Avinash Patwardhan

The Value of Pharmacists in Health Care

The American health care system is concerned about the rise of chronic diseases and related resource challenges. Management of chronic disease traditionally has been provided by physicians and nurses. The growth of the care management industry, in which nurses provide remote telephonic monitoring and coaching, testifies to the increasing need for care management and to the value of nonphysician clinicians. However, this model is challenged by a number of factors, including low enrollment and the growing shortage of nurses. The challenges to the traditional model are causing policy makers and payers to consider innovative models. One such model includes the pharmacist as an essential provider of care. Not only is the number of pharmacists growing, but they are playing an ever broader role in a variety of settings. This article broadly surveys the current state of pharmacist provision of care management services and highlights the increasingly proactive role played by Walgreen Co. toward this trend, using recently conducted research. Pharmacists are making a noticeable impact on and contribution to the care of chronic diseases by improving adherence to medications, a key factor in the improvement of outcomes. Literature also suggests that pharmacies are increasingly encouraging, expanding, and highlighting the role and contributions of their professional pharmacists. Although the role of the pharmacist in chronic care management is still developing, it is likely to grow in the future, given the needs of the health care system and patients.

After-hours Access of Convenient Care Clinics and Cost Savings Associated With Avoidance of Higher-Cost Sites of Care

This study examines the utilization of convenient care clinic services outside of typical physician office hours and estimates the cost savings from potentially avoided visits to the emergency room, urgent care center, and primary care physician associated with convenient care clinic encounters. The results show that 44.6% of convenient care clinic visits occurred on weekdays, 5 pm or later, or on weekends. Savings from avoided encounters with the emergency room, urgent care, and primary care physician were estimated at

Comparison of waiting and consultation times in convenient care clinics and physician offices: a cross-sectional study.

135.53 million.

Yoga Research and Public Health: Is Research Aligned With The Stakeholders’ Needs?

This study measures waiting times and consultation times at convenient care clinics (CCCs), and compares them with equivalent times in traditional, family practice, physician offices. The analysis was limited to conditions most commonly treated at CCCs. It was found that patients using CCCs had significantly shorter waiting times from check-in to seeing a clinician than the equivalent waiting times reported by patients at family practice physicians’ offices and that CCC patients had significantly longer consultation times with the clinician than those reported by family practice patients. Applying a correction factor to adjust for potential differences between real waiting times and perceived waiting times did not substantially alter the conclusions. Shorter waiting times may increase satisfaction and thereby encourage patients to seek care; and spending additional time with the clinician may help ensure that all of a patient’s concerns or questions are addressed. This study provides objective evidence from a large database that CCCs provide prompt, satisfying care.

Is the Integration of Yoga with Psychotherapy Compatible? What are the Risks?

Research on yoga is witnessing an unprecedented proliferation currently, partly because of great interest in yoga’s health utility. However, yoga research does not seem to be sufficiently public health oriented, or its quality corresponding to its quantity. Yoga research is falling short to enable key stakeholders like end users, prescribers, and payers to meaningfully, confidently, and fruitfully answer the questions like: Is it generalizable? Is it standardizable? Which yoga style should be used/recommended/paid for? Or will it be worth the money? Therefore, it is important to examine the alignment to purpose or value of yoga research from a public health point of view so as to make it more practical. The issues such as lack of clear definition of yoga, wide variation in its dosage, cacophony of lineage-based styles, no data about comparative effectiveness between the yoga components, confounders and biases clouding the evidence regarding its benefits, too little data on long-term adherence, equivocal results about its cost effectiveness, discussions lacking embrace of better methods in research, and absence of a theory of yoga are examined. This is not a detailed discussion of every issue yoga research faces, but a high-level overview of those that have direct practical bearing. In the end, a few pragmatic approaches are offered. The article suggests that yoga-component analysis, development of a theory of yoga, adoption of a health-aligned functional typology of yoga, development and testing of a simple universal basic prototype of yoga intervention, emphasis on research about long-term adherence, and discouragement for mere proof of concept research might make yoga research serve the stakeholders better. It urges the research community to practice “context cognizant scholarship” to disentangle health compatible yoga from its historical-cultural-social body before examining it for health or medical application.

