Renal impairment among postmenopausal women with osteoporosis from a large health plan in Israel.

UNLABELLED: Bisphosphonates are a first-line treatment for osteoporosis but require adequate renal function. We estimated the prevalence of renal impairment among osteoporotic women in Israeli. Approximately 2.3 % of women had renal impairment at a level that makes them inappropriate for bisphosphonate use, demonstrating the need for alternative therapies for osteoporosis treatment. PURPOSE: The purpose of this study is to estimate the prevalence of renal impairment among postmenopausal osteoporotic women within a large Israeli health plan. METHODS: This was a retrospective analysis of Maccabi electronic medical records, including Israeli women aged ≥55 with either an osteoporosis diagnosis or osteoporosis-related fracture between January 1, 2007, and December 31, 2011. The estimated glomerular filtration rate (eGFR), which was calculated from the lowest serum creatinine levels reported during the study period, was used to classify stage 1-5 renal impairment: normal ≥90, mild 60-89, moderate 30-59, severe 15-29, and failure <15 mL/min/1.73 m(2), respectively. Outcomes were distributions of renal impairment across the study population and stratified by age and osteoporosis-defining event. RESULTS: A total of 15,608 patients met all eligibility criteria. Patients with stage 1-5 renal function accounted for 25.2, 54.9, 18.5, 1.2, and 0.3 %, respectively, of all patients. Of osteoporotic patients, 2.3 % had eGFR levels (<35 mL/min/1.73 m(2)) that make them inappropriate for bisphosphonate use. This rate was 1.6 % among patients with an osteoporosis diagnosis and 3.8 % among patients with osteoporosis-related fracture. Within the group of renally impaired patients, older patients were overrepresented. Of the fracture group, patients with hip fractures had a higher prevalence of renal dysfunction (9.3 %) than those having vertebral fractures (3.2 %) or other fractures (2.0 %). CONCLUSIONS: Among postmenopausal women with osteoporosis, 2.3 % had renal impairment which makes them inappropriate for bisphosphonate use in Israel.

Availability of nutrition services for Medicaid recipients in the northeastern United States: lack of uniformity and the positive effect of managed care.

OBJECTIVES: To evaluate third-party coverage of medical nutrition therapy for the Medicaid population, among whom obesity is a common health problem, and to compare coverage in managed care Medicaid programs with that in fee-for-service state Medicaid programs. METHODS: Fifty-four Medicaid organizations in 14 states were surveyed by telephone and asked about their provision of nutrition counseling to members. RESULTS: Overall, similar percentages of state Medicaid programs and Medicaid managed care organizations (MCOs) reimbursed for nutrition counseling; significantly more Medicaid MCOs reimbursed for this service for treatment of obesity alone. Analysis of Medicaid MCO responses by plan size failed to show a difference in the nutrition services offered. CONCLUSIONS AND RECOMMENDATIONS: Nutritionist consultation, an inexpensive and effective intervention for treatment of obesity, is not uniformly available to Medicaid patients. The inclusion of managed care in Medicaid has increased access to this service in the northeastern United States. We propose that all Medicaid recipients should have access to visits with a registered dietician or certified nutritionist either as part of a defined benefit structure or through a disease management program for obesity.

Determinants of successful community health system planning.

Needs assessment and other community health planning projects are being conducted in many parts of the country. Whether these projects are successful, in that they lead to implementation of recommendations, has not been systematically assessed. This study describes how local public health officials in Iowa view the planning projects that were conducted in their communities. Planning projects occurred in over half of the counties in the state. Most were led by local public health agencies. Hospitals were participants in three-fourths of the projects. Successful implementation was associated with the number of planning techniques used and the breadth of representation on the steering committee. The most common recommendations related to the expansion of prevention/promotion services and community health nursing. Public health nursing had been integrated with local hospitals in one-third of the counties, with no reductions in performance.