Tuesday, May 31, 2022

Coronavirus positive-test rate in Ky. went up again, but more slowly, as cases, deaths and hospitalizations dropped last week

State Department for Public Health map, adapted by Kentucky Health News; to enlarge, click on it.
By Melissa Patrick
Kentucky Health News

Three key metrics of the coronavirus in Kentucky dropped last week, including new cases, deaths and hospitalizations. However, the share of Kentuckians testing positive for the virus rose to 11.2 percent from 10.5 percent. 

The state's weekly report shows the share of Kentuckians testing positive for the virus in the reporting week has gone up eight straight weeks, from a low of 1.97%. The figures do not include results from home tests. 

The report, for the last Monday-to-Sunday reporting period, showed 7,140 new cases of the virus, an average of 1,020 per day. That's a 12% drop from the 1,161 daily rate the week before.

The state reported a case-incidence rate of 21.68 cases per 100,000 residents in the week ended May 30, down from 23.84 per 100,000 people the previous week. Twenty-eight Kentucky counties had higher rates; the top 10 were Clark, 36.6; Jefferson, 35.3; Woodford, 34.2; McCracken, 33.8; Fayette 33.8; Anderson, 30.8; Scott, 29.8; Harrison, 28; Boyd, 27.5; and Perry, 26.1.

The New York Times reported a much lower rate of 8 cases per 100,000, giving Kentucky the lowest infection rate among the states, with a 66% drop in cases in the last 14 days. The Times map says the state's highest rate, 123 per 100,000, is in Henry County and it reported 20 cases per day in the last week.

The state attributed 37 more deaths to Covid-19 last week, an average of 5.29 deaths per day. That's the lowest daily rate for a week since Aug 8, 2021. The state's pandemic death toll is now 15,945. 

Kentucky's Covid-19 hospitalization numbers remain low. Hospitals reported 234 Covid-19 patients Monday, down 30 from 264 a week earlier, with 29 in intensive care and nine on mechanical ventilation. 

The report shows 73.67% of the state's intensive-care beds occupied, with the Northern Kentucky region using 97% of its ICU beds, down from 100% last week. Of the ICU patients, only 3.1% have Covid-19, but that is up from the 1.4% reported last week. 

Covid-19 vaccinations and boosters continue to protect against the virus, hospitalizations and death. State data compiled from March 1, 2021 through May 26, 2022 shows that 72.5% of cases; 81.3% of Covid-19 hospitalizations and 74.7% of Covid-19 deaths are among Kentuckians who are either partially vaccinated or unvaccinated. 

So far, 57% of Kentucky's total population and 61% of the eligible population, 5 and older, are fully vaccinated and 45% of those who are fully vaccinated have been boosted. 

The Washington Post reports that an average of 3,581 doses of vaccine per day were administered in Kentucky in the last week, a 16% increase over the previous week before.

Sunday, May 29, 2022

Many rural areas still short of doctors; UK's health VP says recent federal funding hike for med-school resident slots was inadequate

Photo from The Lane Report
Just like the rest of the nation, Kentucky needs more doctors, and people and institutions in the state are working on several initiatives to address the challenge. 

The U.S. faces a projected shortage of between 37,800 and 124,000 physicians by 2034, including upwards of 48,000 primary-care physicians and upwards of 77,100 specialists, according to The Complexities of Physician Supply and Demand: Projections From 2019 to 2034, a report released by the Association of American Medical Colleges.

The report cites several reasons: demand for services increases as the population ages and grows larger; many physicians are nearing retirement age; and the demands of the pandemic will accelerate retirements.

The pandemic has also raised awareness of the disparities in health care, emphasizing the need for more access to care, meaning we need more doctors.

For The Lane Report, a Lexington-based business magazine, Jeff McDanald reported how Kentucky's medical schools are stepping up to meet the challenge. 

Kentucky ranks 40th among the states in primary-care physicians per 100,000 people, with only 2,696 practicing statewide, McDanald reports.

“There is certainly a maldistribution of primary care providers, with four of our counties (Ballard, Metcalfe, Owsley and Robertson) having no primary care physician and eight others (Bath, Carlisle, Edmonson, Hancock, Hickman, Nicholas, Spencer and Webster) having only one,” Dr. John Lee Roberts, vice dean for graduate and continuing medical education at the University of Louisville School of Medicine, told McDanald. “And 75 of our 120 counties are classified as primary-care health-profession shortage areas.”

