| CLINICAL
NEWS FOR OUR PARTICIPATING HEALTH CARE PRACTITIONERS
Table of Contents
Washington Hospital Center's Teen Alliance
for Prepared Parenting Helps Young Parents
National Teen Pregnancy Prevention Month
Our QI Program: Setting Goals for Improved
Care and Service
Association of ADHD in Siblings
Utilization of Behavioral Health Services
New and Emerging
Technologies
Recent Literature on: Cardiovascular
Disease, Diabetes, Congestive Heart Failure, Asthma
and Cancer
Educate Patients about Food Allergies
Philosophy of Care
Washington Hospital
Center's Teen Alliance for Prepared Parenting Helps
Young Parents
The following is presented in an effort to highlight
hospital "best practice" around the region.
CareFirst BlueCross BlueShield (CareFirst) wants to
share with you the innovative ways in which
Maryland, Virginia and Washington, D.C. hospitals are
improving quality of care while controlling the rising
cost of health care. Look for additional "best
practice" features in future issues of InFocus.
Washington Hospital Center reports that the birth rate
among teens in Washington, D.C. in 1997 was nearly twice
the national rate-- 9.1 percent versus 5.2 percent.
To focus on the special needs of young parents, Washington
Hospital Center developed the Teen Alliance for Prepared
Parenting (TAPP). TAPP is a comprehensive, multi-site
program that provides clinical and psychosocial services
to help adolescent men and women improve their and their
children's futures.
TAPP's mission is to engage young people in positive
relationships that support their pregnancies, parenting
and overall health, while also serving as a catalyst
for their personal development.
TAPP also seeks to reduce subsequent pregnancies among
adolescents by 30 percent and believes that pregnancy
can be prevented through the combination of medical,
educational and social interventions. TAPP strives to
help young parents —
- Increase health knowledge and promote healthy behavior
- Improve life management skills
- Foster a sense of hope and boost expectations for
the future
- Access postpartum family planning and reproductive
health services
"Being with the [teen] clinic has helped me emotionally
and physically. They have introduced great programs
that have helped me with housing and nutrition,"
said a participant in the program. TAPP also encourages
young parents to continue their education and get permanent
jobs.
The following services are available to participants
for free.
- Prenatal/postpartum care
- Prenatal education
- Parenting education
- Family planning services
- Individual/group/couple counseling
- Referral services (e.g., adoption, mental health
and medical insurance)
- Training in communication, conflict resolution and
other life management skills
A newsletter, TAPP into the News, is sent quarterly
to participants. The newsletter highlights parents who
have done well in the program, gives health tips and
serves as an outlet for young parents or parents-to-be
to ask questions about pregnancy, birth control and
parenting.
TAPP provides services during pregnancy through at
least 24 months postpartum. Currently, TAPP serves over
200 adolescent women and their partners.
TAPP services are offered at--
|
Washington Hospital Center’s
Adolescent Clinic
110 Irving St., NW
Washington, D.C. 20010
202-877-7101
|
Woodland Terrace Clinic
2707 Langston Place, SE
Washington, D.C. 20020
202-678-0113
|
Upper
Cardozo Clinic
3020 14th St., NW
Washington, D.C. 20009
202-745-4300 |
Children's National
Medical Center’s
Good Hope Road Clinic
2501 Good Hope Rd., SE
Washington, D.C. 20020
202-884-6900 |
More Washington Hospital Center
Initiatives
Fighting Diabetes
Access to information about how to live with and manage
diabetes is available to all at the Diabetes for Life
Learning Center at the Martin Luther King, Jr. Library
in Washington, D.C. It is a free community-based education
and research program that offers diabetes education
classes for those interested and The Diabetes Corner,
a permanent corner of the library that offers diabetes-related
literature and a computer for individualized diabetes
research.
The research program helps determine whether the educational
program and its accessibility helps people with diabetes
gain a greater understanding and control of their disease.
Washington, D.C. residents who participate in the research
component of the project receive a free pre- and post-class
glucose, A1C and cholesterol testing.
This program is jointly supported by CareFirst BlueCross
BlueShield, Washington Hospital Center, the Martin Luther
King, Jr. Library, NBC4, MedStar Diabetes Institute,
MedStar Research Institute, the Diabetes Control Program
of the District of Columbia and the D.C. Department
of Health and Human Services.
For more information about Washington Hospital Center's
participation in the program, call 202-877-DOCS.
