A new report from Accenture estimates that by 2019, two-thirds of US health systems will offer patients the opportunity to digitally self-schedule physician appointments. By reducing the time spent scheduling and rescheduling (an average of 8 minutes per phone appointment versus less than a minute for online self-scheduling), this simple change could save the health care system an estimated $3.2 billion.
Accenture says that nationwide, 11% of health systems currently offer self-scheduling of appointments, but only 2.4% of patients who have the opportunity take advantage of it. That may be partly because retirees—a population that generally prefers conducting business by phone—make up nearly half of the US population. Still, a recent Accenture survey indicated that 77% of patients thought that the ability to book, change, or cancel medical appointments online was important.
In an interview with Medscape’s Dr. Eric J. Topol, editor in chief, Dr Atul Gawande discusses his journey from medical school to working in the Clinton administration to being a journalist. Dr. Gawande is currently a Professor in the Department of Health Policy and Management at the Harvard School of Public Health and a Professor of Surgery at Harvard Medical School.
In comparing surgeons with politicians, Gawande said, “Surgeons are grappling with having limited information and knowledge, imperfect science, but have a necessity to act in the face of both imperfection in their own abilities and imperfect knowledge in the world. I saw a lot of the same incredible range of characters and people [in politics and the operating room].” Dr. Gawande concluded that this is a fascinating time in medicine because “we’re all trying to figure out how to make systems work instead of just using drugs and devices.”
The Internet has fundamentally changed how orthopaedic surgeons discover and share information, but it has also put greater emphasis on the need for quality information. The editorial teams at JBJS work exceptionally hard to ensure that the information we publish is reliable, evidence-based, and trustworthy. Our peer review process is one of the tools we use.
Peer review has been under pressure lately. Some publishers have decreased the steps involved. Others have eliminated roles such Editor-in-Chief from journals they publish. Still others have even started journals with professional editors and then, once they began to receive enough submissions, simply fired the professional editor and replaced him or her with a staff person. Standards for acceptance vary more than ever, with some publications publishing works if they are “methodologically sound” or even if “they are science.” These definitions are clearly inadequate, especially when patient care is involved.
We don’t want our readers to be confused about what “peer review” means for the core articles in The Journal of Bone & Joint Surgery, so we’re introducing a new feature on each article starting this month – the peer review statement.
This statement lays out in just a few sentences who reviewed the article, from the Editor-in-Chief to the Deputy Editors to the outside reviewers and experts in methodology and biostatistics. We also mention the talented and experienced staff editors who help authors fine-tune the language and keep the numbers straight. It’s all part of achieving “Excellence Through Peer Review.” You can read more about this new feature in editorial published this month in The Journal.
In an age where everyone’s a publisher, quality matters more than ever. We remain committed to ensuring that you can trust what we publish, and we are proud to describe the process we use to get the best and most reliable information to you. Thank you for translating this information into superior outcomes for the patients you treat every day.
If you are a sales rep in the pharma market, 6 minutes may be as long as you get with your customer, often while standing on your feet. In a secret-shopper study done by BioPharma Alliance among 200 specialists, undercover former drug reps observed 350 pharmaceutical rep visits. From their observations, nine out of ten calls lasted 6 minutes and almost half were conducted while standing. According to the study, 83% of primary care physicians look for their rep to be an expert when the drug is new compared to 76% when the drug is already established. However, when doctors were asked about their frustrations in dealing with sales reps, topping the list was, “no new information.” Similarly, “pushy” and “aggressive” sales reps are also top annoyances.
According to Mike Luby, of consultancy BioPharma Advisors, “The biggest problem pharma has is admitting they have nothing new and adjusting their approach.” Luby goes onto say, “Consider the doctor who sees the rep waiting for them at the sample closet. They don’t know if it is new information, good science, a valued medical update waiting for them, or someone waiting to tackle them and pretend that they have something new on an old brand that hasn’t had any new information in years. So it burns doctors out. It also drags all reps down, because as a doctor, you don’t know until you are in the conversation, when you’ve invested time you will never get back.”
When patients don’t show up for their scheduled surgery, many costs are incurred that cannot be recouped, including the OR staff, the anesthesiology team, and equipment and medication that have been ordered. Reducing potential “no-shows” is imperative to maximize efficiencies. In addition to “no-shows,” reasons for cancelled surgeries to include scheduling errors, equipment problems, cancellations due to patient medical status, and emergency surgeries bumping medical procedures.
Key predictors of no-shows include prior missed appointments, history of alcoholism or other substance abuse and/or psychiatric issues. Measures can be taken to deter no-shows among patients from low-income background, such as scheduling appointments around public transportation times, educating patients on the benefits of the surgery, and eliminating the fear of uncomfortable procedures that seems to be higher in low-income patients.