One way U of L has worked to improve these numbers is offering scholarships to help offset medical-school debt.

“The average student-loan indebtedness of a graduating medical student is now well over $200,000,” Roberts told McDanald. “A partnership with the Greater Louisville Medical Society has been generating five or six scholarships per year for University of Louisville students.”

U of L and the University of Kentucky have also secured more Medicaid support for graduate medical education in the state, which has led to more resident and fellow positions in the past few years, which is key to alleviating the doctor shortages, McDanald reports.

However, Dr. Mark Newman, executive vice president of health affairs at UK, told Kentucky Health News that while the Centers for Medicare and Medicaid Services has increased funding for residency slots, it is not enough. 

"UK welcomes this important funding; however, we estimate that it will likely result in just five additional slots for UK over five years," Newman said in an e-mail. "We will continue to work with our national associations on the need for additional funding for graduate medical education." 

McDanald reports that the state’s three medical schools combined graduate about 500 students each year, but there are only about 400 entry-level residency positions in the state.

“Kentucky is a net exporter of doctors,” Roberts said. “We need more entry-level residency positions in Kentucky, and that starts with funding. . . . This is important because we have good data that shows 45 percent of the students who go to medical school in-state will ultimately practice in the state. Similarly, 45% of the residents and fellows who do their residency and fellowship in the state will ultimately practice in the state. But if you have Kentucky medical students who stay in Kentucky for residency and fellowship training, the numbers increase significantly to 74% of them who will end up practicing in the state.”

Role of economic development

Dr. Brent Wright of Glasgow, who has spent his career at a rural family medicine training program, told McDanald that while it is medical schools' responsibility to train residents, it is the responsibility of hospitals and communities to recruit them. Wright is associate dean for rural health and as an associate professor of family and geriatric medicine at U of L.

“Some communities do an extremely good job of referring physicians and are well aligned to their local government, but I think some places struggle,” Wright told McDanald. “When you recruit a physician you recruit the spouse, who may also want to work in the community. And if they have children, they’re looking for a good school system.”

“The ultimate placement of a physician in a community is really a team sport,” Wright said. “Communities need good infrastructure. This gets back to economic development, and if you have areas that start to become depressed, it’s really hard to reverse that.”

Geographic challenges

Dr. Charles H. Griffith, acting dean of the UK medical school, talked to McDanald about the need for physicians in rural parts of the state, especially when it comes to mental-health care. 

"Kentucky is one of the worst states for under-served areas," Griffith told McDanald. "In some areas like Lexington and Louisville we probably do have sufficient doctors, but in our rural areas—which is a lot of the state—there is a dire need. We need primary-care doctors everywhere, but to be honest, there is a need for some of the general specialists out in rural areas.”

Griffith added that there is a great need for more psychiatrists in Kentucky.

“It’s especially evident with the mental-health crisis that’s been exacerbated by the pandemic,” he said. “There are just not enough psychiatrists to meet the mental health needs of children and adults, too.”

Griffith also noted that other health care providers, like nurse practitioners and physician assistants, are meeting some of the need to provide health care in Kentucky, noting that they "can do quite a bit." 

Home-grown rural doctors

Another approach to get more physicians to practice in rural areas is to recruit rural medical students and provide rural residency programs, which is what the UK's Rural Physician Leadership Program aims to do. 

“The program is based on the idea that it’s sometimes difficult to transplant someone into an underserved or rural area who is not familiar with the community,” Dr. Rebecca M. Todd, who heads the program in Morehead, told McDanald. “So instead, we go with the opposite approach of recruiting young men and women right out of these communities to go to medical school. Therefore, they are in tune with that patient population, they love the community, and they want to live and work there. It’s been a phenomenally successful program." 

So much so that UK has now opened two larger regional campuses in Bowling Green and Northern Kentucky, McDanald reports. 

The University of Pikeville's Kentucky School of Osteopathic Medicine has also helped to supply primary-care physicians to rural areas. 

“Pike County used to be a medically underserved area and is no longer such because of the number of physicians who have come back to the area or have been attracted to the area partly due to the medical school being here,” Dr. Joe Kingery, dean of the osteopathic school, told McDanald. 

Kingery told McDanald that  83% of UPike osteopathic graduates practice in primary care and stay in Kentucky, which exceeds the percentages for UK and U of L medical-school graduates.