Mama and Baby Bus
This mobile medical outreach facility, sponsored
by Washington Hospital Center, ABC/WJLA-TV and Univision,
provides free access to dental and prenatal services
for children and pregnant women in center city neighborhoods
in Washington, D.C.
For questions regarding the Mama and Baby Bus and schedules,
call 202-332-4476.
Obesity Institute
Washington Hospital Center in Washington, D.C. and the
MedStar Research Institute have opened the Obesity Institute,
the only non-federally funded entity in the U.S. specifically
devoted to obesity medicine. The Institute's mission
is to bring together professionals with an interest
in obesity for patient care, research and education.
The Obesity Institute is located at the MedStar Research
Institute, 650 Pennsylvania Ave., SE in Washington,
D.C. Anyone interested in learning about the program
at the Obesity Institute can visit the Washington
Hospital Center Web site or call 202-675-6023.
Weight Management for Children and Adolescents
Children and adolescents are treated for obesity in
a family-oriented setting at the MedStar Weight Management
Center. The center is staffed by physicians from the
Washington Hospital Center, Georgetown University Hospital
and MedStar Research Institute.
In addition to obesity treatment, medical and psychological
counseling is available for eating disorders. For more
information about the MedStar Weight Management Program,
call 202-675-6023.
| CareFirst
does not interfere in the professional relationship
between CareFirst’s independently contracted physicians
and CareFirst’s members. Physicians are free to
discuss health care issues and health treatment
options with the members. The ultimate decision
concerning whether or not the member should undertake
any given course of treatment rests with the member
and the member’s physician. The obligation of CareFirst
is limited to providing covered services according
to the terms of the member’s health benefit certificate. |
National Teen Pregnancy
Prevention Month
Baltimore-based Campaign For Our Children (CFOC) seeks
to reduce teen pregnancy and acknowledges May as National
Teen Pregnancy Month.
Teen pregnancy deserves further attention despite recent,
steady declines of national teen birth rates. Four out
of 10 girls in the U.S. become pregnant at least once
by the age of 20.Twenty teens give birth every day in
Maryland.
CFOC incorporates print, transit, television and radio
advertising with in-school lesson plans, audiovisual
materials and activities to support community-based
programs. CFOC’s research-based messages and campaigns
help raise public awareness about adolescent preventative
health issues that deal with sexual activity among teens.
Share CFOC’s prevention messages and abstinence educational
campaigns with teens and their parents to encourage
healthy, responsible sexual decisions.
Teen mothers’ children have a greater chance than those
of older mothers of becoming teenage parents and are
more likely to face poor health, failure in school,
abuse, neglect and involvement with the criminal justice
system. Young mothers are often trapped in a cycle of
poverty because they are unable to complete their education
and attain financial independence. Young fathers are
frequently unwilling or unable to support their families.
When CFOC began its work in 1987, Maryland’s teen birth
rate was the fourth highest in the nation. According
to the Centers for Disease Control, Maryland now ranks
33rd, and the state’s teen pregnancy rate among girls
15 to 19 decreased almost 20 percent from 1995 to 1997,
which is the greatest decline in the nation.
CFOC information is available online,
or by calling 410-576-9015.
Our QI Program:
Setting Goals for Improved Care and Service
CareFirst is committed to providing the highest quality
of care and service to its members. The Plan’s Quality
Improvement (QI) Program strives to improve clinical
care and administrative services in all areas of the
delivery system.
Our QI Committees work closely with community physicians
to develop and implement the QI Program in a coordinated
effort to promote preventive health care, manage chronic
illnesses and continuously improve the care and services
our members receive.
Annually, CareFirst implements a QI work plan that
outlines specific clinical and service-related improvement
activities using the National Committee for Quality
Assurance (NCQA) Standards for Performance as a framework.
Data are collected and analyzed for each activity throughout
the year. Work groups then study barriers to improvement
and develop targeted interventions to help us achieve
established goals. For example, in order to improve
childhood immunization rates, a series of age-specific
letters was developed to educate parents and remind
them about the immunizations due for their child.
Categories of measures included in CareFirst’s quality
improvement plan are—
- Use of preventive services
- Compliance with clinical practice guidelines
- Continuity and coordination of care in medical and
behavioral health care
- Effectiveness of disease management programs
- Patient safety
- Availability of practitioners and access to care
- Potential overutilization or underutilization
- Member and provider satisfaction
If you would like more information about the QI Program
and how CareFirst is meeting its established QI Program
goals, please call 410-528-7997 or 800-323-4472.
