminders to schedule needed preventive care.

Community Health Centers and Other Public Clinics Are Important Providers of Care to Vulnerable Patients.

* Although they care for a large proportion of uninsured, low-income, and minority adults, patients report that community health centers (CHCs) or other public clinics are less likely to have all four characteristics that comprise what the survey defined as a "medical home." Twenty-one percent of CHCs or public clinics have all four indicators of a medical home, compared with 32 percent of private doctors' offices.
* The main reason CHCs and other public clinics do not function as medical homes is because patients say they have more difficulty getting medical advice or care in the evenings or weekends. Since these safety net providers play a critical role in the care of vulnerable patients, the authors say it is important to find ways to support CHCs and public clinics becoming medical homes.

Promoting standards for the medical home through public reporting of performance and rewarding providers that meet these performance benchmarks would go a long way toward improving the way care is delivered and eliminating disparities, say Commonwealth Fund authors.

"We know the medical home is a promising model of care for narrowing health care disparities and providing patients with much higher quality care in terms of prevention and chronic disease management," says Fund Executive Vice President Stephen C. Schoenbaum, M.D. "Adopting policies to encourage practitioners to embrace this model would improve care for everyone, particularly those in safety net settings," he adds.


The survey was conducted by Princeton Survey Research Associates International from May 30 through October 19, 2006. The survey consisted of 25-minute telephone interviews in English or Spanish among a random, nationally representative sample of 3,535 adults at least 18 years of age living in the continental United States. The report restricts the analysis to the 2,837 respondents ages 18-64. The sample was designed to target African American, Hispanic, and Asian households and it classifies adults by insurance status and annual income. The survey has an overall margin of sampling error of +/- 2.9 percentage points at the 95 percent confidence level.

The Commonwealth Fund is a private foundation working toward a high performance health system.

Note: This story has been adapted from a news release issued by Commonwealth Fund.