“We have 57% of our graduates who are practicing in a rural area in Kentucky,” Kingery said. “It speaks to our story that we’re placing primary care physicians into underserved areas and the Appalachian region.” Kingery said. “That being said, our graduates can go into any specialty they want. We have orthopedic surgeons, neurologists, neurosurgeons, you name it. In a given year, we usually graduate about 125 to 130, with 65% to 70% of our graduates going into a primary care residency program. And for us, primary care is defined by only three specialties: family medicine, internal medicine and pediatrics.

In January, Campbellsville University welcomed the first class of students to its School of Chiropractic, the first in Kentucky and the only one within a 300-mile radius. It's in Harrodsburg.

“We’re responding to the doctor shortage by graduating doctors of chiropractic trained much like any physician as a port-of-entry care provider," Dr. Trevor Foshang, dean of chiropractic education, told McDanald.

Feds say they are investigating whether state hospitalizes too many Louisville metro-area residents who have mental illness

By Melissa Patrick
Kentucky Health News

The U.S. Department of Justice says it is investigating whether adults with severe mental illness in the Louisville metropolitan area are being subjected to excessive institutionalization in psychiatric hospitals.  

“When people do not receive the community-based mental health services they need, they often get caught in a cycle of psychiatric hospital stays,” Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division said in a May 24 news release. “This investigation also seeks to ensure that people with serious mental illness are not unnecessarily brought into contact with law enforcement.”

The department said it was acting under the Americans with Disabilities Act. The release said, "The investigation will examine whether Kentucky unnecessarily segregates people with serious mental illness in psychiatric hospitals and places them at risk of law enforcement encounters by failing to provide integrated community-based mental health services needed to avoid these results."

Gov. Andy Beshear said when asked about the probe two days later that he was "perplexed" by the announcement of it, saying his administration was notified about an hour in advance and the Justice Department had not gathered any data or information on this issue prior to issuing the release.

"I certainly wish, if they were going to claim they're announcing an investigation, they would have come to us and gotten facts to see whether putting out a release like that was appropriate or not," Beshear said, adding that his administration would cooperate with the investigation. 

"I hope we'll learn more and when we do we'll be completely transparent about it," he said. "If this is something that helps us do better, we want to do better. But this is something that requires both sides to be communicating. We look forward to communicating with them."

Individuals with relevant information are encouraged to contact the department via email at Community.Kentucky@usdoj.gov or through the Civil Rights Division’s Civil Rights Portal, available at https://civilrights.justice.gov/.

Saturday, May 28, 2022

FDA chief says baby formula supply is expected to remain short through late July; meanwhile, shortage gets worse in Kentucky

Photo from The Associated Press
By Melissa Patrick
Kentucky Health News

The baby formula shortage continues to worsen in Kentucky, with the state's out-of-stock rate increasing by 20 percentage points since May 8, according to the retail data firm Datasembly

Datasembly reports that in the week starting May 15,  the latest data available, Kentucky's out-of-stock rate for baby formula increased to 75%, up from 55% the prior week. That placed Kentucky 26th among the states, with out-of-stock rates ranging from a high of nearly 89% in Utah to a low of 45% in Illinois. The nationwide out-of-stock rate is 70%. 

Gov. Andy Beshear said at his May 26 news conference that he could not confirm the data, but said, "Certainly there is a nationwide shortage, which is real concerning." 

Kelly Potts, a spokeswoman for Datasembly, said in an e-mail that their data comes from more than 230 retailers with over 130,000 stores across the U.S., Canada and Mexico, and the out-of-stock (OOS) index only includes U.S. stores. 

"Datasembly’s proprietary data collection platform collects OOS information for each designated product based on OOS indicators . . . We collect the in-stock and out-of-stock information at the product level for each of the stores," Potts said. "For example, if a retailer offers 10 unique formula products on the shelf and the indicators point to 5 of the 10 products being out of stock, this would generate a 50% out-of-stock status." 

Beshear encouraged Kentuckians who are part of the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, to reach out to their WIC provider, which is usually the local health department, if they are struggling to get enough formula. He said those who are not part of the WIC program should reach out to their pediatrician.