Association
of ADHD in Siblings
Attention Deficit/Hyper-activity Disorder (ADHD) is
a common mental health condition that many American
families face; one out of every 20 children is affected
by it. Magellan Behavioral Health (Magellan) offers
a preventive health program to CareFirst BlueChoice,
Inc. members that helps educate parents about the increased
risk of ADHD in children with siblings that are diagnosed
with the condition. The association of ADHD in siblings
of children with the condition is estimated to be 25
percent.
Magellan sends families who have a child with ADHD
a survey to determine whether any siblings show symptoms
of ADHD. Parents are asked to complete and return a
survey for each sibling between 5 and 17 years old that
is not diagnosed with ADHD. If a survey indicates symptoms
of ADHD in an undiagnosed sibling, a Magellan care manager
will contact the parent and refer the child to a Magellan
behavioral health practitioner. If the parent prefers
to follow up with the primary care physician (PCP),
Magellan will send the completed survey to that provider.
If a behavioral health practitioner sees a child, Magellan
encourages communication with that child’s PCP.
From April 2002 to December 2002, one percent of the
surveys sent to families were returned to Magellan.
Twenty-three percent of the returned surveys showed
children with symptoms of ADHD. Twenty-five percent
of those families accepted a referral to a behavioral
health specialist.
A child should be evaluated to rule out other causes
of his/her problems before being diagnosed with ADHD.
Input from family and the school system is often part
of this evaluation. Treatment options for an ADHD diagnosis
include medications, behavioral therapy and school/educational
intervention.
Early detection, diagnosis and treatment of children
with ADHD can have a positive impact in a child’s life.
As a CareFirst BlueChoice provider, you can help make
this preventive health program successful by encouraging
parents of children with ADHD to complete surveys and
get treatment. If you have questions or helpful information,
please email the Magellan
ADHD Preventive Health Workgroup or call 410-423-6702.
CareFirst Medical Policy
CareFirst’s Medical Policy Reference Manual is available
online
(click on Medical Policy) and contains approved
medical policies and operating procedures for all CareFirst
products.
Medical policies, which are based on the research available
at the time of policy development, state whether a medical
technology, procedure, drug or device is--
- experimental/investigational
- cosmetic
- medically necessary
Utilization of Behavioral
Health Services
CareFirst is committed to providing ongoing behavioral
health benefits to its members. Magellan Behavioral
Health (Magellan) manages behavioral health benefits
for CareFirst members. Magellan has a Utilization Management
Program that offers care management focused on providing
appropriate attention to an individual member’s clinical
needs, cultural characteristics, safety and preferences
within a timeframe that the clinical urgency of the
member’s situation indicates.
Magellan makes utilization management decisions based
on appropriateness of care and service. Individuals
that need behavioral health services have access to
the full continuum of care. Clinically necessary treatment
occurs in the least restrictive environment that is
available, safe and clinically appropriate.
Magellan does not reward, financially or otherwise,
employed or contracted personnel:
- For issuing denials of coverage or service when
conducting utilization review.
- For making decisions that result in under-utilization
of services.
New and Emerging Technologies
Beginning with this issue, InFocus will include
descriptions of new and emerging technologies reviewed
by CareFirst.
CareFirst’s Technology Assessment Committee, which
includes CareFirst physicians, CareFirst nurses and
consulting physicians outside of CareFirst, reviews
new and developing technologies. The committee relies
on current medical literature, local expert consultants
and physicians to determine whether those technologies
meet our criteria for coverage. The review criteria
can be found on our Web
site by clicking on Medical Policy. The Technology
Assessment Committee recently made the following determinations.
| New Technology |
Description |
CareFirst
Determination |
| Full-field digital mammography |
An X-ray technology that uses digital
equipment, as opposed to conventional film technique,
to produce a display image. |
Based on the evidence, the images produced by
the digital equipment are substantially equivalent
to those produced by conventional X-ray imaging.
The advantages of digital imaging are ease of
storage, portability, electronic transmission
capability and the ability of radiologists to
use electronic enhancements to clarify or highlight
images.
