Patient Counseling

Patient Counseling

PATIENT COUNSELING Medic Alert Week Targets Older Americans Medic Alert International, a widely used, nonprofit alert system for people with special ...

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PATIENT COUNSELING

Medic Alert Week Targets Older Americans Medic Alert International, a widely used, nonprofit alert system for people with special medical conditions, is calling attention to emergency care for older Americans during Medic Alert Week, May 5-11. Especially at risk are older patients with heart disease, diabetes, and hypertension, and those who take multiple medications, according to Stephan G. Lynn, MD, the campaign's spokesman and director of the Department of Emergency Medicine at St. Luke'sRoosevelt Hospital Center in New York City. "People with these conditions frequently take medication that makes them appear perfectly normal, yet masks the underlying

Features of Emergency Medical Systems According to John MeN amara, Medic Alert Intemational's vice president of marketing, there are "dozens and dozens" of emergency medical alert systems in existence. Prices vary, and so does stability. "They come and go so quickly it's hard to keep track," he says. What should pharmacists advise patients who ask about the merits of different systems? According to a 1990 pilot study conducted for Medic Alert, 88% of emergency medical personnel usually or frequently look to see if the patient is wearing a bracelet with an emblem, and 77% usually or frequently look for a neck emblem, as compared to 24% who usually or frequently look for a wallet card. The 844 respondents to the survey were emergency medical technicians, firemen and policemen, emergency room physicians and nurses, and other emergency personnel in California. A brief rundown of the pros and cons of the most popular systems follows:

problem," he said. Medic Alert identifies patients who have allergies to common drugs, have chronic medical conditions, take medications that can interact with other drugs, and wear medical devices that can affect health care. Participants receive an engraved bracelet or necklace that bears their personal identification number, a brief listing of their specific medical conditions, and a hotline number that medical personnel may call 24 hours a day for information from the patient's medical file. This information includes health problems, medications taken, and names and phone numbers of physician, pharmacist, and family contact person. Patients also receive a wallet card that carries more information than the emblem can hold; updated cards are issued each year. • Printed cards. Essential data are summarized on wallet-sized cards. These can be updated regularly, but, like other personal belongings, they are often separated from the victim in an emergency. Also, it is illegal in some jurisdictions for anyone but the police to open a victim's wallet. Wallet cards have limited value if they do not carry a phone number that medical personnel can call 24 hours a day for additional data on the patient's medical history. • ID necklaces or bracelets. These are durable and more likely to stay with the victim than cards are. Also, they are worn near pulse points, which helps make them visible in emergencies. Their size limits the amount of information they can hold, so these, too, must bear a phone number that can be called around the clock. MeNamara cautions against purchasing preprinted emblems, which typically carry a brief warning-such as "diabetes" or "allergies"-but are not hooked up to a patient database. "It's not enough information to be useful," he says. • Stickers for refrigerators, windows, license plates, etc. These are

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Patients may update their files at any other time for $7. The onetime fee to join Medic Alert is $30. Medic Alert also offers a national registry for patients with pacemakers and other surgical implants, and a quick response system that patients can use in an emergency to signal medical personnel immediately. Medic Alert urges pharmacists to help ensure that every patient in need of protection is registered with the organization. (Many pharmacists across the country promote Medic Alert to patients regularly, as part of a pharmacy campaign launched in 1987.) For more information on how to participate, contact Medic Alert International, Turlock, CA 95381-1009. (800) 432-5378; (800) 736-3342; or (209) 669-2406. Ask for the professional services group. helpful only if the emergency takes place in the victim's home or car, and only if the medical personnel happen to look for them. Again, they should display a phone number to call for the patient's medical data. • Cards on microfiche, or with microchips or magnetic memory strips. These can store large amounts of data, but most hospitals do not have the readers and scanners necessary to gain access to the information. Also, these can get damaged, "like when your bank's teller machine spits your card out and won't let you make your transaction," McNamara says. "There may be a place for these many, many years down the road, but right now you don't want to rely on a system that's machine dependent," he says. No regulatory body oversees emergency alert systems. When selecting one, consumers should not only consider the factors above but also find out how long the system has been in operation, how easy it is for callers to get through to the databank, what local emergency personnel think of the system, and how much the service costs.

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PATIENT COUNSELING

NHLBI Releases New Guidelines for Asthma New guidelines for diagnosing and managing asthma, recently released by the National Heart, Lung, and Blood Institute (NHLBI), emphasize the key role that inflammation plays in the disease. Although asthma has long been thought of as a disease that primarily involves bronchial constriction, the latest scientific findings have led experts to conclude that "preventing inflammation, not just reversing bronchial constriction, is central to asthma management," according to Albert L. Sheffer, MD, a Harvard Medical School professor and chairman of the panel that developed the report. The panel was composed of allergists, pulmonologists, nurses, and behavioral scientists. "This means not only using an inhaled beta2-agonist, a bronchodilator, to provide immediate symptomatic relief, but also using anti-inflammatory agents, such as cromolyn sodium or inhaled corticosteroids, to reduce inflammation over the long term," Sheffer said at a press conference announcing the guidelines. Concern about asthma is growing because its incidence has increased by about one-third over the past decade. Deaths from asthma have increased about 6% per year. Experts are unsure why this trend is occurring, but suspect that more accurate diagnosis, which distinguishes asthma from infections and smoking-related conditions, as well as increasing allergens in the environment may play a part. The guidelines emphasize that most asthma patients can expect to lead normal lives and point to four integral components of asthma therapy: patient education, environmental control measures to avoid allergens, pharmacological

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therapy, and use of objective measures to assess asthma severity and monitor treatment. Also recommended are: • A "step-care" approach to therapy in which the number of medications and their frequency of administration are increased as necessary. • Home monitoring of lung function with a peak expiratory flow meter for patients with moderate to severe asthma, to alert them to early deterioration before symptoms can be felt (see story, p. 24). The report also provides specific recommendations for treating patients at high risk of death from asthma, pregnant women, the elderly, and other special groups. To obtain a copy, contact the National Asthma Education Program, 4733 Bethesda Ave., Bethesda, MD 20815. (301) 951-3260.