WIC is available to Kentucky residents who are pregnant, breastfeeding or have a child 5 or younger and have household income of no more than 185% of the federal poverty level, with rules governing what counts as income. Anyone who receives Medicaid or is part of the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) automatically meets the income requirements for WIC. Click here for a WIC PreScreening Tool to see if you are eligible for WIC benefits. 

According to the state Department for Public Health, Kentucky has about 19,500 infants on WIC who are fully formula-fed in any given month. 

The health department said it connects WIC participants with about 350,000 containers of formula per month, accounting for about $2.2 million in WIC benefits per month, just over a third of the total benefits. 

The department said redemption of formula since the February recall by major manufacturer Abbott Laboratories has declined by about one-third, from an average utilization rate of about 82% six months before the recall to about 69% in the first quarter of the year.

The agency said it took several actions in response to the recall. 

"The Kentucky WIC Program quickly requested and began to execute all waivers available to the states as soon as the U.S. Department of Agriculture provided for them," Susan Dunlap, spokeswoman for the department, said in an e-mail. "However, that has only been a small part of their response." 

Louisville's WFPL reports that Kentucky made its first policy change to expand the types of formula covered by WIC in February, and has since updated this policy several times to add more types of formula to the list. Click here to see the list of approved formulas available to WIC participants. 

Dunlap said the state has worked to keep local health departments updated as the situation has unfolded; is pushing important updates to WIC families via the WIC Shopper smartphone app; and are in "constant contact" with Abbott about reports of regional supply deficiencies. 

In a story about the baby formula shortage that opened with the state's May 8 out-of-stock rate, Norge Garcia told the Louisville Courier Journal about his struggles to find the specific formula for 4-month-old, who was born premature and can only have one type of formula, Nutramigen, because of his weight.
"I walked the day before yesterday more than six hours looking for milk, and of the 10 cans that WIC gives us . . . we only got one," Garcia told the newspaper in Spanish.

"I went to seven Walmarts — all the Walmarts that are here in Louisville, I went to all of them," he said. "I went to Target and none of them have any. There is only milk for babies 9 months and older."

Abbott and the U.S. Food and Drug Administration recently agreed how to reopen the Michigan plant where formula is made, but it will take several weeks to affect supplies. Beshear said Thursday, "We believe that we're going to see a significant boost in the coming weeks, but we've got to get to that point." 

The baby formula shortage in the U.S. will likely not be resolved until late July, FDA Administrator Robert Califf said Thursday at a Senate Health Committee hearing, The Hill reports.

"My expectation is that within two months we should be beyond normal, and with a plethora,” Califf said. “It’s going to be gradual improvement up to probably somewhere around two months until the shelves are replete again.”

Reducing screen time can help children be more physically active

Illustration by Becky Wright, Happiful
Reducing screen time seems to encourage children to be more physically active, but it's unclear whether it can help them get better sleep.

A study by researchers at the University of Southern Denmark involved 89 families from 10 municipalities in the region. The researchers assigned each family to one of two groups: 45 families (including 86 children and 82 adults) were assigned to the intervention group and told to limit the amount of time they spent using electronic devices, and 44 families (95 children and 82 adults) were assigned to a control group and told to continue using electronic devices as usual. In the intervention group, some of the adults could not give up their smartphones because of work, but in each family, at least one adult was able to relinquish their smartphone and replace it with a non-smartphone. The participants in the intervention group were allowed up to 30 minutes of necessary screen time a day for activities such as coordinating appointments.

The intervention lasted two weeks. The researchers determined that was long enough for the participants to adapt to a life with less screen time while still remaining compliant with the study. To be considered compliant, participants had to have no more than seven hours of screen media use during the period. Screen media use was measured with noncommercial apps and a television monitor developed in-house and installed by a research team member. The study is published in JAMA Network.

After the two weeks, the researchers noticed a significant difference in rates of physical activity between two groups. Children in the intervention group averaged 45 more minutes of moderate to vigorous physical activity, while children in the control group averaged just 1 minute more. There was also a far greater difference in how much time children in the intervention group engaged in leisure, non-sedentary activities than in children in the control group.

No significant difference was found in adults between the groups. Nor was there a significant difference in any of the children's or adults' sleeping habits, including total sleep duration, sleep onset latency, wake after sleep onset in children and adults, or the duration of stage of sleep lasts in children or adults. The researchers noted how the results for sleep parameters in children are not consistent with evidence from a systematic review of trials targeting screen media use (often in combination with co-interventions). 