CareFirst considers digital mammography a covered
benefit with the same extent of coverage for conventional
mammography.
|
| Low-level laser treatment for carpal
tunnel syndrome |
This treatment involves the use of
the “cold laser,” a near-infrared light-emitting
device that is said to penetrate the skin to the
connective and nerve tissue involved in carpal tunnel
syndrome. A photo biostimulation effect excites
the vascular and immune systems to promote healing
and relieve symptoms. Patients reported that they
felt no sensation of heat from this level of wavelength
and intensity. One such device, a battery-powered
unit resembling a flashlight, has received a 510(k)
clearance from the FDA. |
There are few studies published that support
this type of treatment. Two randomized, controlled
studies were reviewed. One study did not show
results that were significantly better than placebo,
and the other involved a study cohort too small
to draw meaningful conclusions on the reported
results. A meta-analysis described by an independent
author reported that the results to date do not
support the use of cold laser therapy as a treatment
for carpal tunnel syndrome.
Some alternative health practitioners have promoted
the technology.
Based on the evidence, this technology does not
meet criteria for coverage and is considered experimental
and/or investigational.
|
| Essure® permanent contraception
system |
Recently approved by the FDA for use
in the U.S., this system is a minimally invasive
method of female sterilization. Specially designed
metallic coils are inserted into the fallopian tubes
via a hysteroscopic procedure. After approximately
three months, during which the patient must use
an alternate form of contraception, sufficient tissue
will grow in and around the micro-coils to cause
a complete and permanent occlusion of the tubes.
A hysterosalpingogram is taken to confirm the tubal
occlusion. Once confirmed, the patient may cease
to use other contraceptives. |
The desired outcome for use of this technology
is to prevent unwanted pregnancy with a record
of safety and efficacy the same or better than
the traditional laparoscopic tubal ligation. The
evidence for the procedure is derived principally
from the pivotal clinical trial results submitted
to the FDA, which involved a study group of 507
patients who would otherwise be candidates for
elective laparoscopic tubal ligation. The results
were positive; less than 1 percent of the group
had complications, and efficacy of pregnancy prevention
is estimated near 100 percent.
CareFirst determined that the hysteroscopic tubal
occlusion system can be considered a covered benefit
for female members whose health plan provides
coverage for elective sterilization.
|
| Auto-Move® EMG-triggered neuromuscular
electrical stimulation |
Electrical muscle stimulation is used
in stroke rehabilitation programs with variable
results. EMG-triggered NMS attempts to help the
patient regain motor control of extremities, particularly
the arms or wrists, that may have been impaired
as a result of suffering a stroke. The Auto-Move
system was developed as a device for use by the
patient in the home setting. |
The National
Institute of Neurological Disorders and Stroke
(NINDS), a National Institute of Health, is
presently recruiting subjects for a scientific
clinical trial to determine if EMG- triggered
stimulation enhances motor function, and if any
clinical improvement is related to brain reorganization.
In previous studies, there were serious design
flaws that do not permit conclusions about the
effect of EMG-triggered stimulation on overall
patient outcomes. No studies are published that
address whether patients who have used such devices
in the home setting can expect better outcomes
than patients who undergo conventional stroke
rehabilitation.
Although the Auto-Move device has received clearance
for marketing from the FDA under 510(k) provisions,
based on the evidence, CareFirst determined that
the device does not meet criteria for coverage
as durable medical equipment.
|
Recent Literature
on: Cardiovascular Disease, Diabetes, Congestive
Heart Failure, Asthma and Cancer
By T.A. Dadisman, M.D., Medical Director, Preventative
Medicine and Health Promotion
This article is intended to call your attention to
recent information you may have missed on issues concerning
cardiovascular disease, diabetes,
congestive heart failure, asthma,
cancer and other items
of interest.
Cardiovascular
Disease
| What's Available: |
Where to Find
It: |
| Beginning in the 1980s, angioscopy
showed atheromatous plaques had a smooth surface
in patients with stable angina, while plaques had
disrupted surfaces in patients with unstable angina.
Plaque instability has become much better defined.
