This link is to a well written op-ed from the Washington Post and is worth a read. It's fairly brief, to the point and quickly summarizes the similarities and differences in structure, cost and quality of health care in various industrialized nations compared to the U.S.
It certainly reflects the data on the subject, and also my experience of health care in other countries as experience by me, my family or as related by my patients.
Realize that the H1H1 vaccine is separate from this, and is likely to require two shots in series.
The word is that access and supply are not going to be a problem, but in the event that it is, the CDC is recommending that certain groups get first access. Mind you, other sources such as WebMD had news coverage less than a week ago of production delays. It is important to remember that researching, developing and producing vaccines and other biologicals is extremely difficult. The flu vaccines are matured on chicken embryos for gosh sakes!
At any rate, the current recommendations for novel H1N1 flu vaccination in the event of inadequate supply is as follows:
First:
Pregnant women
Children 6 months to 4 years old
Children 5 to 18 years old with chronic medical conditions
health care workers with direct patient contact
people living with or caring for children under 6 months old
Second:
19-24 year olds
25-64 year olds with chronic illnesses
Third:
25-64 year olds without chronic illnesses
Last:
all persons 65 and older
Note that the reason for "seniors" to get H1N1 vaccine last is because they are at very low risk to even get the swine flu. This probably means that if you are 65 or older, you got a flu back when you were younger that was similar and gives you partial immunity to the swine flu. Younger folks don't have this response because they weren't around yet!
Remember, this is different than the usual annual flu shots. Those are available and plentiful and should be received between Hallowe'en and Thanksgiving for best effect.
The novel H1N1 influenza ("swine flu") is still being seen, including the unfortunate death of a local 52 year-old woman who apparently had chronic medical conditions as well.
Folks who are at higher risk for severe infection are those with chronic conditions (such as chronic lung disease) and also morbid obesity with a Body Mass Index over 35. The reason for this latter is not clear. Body Mass Index is calculated as follows: Weight/Height x Height and then multiply by 703.
Unfortunately, swab tests for detecting flu are not very accurate, and may detect flu only 50% of the time!
Otherwise, the H1N1 flu is similar to usual winter-time flu insofar as:
Symptoms are different than a common cold, since body aching and sense of weakness and illness is more severe.
Medications for treating this flu are the same, and should be started within the first 2-3 days to be effective.
You should cover your mouth when you cough, or wear a mask.
Wash your hands frequently.
You may return to work or school 24 hours after the fever has gone.
The death of two neighbors and friends in a single day is a deep loss and sorrow. Patient privacy forbids me to name them, but we know who we're talking about here.
I've known and doctored both fellows for years, and their deaths are painful to me as the loss of two patients whom I've known, liked and respected for a long time.
For your community, I'm sure this sadness runs very deep. I have always, and will continue to be truly impressed by the genuine sense of mutual support and real neighborliness in your community.
Much of what happens when you have a prescription occurs behind the scenes.
When you bring in a prescription, or if we call or fax it for you, the medication is labeled, placed in a secure bottle and checked against other medicines you obtain through that pharmacy to be sure that it is safe with your other medicines. The pharmacy also provides verbal and written instructions and precautions about the medicine.
When you need a refill, they provide this by phone and in many cases on-line through a dedicated website.
Even when the bottle says that there are no further refills, a call to the pharmacy will take care of this.
What happens is that they will fax me a request to okay any refills. We respond by faxing them back within 4 hours or less of receiving the request.
Mind you, we may also contact you if we notice that you are overdue for an annual physical or a follow-up appointment for a chronic medical condition. We may also wish to see you first if you are requesting a refill on a medicine that was prescribed a long time ago (such as a pain pill for a condition that went away a few years ago).
Because of the contracts that pharmacies have with commercial insurances (such as Blue Shield, Anthem, United, etc.) they can only fill prescriptions for 30 days at a time. I'm sure they'd be happy to be able to fill more at once, but if they do the insurance won't pay them for the medicines.
The reason for this is that the insurance companies have out-sourced discount contracts for medicines to Pharmacy Benefit Managers (PBM's) or "the mail order pharmacies" such as MedCo and Express Scrips. These companies are contracted with your insurance to contract with drug companies to provide discounted prices for large-volume buyers. In other words, your insurance saves money on medication costs by getting discount rates and requiring you to use them if you want to get more than a month's supply of medicines at a time.
You may use your insurances PBM by looking through the materials they send you every year, or by calling them at the toll-free number on your insurance card. They will provide you with any necessary paperwork. We can provide a 90 day prescription with up to a year's worth of refills if you ask. When this is sent in, they will mail 90 days at a time for up to a year to your address.
Do realize that you probably should not use the 90 day option for a new pill or a change in the dose, until we know it's working well and not causing you any problems.
Also, be aware that the military (CHAMPUS, TriCARE) operates differently. If you have no insurance, WalMart will fill many prescriptions for $4/month or $10/90 days. Just let us know which one you need when asking for a prescription.
This link is to a well written op-ed from the Washington Post and is worth a read. It's fairly brief, to the point and quickly summarizes the similarities and differences in structure, cost and quality of health care in various industrialized nations compared to the U.S.