The article, “Guiding Femoral Rotational Growth in an Animal Model” by Arami, et al. is an intriguing variation on the common applications of guided growth in pediatric patients. Implants that bridge the physis to inhibit growth in a given anatomic location are widely used to correct angular deformity or leg-length differences in the growing child and to decrease the need for a more invasive corrective osteotomy.
At present, correction of rotational deformity in the pediatric femur or tibia requires a derotational osteotomy and commonly six weeks of casting postoperatively. This study in rabbits demonstrates the ability of implants to alter the rotational profile in the growing femur by bridging the physis in an oblique orientation, rather than in a vertical orientation used for angular deformity correction.
The authors have elegantly demonstrated histologically the swirling or bending appearance of the physeal columns in treated femora, while controls maintained the normal linear columnar appearance of the physis. This interesting and unique animal study lays the foundation for consideration of using oblique placement of physeal-bridging implants to guide rotational growth in skeletally immature patients, without the need for osteotomy.
It may seem counterintuitive, but runners have a lower risk of knee orthoarthritis than walkers do. A July 2013 study followed more than 75,000 runners and 14,000 walkers and found that runners had a lower overall risk of developing arthritis than walkers. Runners generate greater knee forces than walkers, but due to the longer strides of running, the net result is less overall load on the runners’ knees than on walkers’ knees. Although running doesn’t decrease the cause of ‘wear’ on the knee, it seems better than walking for delaying development of osteoarthritis.
Belgian doctors have identified a “new” knee ligament in humans, although a French surgeon speculated on its existence as far back as 1879. The anterolateral ligament or ALL, is a narrow band of tissue originating at the lateral femoral epicondyle and traveling obliquely to the anterolateral aspect of the proximal tibia. Researchers think the ALL functions to stabilize the outer part of the knee and prevent it from collapsing inward. When people tear their ACL doctors presume that the ALL is also torn, and that its rupture and subsequent withering may have contributed to its obscurity. There’s still a lot to learn about the ALL as surgeons are now in the initial stages of planning and practicing surgical procedures for treating all tears.
This past fall, JBJS released the results of its annual survey of orthopaedic surgeons, “The Third Annual Role of the Orthopaedic Surgeon Study 2013.” Surgeons surveyed identified 10 ways that orthopaedic practices are changing. Other reported trends included a growth in services offered and staff employed. For example, respondents said they’ve hired more physician assistants, coding specialists, physical therapists, hospitalists, and nurse practitioners over the past 12 months. Also, more orthopaedic practices are adding x-ray, physical therapy, and MRI to their list of services.
On December 4, in association with the Journal of Orthopaedic & Sports Physical Therapy, JBJS hosted a complimentary webinar, “Adhesive Capsulitis/Frozen Shoulder.” The webinar presented a unique, dual perspective on managing frozen shoulder and examined how these two disciplines can work together for the best patient outcomes. Moderated by Andrew Green, MD, the webinar reviewed the following recently published articles, which were presented by authors George Murrell, MD, and Martin J. Kelley, DPT:
• Long-Term Outcomes After Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis. J Bone Joint Surg Am. 2012 Jul 3;94(13):1208-16. doi: 10.2106/JBJS.J.00952
• Clinical Practice Guidelines: Shoulder Pain and Mobility Deficits: Adhesive Capsulitis. J Orthop Sports Phys Ther. 2013 May;43(5):A1-31. doi:10.2519/jospt.2013.0302
Commentary was provided by Jo Hannafin, MD, PhD, and Philip McClure, PT, PhD.
Below are some of the highlights from this interactive webinar.
6 important treatment methods to consider:
- Release of anterior, posterior, and inferior capsule
- Use of perioperative intra-articular steroids
- Early postoperative physical therapy
- The reasonable postoperative goal should be patient satisfaction and functional range of motion, not necessarily full range of motion
- Pain and muscle guarding can lead to a patient losing half of his or her range of motion on the 1st post-operative day
- Don’t push a patient going through physical therapy to a range of motion beyond that which was achieved immediately post procedure
One of the questions from the Q & A portion of the webinar:
Q (audience): Are there rheumatoid or inflammatory markers or factors that have been associated with any of the phases of adhesive capsulitis/frozen shoulder?
A (Jo Hannafin, MD, PhD): No there haven’t. There have been cellular responses that would intimate that you had an inflammatory factor. One of the things that causes the contraction of the capsule is an increase with myofibroblasts. Some years ago, there was a demonstrated increase of TGF-beta staining in the capsule as well as connective-tissue growth factor. It has never been measured in synovial fluid, but you can see the staining in the perivascular region of the capsule.
This complimentary webinar was recorded and is now available on-demand: http://bit.jbjs.org/IHPY2n