“Prevention of Plaque Rupture: A New Paradigm
of Therapy” describes the destabilization process
and details specific strategy to counteract the
process using angiotensin inhibition, statins, aspirin
and other therapy. |
(Annals
of Internal Medicine, 2002, 137:823-833)
|
“Cholesterol Treatment Guidelines
Update” is a discussion of major risk factors
that should lead to aggressive treatment
of LDL, “CHD equivalents,” which are conditions
representing the same risk as clinical CHD itself
and treatment approaches to hyperlipidemia. Remember,
“…only 38% of patients being treated for hyperlipidemia
are at NCEP LDL cholesterol target levels. The patients
who are most likely to benefit are the least likely
to achieve their target levels: only 37% of high-risk
patients and 18% of patients with coronary heart
disease have reached target LDL cholesterol levels.”
|
(American
Family Physician, 2002, 65:871-880) |
| “Poor Hypertension Control: Let’s
Stop Blaming the Patients” points out that “while
patient noncompliance and financial barriers
are undoubtedly important, several lines of evidence
suggest that the most modifiable barrier to hypertension
control is the failure of physicians to aggressively
pursue recommended goals for blood pressure treatment.” |
(Cleveland
Clinic Journal of Medicine, 2002, 69:793-799)
|
| “Transient Ischemic Attack”
is a Clinical Practice article that discusses
this common problem, its significance and modern
approaches to treatment. |
(New
England Journal of Medicine, 2002, 347:1687-1692)
|
| “The Underlying Risk of Death after
Myocardial Infarction in the Absence of Treatment”
states that everyone who has had an MI, even years
previously, should indefinitely receive preventive
treatment, including aspirin, statins, ß-blockers
and ACE inhibitors. |
(Archives
of Internal Medicine, 2002, 162:2405-2410) |
Diabetes
| What's Available: |
Where to Find
It: |
| “Initial Management of Glycemia
in Type 2 Diabetes Mellitus” is a Clinical
Practice feature with case vignette that
presents evidence supporting various strategies,
reviews formal guidelines and discusses clinical
recommendations. The emphasis is on aggressive and
accelerated implementation of treatments known to
be effective. Similarly, the editor urges aggressive
treatment of coexisting hypertension and dyslipidemia. |
(New
England Journal of Medicine, 2002, 347:1342-1349)
|
| “Trends in Care by Non-Physician
Clinicians in the U.S.” shows that between 1987
and 1997, the proportion of patients who
saw both a physician and a variety of non-physician
clinicians increased from 23.5% to 30.9%. For those
patients with diabetes who saw both an MD and a
non-MD, the increase was from 32.7 % to 45.6%. (Visit
the American
Association of Diabetes Educators to find a
Certified Diabetes Educator in your area to assist
with the care of your patients with diabetes.) |
(New
England Journal of Medicine, 2003, 348:130-137)
|
| “American Diabetes Association
Clinical Practice Recommendations 2003” contains
a rewritten “Diabetic Retinopathy” standard
that includes summary tables and updates to the
treatment of hypertension and nephropathy. These
revisions focus on the aggressive use of angiotensin
conversion enzyme (ACE) inhibitors, angiotensin
receptor blockers (ARBs) and ß-blockers for
treatment of hypertension. |
(Diabetes
Care, 2003, 26:S1-S156) |
Congestive
Heart Failure
| What's Available: |
Where to Find
It: |
| “ß-Blockers: New Standard
Therapy for Heart Failure” summarizes the established
evidence of the benefit of ß-blockers for
heart failure and provides practical information
regarding the use of ß-blockers. The new guidelines
from the American College of Cardiology/American
Heart Association recommend the use of ß-blockers
in all patients with left ventricular systolic dysfunction. |
(Mayo
Clinic Proceedings, 2002, 77:839-846)
|
| “Burden of Systolic
and Diastolic Ventricular Dysfunction in the Community”
studied 2042 Minnesota residents over 45. 20.8%
of the population had mild diastolic dysfunction;
5.5% had moderate diastolic dysfunction; and 0.7%
had severe diastolic dysfunction. The prevalence
of any systolic dysfunction was 6.0%. The prevalence
of moderate or severe systolic dysfunction was 2.0%.