The researchers said the large effect on physical activity suggests that the high levels of recreational screen media use seen in many children should be a public health concern and emphasizes the importance of developing and implementing measures to balance recreational screen media use to prevent physical inactivity in children.

Friday, May 27, 2022

Kentucky extends post-birth Medicaid coverage to one year

CDC photo
By Melissa Patrick

Kentucky Health News

The Centers for Medicare and Medicaid Services has approved a plan to expand Medicaid coverage for postpartum care in Kentucky from the current 60 days to 12 months, which will allow an estimated 10,000 mothers to maintain their health coverage for one year after giving birth.

“Currently, more than half of Kentucky’s children are covered in Medicaid or KCHIP, and each year we cover half of all births in the state," Cabinet for Health and Family Services Secretary Eric Friedlander said in a news release.

This change is important to address the health-care needs of postpartum women in the year after giving birth. A federal report that looked at the implications of extending postpartum coverage found that one in three pregnancy-related deaths occur between one week and one year after childbirth. It adds that the postpartum period is critical for recovering from childbirth, addressing complications of delivery, ensuring mental health, managing infant care and transitioning from obstetric to primary care.

The change was made possible by a provision in the American Rescue Plan Act and the 2022 General Assembly's passage of Senate Bill 178, directing the state to extend postpartum Medicaid coverage to 12 months. A spokeswoman from the Cabinet for Health and Family Services told Kentucky Health News that the coverage will be retroactive to April 1, 2022. 

Speaking about the bill in the House, Rep. Kim Moser, R-Taylor Mill, said, "Kentucky has rates of maternal death that rival third world countries. We have 37.7 maternal deaths per 100,000 live births, which is the highest in the nation."

The state Department for Public Health's 2020 Maternal Mortality Review report, with data from 2013-18, shows that 76 mothers in Kentucky died from complications related to pregnancy and birth in 2018. The report also shows that in 2018. Black mothers in Kentucky had a death rate of 42.1 per 100,000 live births compared to 17.2 for white mothers. The state estimated in 2017, 78% of maternal deaths were preventable. 

Kentucky joined California, Florida and Oregon in obtaining the latest rounds of approval for 12-month postpartum care. States that previously received approval were Illinois, Louisiana, Michigan, New Jersey, South Carolina, Tennessee and Virginia.

“This coverage will allow them to access medical services to make sure their health-care needs, as well as the health care needs of their babies, continue to be met," Kentucky Medicaid Commissioner Lisa Lee said in the release.

Thursday, May 26, 2022

Covid-19 risk levels are high in four Ky. counties, medium in 21; state discounts case and transmission rates, high in many places

Centers for Disease Control and Prevention has 25 Kentucky counties with elevated Covid-19 risk. 
By Melissa Patrick
Kentucky Health News

Four Kentucky counties are red on the latest Centers for Disease Control and Prevention's national Covid-19 risk map, indicating a high level of coronavirus transmission. Twenty-one Kentucky counties are yellow, indicating a medium level of transmission.

The red counties are McCracken in Western Kentucky and Greenup, Boyd and Lawrence in the northeast. McCracken was the only red county on last week's map; officials there questioned the status.

Gov. Andy Beshear referred to last week's map at a news conference a few hours before release of the new one. "We should be a little bit concerned" with having counties in red on the CDC's risk map, he said, because it is based on hospital admissions and capacity as well as new coronavirus cases. 

In red counties, state guidelines call for wearing masks in indoor public spaces, limiting in-person gatherings, limiting the size of gatherings, and social distancing. Beshear said of the mask recommendation, "It is a wise decision to make." 

The 21 yellow counties are Ballard, Carlisle, Hickman, Graves, Livingston, Marshall, Crittenden, Lyon, Hardin, Jefferson, Anderson, Woodford, Fayette, Scott, Menifee, Morgan, Rowan, Elliott, Carter, Martin, and Pike. Last week there were 33 yellow counties in Kentucky.  

The CDC says people in yellow counties who are immunocompromised, or at high risk for severe illness from the virus, should talk to a health-care provider about whether they need to wear a mask or take other precautions.

The cluster of yellow and red counties in Eastern Kentucky border a large cluster of red and yellow counties in West Virginia. Some Southern Illinois counties are near the West Kentucky cluster.

CDC case-incidence map shows high virus transmission in many counties.