Physicians-Pharmaceutical Sales Representatives Interactions and Conflict of Interest: Challenges and Solutions

In view of recently increasing burden of mental health problems in the US, on the top of the corresponding workforce shortage, it is understandable that mind-body modality like yoga is drawing attention of practitioners and scholars as a potential supplement and complement to psychotherapy. Yoga originated in ancient India primarily as an art or craft to modulate mental activities. Therefore, it has the potential to offer promise in helping diverse mental health problems. However, using yoga for this purpose entails many challenges, risks, and consequences that must be borne in mind before any decisive reforms are implemented in the field of psychotherapy and or yoga. In general, the field of yoga is flooded with hype and frivolity, where enthusiasm and advocacy far outweighs understanding and evidence. This article critically examines various pros and cons of integrating yoga with psychotherapy. It argues that while yoga practices might have value in mental health, yoga is not easy to integrate with psychotherapy for many reasons. For example yoga is a spiritual experiential practice, which is outside of psychotherapy domain, or the fundamental philosophical underpinning of yoga is starkly antithetic to that of western psychotherapy. It is posited that a hasty not well thought out integration, given that the challenges of integration are more daunting than the justifications, may lead to disappointment and harm than help. It is suggested that a cautious approach is required to address this issue.

Decline in the Use of Medicalized Yoga Between 2002 and 2012 While the Overall Yoga Use Increased in the United States: A Conundrum:

Physician-industry relationships have come a long way since serious debates began after a 1990 Senate Committee on Labor and Human Resources report on the topic. On one side, the Sun Shine Act of 2007, now a part of the Patient Protection and Affordable Care Act that mandates disclosure of payments and gifts to the physicians, has injected more transparency into the relationships, and on the other side, numerous voluntary self-regulation guidelines have been instituted to protect patients. However, despite these commendable efforts, problem persists. Taking the specific case of physician-pharmaceutical sales representative (PSR) interactions, also called as detailing, where the PSRs lobby physicians to prescribe their brand drugs while bringing them gifts on the side, an August 2016 article concluded that gifts as small as

Developing a Small Theory of Treatment of Yoga

20 are associated with higher prescribing rates. A close examination reveals the intricacies of the relationships. Though PSRs ultimately want to push their drugs, more than gifts, they also bring the ready-made synthesized knowledge about the drugs, something the busy physicians, starving for time to read the literature themselves, find hard to let go. Conscientious physicians are not unaware of the marketing tactics. And yet, physicians too are humans. It is also the nature of their job that requires an innate cognitive dissonance to be functional in medical practice, a trait that sometimes works against them in case of PSR interactions. Besides, PSRs too follow the dictates of the shareholders of their companies. Therefore, if they try to influence physicians using social psychology, it is a job they are asked to do. The complexity of relationships creates conundrums that are hard to tackle. This commentary examines various dimensions of these relationships. In the end, a few suggestions are offered as a way forward.

Aligning Yoga With Its Evolving Role in Health Care: Comments on Yoga Practice, Policy, Research:

We analyzed the National Health Institute Survey Alternative Medicine supplement yoga data for 2002, 2007, and 2012 to answer the following questions: (1) Do the claims about increase in the use of yoga hold true at the level of specific health problems? (2) Do trends support a proposition that yoga is believed to be helpful in amelioration of disease conditions? (3) Do the prescribing patterns of health care providers correspond with the increasing popularity of yoga? Data were analyzed using SAS software, version 9.4. Response percentages were compared using chi-square test after adjusting for age. Between 2002 and 2012, use of yoga increased but adherence failed to increase, and use for specific health problems and for back pain declined; use of health care providers’ referral–driven yoga declined between 2007 and 2012. All results were statistically significant. Our results suggest that the use of medicalized yoga declined between 2002 and 2012.

Disparities in the Use of Yoga: An Opportunity for Yoga Tourism Industryto Make a Triple Impact

Yoga is presently considered as a complementary and alternative medicine modality [1]. However, there is an emerging trend to medicalize it and use it as a part of integrative medicine [2,3]. This in turn is leading to recognition of yoga as a therapy rather than a mere spiritual or health promotional activity [4]. Naturally, discussions regarding licensure, regulation, and third party payment for its services have ensued [5]. The decisions regarding the best policies and practices related to these issues, which must be driven by evidence, require the support of a solid foundation of evaluation research. Yoga has been researched for almost a century now and a huge body of literature is available that has examined and elucidated its various facets from different perspectives [6]. As a part of that process, yoga’s mechanism of action has also been extensively investigated and many different explanatory models are being offered [7]. However despite all efforts in research, it is still not exactly known how yoga works [8]. There appears to be a missing link at the very core. This gap is subtly undermining the utility of yoga by precipitating problems at many levels related to its practical implementation. Knowledge about yoga’s mechanism of action has been uncovered primarily by empirical research, which in turn has been usually guided by theory, albeit sometimes the theory is tacit. This also implies that mechanism of action is not the same thing as theory.