Less than half of these patients had recognized
CHF. The lifetime risk for people 40 and older of
developing CHF may be as high as 20%. This exceeds
the lifetime risk of many conditions commonly screened
for in this community. |
(Journal
of the American Medical Association, 2003,
289:194-202) |
Asthma
| What's Available: |
Where to Find
It: |
| “Asthma in Adventure Travelers”
recognizes that asthma should not be ignored as
a potentially life-threatening disorder. Frequent
pre-travel use of inhaled bronchodilators and plans
for intensive trekking indicate that caution should
be used when traveling. |
(Archives
of Internal Medicine, 2002, 162:2421-2426)
|
| “Guidelines for the Diagnosis and
Management of Asthma - Update on Selected Topics,
2002” discusses medications for the long-term
management of mild or moderate persistent asthma
in children, combination therapy in moderate persistent
asthma and use of antibiotics to treat exacerbations
of asthma. The recommendations also discuss asthma
action plans and effects of early treatment on asthma
progression. |
http://www.nhlbi.nih.gov/guidelines/
asthma/index.htm
|
Cancer
| What's Available: |
Where to Find
It: |
| “American Cancer Society
Guidelines for the Early Detection of Cervical Neoplasia
and Cancer” introduces new screening recommendations
that address when to begin and end screening, screening
of women who have had a hysterectomy, appropriate
screening intervals and new screening technologies,
including liquid-based cytology and HPV DNA testing. |
(CA:
A Cancer Journal for Clinicians, 2002, 52:342-362) |
| “Intratumoral T-Cells, Recurrence
and Survival in Epithelial Ovarian Cancer” discusses
the correlation between the presence of intratumoral
T-cells and improved clinical outcome in advanced
ovarian carcinoma. See also the Perspective
article “Immunosurveillance against Cancer and
Immunotherapy” in the same issue (pg. 252-54). |
(New
England Journal of Medicine, 2003, 348:203-213)
|
| “A Serious Adverse Event after
Successful Gene Therapy for X-Linked Severe Combined
Immunodeficiency” states that sustained correction
of X-linked severe combined immunodeficiency was
achieved in 4 patients. Thirty months after gene
therapy, one of the four patients showed hepatosplenomegaly
and a mature lymphocyte count of 300,000 cells/mm3,
requiring chemotherapy for acute leukemia. This
trial was halted. See also the Perspective
article, “Risks and Benefits of Gene Therapy”
in the same issue (pg. 193-94). |
(New
England Journal of Medicine, 2003, 348:255-256) |
Other Items of Interest
| What's
Available: |
Where
to Find It: |
| Many interventions
could have prevented adverse drug events (ADE).
Proven ADE prevention strategies are discussed in
“Analysis of Medication-Related Malpractice Claims
- Causes, Preventability and Costs.” |
(Archives
of Internal Medicine, 2002, 162:2414-2420) |
| “Herbal Remedies” is an excellent
review article. These products continue to have
great appeal to patients, which cannot be ignored.
It is imperative to ask patients if they are taking
herbal products, particularly if they have unexplained
health problems. Physicians must be knowledgeable
about the potential effects of herbal preparations. |
(New
England Journal of Medicine, 2002, 347:2046-2056) |
| “Management of Community-Acquired
Pneumonia” is a Clinical Practice article
with excellent, highly useful information--diagnosis
and treatment of pneumonia; risk stratification,
using the Pneumonia Severity Index; recommendations
for initial empirical treatment; and criteria for
determination of the appropriateness of discharge. |
(New
England Journal of Medicine, 2002, 347:2039-2045)
|
Educate Patients about
Food Allergies
Food allergy is the leading cause of anaphylaxis outside
the hospital setting, accounting for an estimated 30,000
emergency room visits, 2,000 hospitalizations and 150
to 200 deaths each year in the U.S.
Research analyzing public perception of food allergy
indicates that as many as 15 million Americans believe
they have a food allergy. Prevalence data shows between
6 and 7 million people in the U.S. actually have a food
allergy.
Diagnosis of Food Allergies
Some patients, such as infants and children, are at
higher risk for developing a food allergy. “Infants
born to families in which at least one parent or sibling
has a personal history of allergy (allergic rhinitis,
asthma, food allergy or allergic eczema) may have as
high as a 20 percent chance of developing food allergies
in the first 5 to 7 years of life,” said Robert S. Zeiger,
M.D., Ph.D. and Medical Advisory Board member of the
Food Allergy & Anaphylaxis Network (FAAN), a national
nonprofit patient advocacy group.
Diagnosis relies on various factors, including a thorough
medical history, physical exam, symptom assessment and
testing. Other methods of diagnosis include food diaries
that record foods eaten, amount ingested and any reactions;
and elimination diets that remove suspected food allergens
from the diet for a period of time to see if symptoms
abate upon removal and return when the food allergen
is reintroduced.
Because false positive results are common with allergy
tests, a food challenge may be needed to confirm or
refute the diagnosis. During a food challenge, the patient
is given increasing amounts of the suspected allergen
and is observed for signs of a reaction. Food challenges
are the standard for determining whether a patient has
developed or outgrown a food allergy. Challenges may
be—
- Open: The patient and provider are aware the test
allergen is ingested.