In a recent newsletter for The Washington Post, Philip Bump said it's important to look at both the CDC's weekly risk map and the community transmission map, because hospitalizations follow infections. He says the risk map, when viewed alone, presents "a much more sanguine picture of the state of the pandemic than is really the case."

The latest CDC community transmission map, based on new cases, shows a high transmission level in many Kentucky counties and those in border states.

Last week, state Public Health Commissioner Steven Stack encouraged Kentuckians to use the CDC risk map to determine the level of coronavirus risk in their communities, saying that the transmission or incidence-rate map, which reflects new cases per 100,000 people in each county, is largely used by researchers, the news media and others who are tracking the disease. "This is not the decision-making map anymore," he said.

Asked about this difference of opinion, Susan Dunlap, spokeswoman for the Cabinet for Health and Family Services, expounded on several points Stack made at that same press conference to support using the CDC map for community transmission guidance. She wrote: 

  • Both the reported incidence of Covid-19 and percent positivity have continued to increase at a slow and steady rate from very low levels in mid-April. However, although we are seeing more spread of Covid-19 in the community, this is not yet corresponding to large increases in severe disease.
  • Hospitalization trends remain both low and stable. We continue to regularly monitor hospital census data for Covid-19 patients, ICU admissions, and ventilator usage. We also monitor syndromic surveillance reports from hospital encounters and emergency department visits. All consistently show that the hospital burden of Covid-19 remains well below levels of concern.
  • Although many counties are now at “moderate” (yellow), “substantial” (orange), and even “high” (red) levels on the incidence rate map, most of these jurisdictions remain “low” (green) on the [CDC's] Covid-19 Community Levels map. The Covid-19 Community Levels [map] combine incidence with hospital admissions data to estimate the overall burden of Covid-19 in the community. These specific metrics were selected for this tool because they most accurately predicted future hospital burden of Covid-19. 
"We continue to recommend that Kentuckians use this Covid-19 Community Levels tool to stay informed on the Covid-19 impact in their communities and follow the corresponding guidance based on their local level of community burden," Dunlap said.

This week's increase in red counties comes after a week when coronavirus cases continued to escalate in Kentucky, although at a slightly slower rate than the week before. Also, the share of Kentuckians testing positive for the virus jumped to 10.52%, up from 9.35% the week before. Hospitalizations remained low, and deaths, a lagging indicator, went down. 

"We should be watching it," Beshear said. "We don't believe that currently what we're seeing is cause for concern, but we should certainly be paying attention."

Beshear said fewer people are being hospitalized with the virus because so many Kentuckians have been vaccinated, boosted or acquired natural immunity from being infected. 

He said vaccinations have increased some recently. The Post reports that Kentucky gave 3,704 doses of Covid-19 vaccine per day in the last week, an 8% increase over the week before. 

State table, adapted by Kentucky Health News
Noting that 66% of Kentuckians have received at least one dose of vaccine, he said, "This is the first day we can report to you that two-thirds of all Kentuckians have had at least one shot."

The state says 2.9 million Kentuckians have received at least one Covid-19 vaccination, or 66% of the total population; 77% of those 18 and older have received at least one shot; and 70% of those five and older have.

Other good news, Beshear said, is that the share of  Kentuckians 75 and older who have received at least one shot went up a percentage point, to 94%. This age group is the most vulnerable to the virus. 

"Remember, if you're over 50, you're eligible for that second booster," the governor said. "Please go get it."

Generics are usually cheaper, but can also cost more than brand names, due to rebate deals between insurers and drug makers

By Wendell Potter

I’m not in the habit of wishing bad things to happen to anybody, but last week, when I was at the pharmacy counter, I was wishing every member of Congress would have to experience the same insanity I was experiencing. If they did, they just might do something to fix the growing crisis they helped create when they passed the so-called “Medicare Modernization Act” (MMA) in 2003.

Wendell Potter
Some background: A few days prior, I had a follow-up visit with my pulmonologist. My primary-care doctor had referred me to her some time ago when I developed a cough and laryngitis that would not go away. She prescribed a Symbicort inhaler, which despite the fact that I pay good money every month for a Medicare Part D drug plan, requires me to pay $606 out of my own pocket for a three-month supply.