Bladder Training Reduces Episodes of Incontinence A study conducted by the Medical College ofVirginia and the National Institute on Aging found that bladder training reduced episodes of incontinence by 57% in 123 noninstitutionalized women over age 55 (JAMA. 1991; 265:609-13). The six-week training consisted of patient education using audiovisuals and verbal and written instructions, and a mandatory urination schedule for the patient to follow. Initially, the subjects emptied their bladders every 30 to 60 minutes; the intervals were increased by 30 minutes each week if the patient's incontinent episodes decreased in number and if they tolerated the schedule without interruptions. The goal was to reach a 2H- to 3-hour interval between voidings. The patients,

who attended weekly clinic visits, were required to keep daily treatment logs, and received ongoing positive reinforcement. The authors of the study urge health practitioners to consider bladder training as initial treatment before proceeding to drug treatment or surgery, both of which may have side effects and risks. For a listing of where patients may obtain bladder training and other information on incontinence contact Help for Incontinent People, Inc., P.O. Box 544, Union, SC 29379. 1-800-BLADDER (toll free) or (803) 579-7900.

Buying Sunglasses As people are becoming more aware of the damage the sun's ultraviolet rays can cause, they are asking more questions about how to protect themselves and still enjoy summer's abundant sunlight. Most consumers are familiar with the rating system for sunscreens, which makes it fairly easy to select an appropriate product for the skin. But what about the eyes? "There is a general consensus that ultraviolet light is a risk to the eyes," said Jim Pritts, vice president of the Sunglasses Association of America. Because many experts believe ultraviolet light can damage the retina and may be responsible for cataracts, the association has adopted standards concerning sunglasses' blockage of ultraviolet light. These were set by the American National Standards Institute and endorsed by the Food and Drug Administration. The standards are not mandatory, but those manufacturers who abide by them will help simplify consumers' efforts to purchase appropriately protective sunglasses. • Sunglasses labeled "cosmetic" absorb 70% of UVB rays and 20%

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of UVA rays. These are useful if sunglasses are worn primarily for fashion purposes, but are not suitable for bright sunlight. • "General purpose" lenses, which absorb 95% of UVB rays and 60% of UVA rays, are good for most activities, including driving, boating, and sunning. • "Special purpose" lenses absorb 99% of UVB rays and 60% of UVA rays. These are needed for skiing, mountain climbing, and tropical sunlight situations. When worn for driving, these lenses could potentially obscure the color of traffic lights. Pritts noted that if a manufacturer claims its lenses block 100o/o of ultraviolet light it may be accurate, but it's also unnecessary; the standards above are suitable for safety. He recommends advising consumers to purchase sunglasses that are sold with an attached address in case of complaints.

Help for Sneaker Foot Youngsters who keep their feet trapped inside occlusive footwear, such as tennis shoes, can develop an unpleasant skin condition their parents may wonder how to tackle: sneaker foot. The condition, also known as sweaty sock syndrome, typically affects young children and looks a great deal like the fungal infection athlete's foot, which is rare in young children. The skin on the foot becomes scaly and appears dry. Then it gets red, tender, and looks macerated. Crusty, oozing blisters develop. The stifled air inside the sneaker has shifted from wet to dry and back again too many times, aggravating the condition. "If the child is outside playing in his sneakers all day, it may be hard for a mother to get him to come in and air out his feet," points out

Jack L. Lesher, Jr., MD, an associate professor of dermatology at the Medical College of Georgia. "The warm, humid environment breaks down the skin and it looks like dry skin but the skin is really retaining too much moisture." The best approach to combatting sneaker foot, according to Lesher, is to encourage children to change socks and shoes regularly. Clean, white socks are preferable to synthetic ones, Lesher said. He also suggested using over-the-counter hydrocortisone or petroleum-based moisturizers on the affected skin. Untreated, sneaker foot may develop into a bacterial infection. If these measures prove ineffective, the child should be seen by a physician.

Health Resources

May Health Promotions National Arthritis Month. Arthritis Foundation, 1314 Spring St., NW, Atlanta, GA 30309. (404) 872-7100. National High Blood Pressure Month. National Heart, Lung and Blood Institute, NIH Information Center, 4733 Bethesda Ave., Suite 530, Bethesda, MD 20814. (301) 951-3260. Older Americans Month. Administration on Aging, 330 Independence Ave., SW, Room 4760, Washington, DC 20201. (202) 619-0641. National Medic Alert Week: May 5-11. Medic Alert Foundation International, P.O. Box 10009, Turlock, CA 95381. (800) ID-ALERT. National Asthma and Allergy Awareness Week: May 5-11. The Asthma and Allergy Foundation of America, 1717 Masschusetts Ave., NW, Suite 305, Washington, DC 20036. (202) 265-0265.

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