- Single blind: Only the provider is aware the test
allergen is ingested.
- Double blind placebo-controlled: Both the patient
and provider are unaware the test allergen is ingested.
Managing Food Allergies
Patients that manage food allergies may have difficulty
adjusting to and following new diets and often turn
to health professionals for help.
Food Labels
Patients must read ingredient statements for
all foods each time they shop because
ingredients may change without warning. Occasionally,
a food manufacturer mislabels a food item. To get information
about product recalls or withdrawals, FAAN has developed
a Special Allergy Alert system. Sign up for this free
service by sending an email
message with the subject, “Subscribe.”
Food labels often contain scientific names for common
foods (e.g., whey or albumin, instead of milk or eggs).
The Food Allergy & Anaphylaxis Network (FAAN) provides
information regarding How to Read a Label, updated regularly,
with the synonyms for many of the most common food allergies.
To obtain a copy, email
FAAN or call them at 800-929-4040.
Outside the Home
Because allergens can appear in a number of unexpected
places, encourage patients to look for potential sources.
For example, common allergens have been found in pet
food, bath products and cosmetics. Patients should also
be careful of craft projects, school lunchtime, classroom
celebrations, social events and childcare.
Patients should use caution when dining away from home.
Some cooking styles may be higher risk than others;
Asian dishes often contain peanuts, tree nuts, fish
or shellfish, which increase the chance of cross contact
between food. Seafood restaurants are also a high risk
for patients with fish or shellfish allergy. Desserts
and baked goods often contain or have had contact with
common food allergens.
It is an industry policy to reuse frying oil; proteins
from various food allergens are released into the oil
during cooking and may contaminate other food fried
in the same oil. It is essential that patients know
how to ask clear, detailed questions about ingredients
in their food. In the table below are some examples
of common questions people with food allergies ask with
suggestions to make them clearer.
| Common
Questions |
| Instead of Asking: |
Advise Patients to Ask: |
| What ingredients are in the breading? |
I am allergic to eggs; will you ask the chef if
the breading contains egg ingredients? |
| Is milk added to the sauce? |
I am allergic to milk; do any ingredients in this
sauce contain milk proteins? |
Sources of Information
Food
Allergy & Anaphylaxis Network (FAAN)
(800) 929-4040
FAAN, founded in 1991, is a national nonprofit organization
based in Fairfax, VA. FAAN provides information about
shopping, cooking and working with schools to accommodate
children with allergies. FAAN materials help families
learn how to manage food allergies. Annual meetings
provide participants with an opportunity to learn about
recent research and the latest strategies in the field,
and to meet other families coping with food allergies.
For more information, contact FAAN.
American
Academy of Allergy, Asthma & Immunology
(800) 822-2762
American
College of Allergy, Asthma & Immunology
(800) 842-7777
Philosophy of Care
We represent a philosophy of health care that emphasizes
active partnerships between patients and their physicians.
We believe that comprehensive health care is best provided
by networks of health care professionals who are willing
to be held accountable for the satisfaction of their
patients and the quality of their services.We are committed
to high standards of quality and professional ethics
and to the principle that patients come first.
We believe that patients should have the right care,
at the right time and in the right setting. This includes
preventive care, as well as comprehensive care for acute
and chronic illness — at home, at the doctor’s office
and in the hospital.
We believe that all health care professionals should
be held accountable for the quality of the services
they provide and for the satisfaction of their patients.
We believe that patients should have a choice within
their health plans of physicians who meet high standards
of professional training and experience, and that informed
choice and the freedom to change physicians are essential
to building active partnerships between patients and
doctors.
We believe that health care decisions should be the
shared responsibility of patients, their families and
health care professionals, and we encourage physicians
to share information with patients on their treatment
options, medical conditions and health status.
We believe that consumers have a right to information
about health plans and how they work. We believe that
working with people to keep them healthy is as important
as making them well.
We value prevention as a key component of comprehensive
care, reducing the risks of illness and helping to treat
small problems before they can become more severe.
We believe that access to comprehensive, affordable
care gives consumers the value they expect and contributes
to the peace of mind that is essential to good health.
Adapted from the American Association of Health
Plans
CareFirst Mission
CareFirst shall be the leading regional health care
company recognized for a comprehensive portfolio of
high-quality, innovative products and administrative
services. Our purpose is to provide the best value to
our customers in partnership with the health care community
and in an environment that promotes respect, fairness
and opportunity for our associates.
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