During my follow-up visit, I asked her if there was a generic inhaler that would be cheaper. It turns out that there is: fluticasone propionate-salmeteroL. It isn’t a generic version of Symbicort but of a similar inhaler called Wixela Inhub. She wrote me a scrip for the generic version of the inhaler and I took it to my local Rite Aid last night.

We’ve been led to believe that generics cost us less than brand-name drugs. While it is true that the list price of generics is typically cheaper, often much cheaper, than brand-name drugs, in the illogical world of U.S. health care, you can wind up paying more out of pocket for a generic than a brand-name drug, as I found out.

You also need to know that Medicare drug plans often don’t provide any coverage for cheaper generics, thanks to secretive rebate deals, allowed if not enabled by the MMA, that insurance companies and their pharmacy benefit managers cut with drug makers. Major parts of the MMA were written by lobbyists for insurance and drug companies to ensure big profits, and those lobbyists worked overtime when the bill was being voted on to get the bill passed as they wrote it. I know this because I was at Cigna when Congress passed that bill in the middle of the night after many hours of arm-twisting by said lobbyists. One of my jobs back then was to provide Cigna’s government affairs team with talking points.

Turns out that my drug plan (marketed by WellCare, whose tagline is, “Beyond Healthcare. A Better You”) provides no coverage whatsoever for the generic inhaler my pulmonologist prescribed.

After hearing from many other folks that Medicare Part D drug plans often provide skimpy coverage for drugs they needed, I enrolled in GoodRx, which provides significant discounts for many medications. GoodRx compares drug prices and tracks down coupons that can yield significant savings. What I have come to realize is that my out-of-pocket obligation is often considerably less if I use GoodRx instead of my WellCare plan. When I was told I would have to pay the full retail price of the generic inhaler under my WellCare plan, I asked the pharmacist what the GoodRx cost would be. She told me a one-month supply of the generic would cost $102.17. I could save $20.01 per unit if I paid $286.50 for a three-month supply.
The Wixela Inhub inhaler

Just as I was about to go with the GoodRx deal, it occurred to the pharmacist to see if my plan would cover the brand-name version of the same medication. Lo and behold, WellCare does indeed cover Wixela, just not the generic. That’s undoubtedly because of the deal WellCare struck with Mylan Pharmaceutical, which makes Wixela. If I went with Wixela, I would have to pay $47 out-of-pocket for a one-month supply (but no discount for a three-month supply), which is $55.17 per unit cheaper than the GoodRx generic price.

This all took some time, as you can imagine. Meanwhile, the line behind me grew longer and longer. I cannot imagine what it is like to be a pharmacist these days.

I’m fortunate that I can afford to pay $141 for a three-month supply of Wixela, and even, albeit reluctantly, $606 for three months worth of Symbicort. Many Americans are not so fortunate. In fact, millions of us with insurance–both public, like Medicare, and private, including employer-sponsored coverage–walk away from the pharmacy counter without our often life-saving drugs because of what our insurance plans make us pay out of pocket.

Many people of course don’t have a clue that they might be able to get their medications at a lower price without using their insurance card, either through outfits like GoodRx or by using manufacturers’ coupons.

And many of us, especially those of us dealing with cancer, multiple sclerosis or other life-threatening chronic conditions, often have to spend thousands of dollars out of our own pockets before our coverage kicks in for even the drugs our insurance plans will cover. This is why so many of us with insurance get buried under mountains of debt and feel we have no alternative other than to beg for money on GoFundMe or file for bankruptcy.

Back to that so-called Medicare Modernization Act of 2003. Not only did it make the Part D drug benefit nearly impossible to figure out because of the ever-changing list of medications insurance plans will or will not cover, but it also prohibited Medicare from negotiating with drug companies for lower prices as the Veterans Administration program can do.

In Nation on the Take, the book I co-authored with Nick Penniman of Issue One, I cited the MMA as an example of how well-funded special interests are almost always able to call the shots in Washington. Here’s a paragraph from the book that provides a hint of how that industry-backed bill got across the finish line: "When asked why he thought House leaders had scheduled the vote long after most Americans had gone to bed, Rep. Dan Burton (R-Ind.), who voted against the bill, said: 'A lot of shenanigans were going on that night [that] they didn’t want on national television.' Among the shenanigans, reportedly sanctioned by House leaders: freezing C-SPAN cameras and allowing lobbyists on the House floor as the vote was being taken."

Those shenanigans have led to the financial ruin and premature death of countless Americans. But year after year, Congress has looked the other way. To change that, more than 50 organizations and businesses have come together in a coalition to demand that lawmakers take action to address what has become not only a national disgrace but a growing crisis.

The good news is that just after a few months, the Lower Out of Pockets NOW coalition is being noticed by members of Congress on both sides of the political aisle. We are determined to hold our lawmakers accountable. Some members are even talking about forming a caucus within Congress to explore solutions. You can be sure I will keep you posted at Tarbell.org.

Campaign for healthy youth behavior cites exercise, nutrition, vaccination, managing stress, monitoring chronic conditions

Centers for Disease Control and Prevention photo
By Melissa Patrick
Kentucky Health News

The Foundation for a Healthy Kentucky and the Kentucky Department of Education have launched a public-service campaign to encourage Kentucky's children and their families to use the summer months to build healthy habits for the next school year and beyond. 

"We want to encourage Kentucky students to create and engage in healthy behaviors because research shows that healthy students are better learners. They often get better grades, they attend school more and stay focused longer in the classroom," Ben Chandler, president and CEO of the foundation said at a news conference to launch the campaign. 

The effort is part of a multi-faceted education and awareness "High Five for Health" campaign that includes animated videos, social media graphics, message points and materials to be distributed at sporting events, youth organizations and various other locations. All campaign materials are available for free download at HighFiveForHealth.org.

Chandler said the campaign is designed to help parents find no-cost or low-cost activities that the whole family can do together, and activities that older children may do independently.

The campaign focuses on five key areas to promote health, including prioritizing physical activity; practicing healthy eating; monitoring chronic conditions such as asthma, obesity and diabetes; staying up to date on vaccinations; and managing stress and emotions. 

The campaign website offers tips on each of these focus areas, including ways to prioritize physical activity and how to know if children are meeting the level of aerobic activity needed to make a difference. It also offers some healthy recipes and recommendations for how many fruits and vegetables a child should eat each day. In addition, it offers suggestions for how to help your child learn how to manage stress. 

When it comes to physical activity, the Physical Activity Guidelines for Americans recommends that children and adolescents get one-hour or more of moderate-to-vigorous physical activity daily.

Many of Kentucky's youth are sedentary. The latest Youth Risk Behavior Survey taken in 2019 found that 19 percent of Kentucky's high school students said they did not participate in at least 60 minutes of physical activity on at least one day in the week before they took the survey and 81% of them said they were not physically active at least 60 minutes per day on all seven days. 

Jim Tackett, the education department's healthy-school project director, encouraged Kentucky parents and youth to have fun as they incorporate some of these new healthy behaviors into their lives, but to also be intentional about it. He also encouraged parents and youth to be open to trying new things and to celebrate small successes. 

"Good health just doesn't happen by itself," Tackett said, adding later, "Each of our behaviors takes a little time to mold or to break. So over the summer months, we're hoping that the High Five for Health campaign will help us establish some new behaviors that we can carry with us down the road." 

Asked about the relationship between high screen time and low physical activity, Tackett recognized that this is an issue, but said this particular campaign largely addresses components suggested by the Centers for Disease Control and Prevention, which funded a large portion of it. 

He said reducing screen time would not only lead to increased physical activity, but also impact the mental health piece of this campaign.

"We would definitely support trying to take a break from those electronic devices," he said. "While they are necessary in the learning process today, we would like to strike that balance if at all possible. . . . I think there is a happy medium that we need to continually talk about." 

A recent University of Southern Denmark study, published in JAMA Pediatrics, found that children in the group that had their smartphones and tablets removed for two weeks and reduced their recreational screen media use to less than three hours per week had an average of 45 minutes more daily physical activity compared to children in the control group, which did not change their usual screen habits. 

"The difference between the groups were largest on weekend days where children in the screen reduction group had an average of 73 min more physical activity compared to children in the control group," lead author Jesper Pedersen said in the news release. 

In addition to making sure your child is up to date with their recommended schedule of vaccines, the campaign also encourages parents get their children who are five an older vaccinated against the coronavirus. To support this effort, the sponsors are offering a Covid-19 vaccine clinic in Lexington. 

In partnership with the state Cabinet for Health and Family Services and other health organizations, Chandler said the foundation and the education department will host Covid-19 vaccine clinics for youth five and older on June 3-4 and June 10-11 in Lexington, weekends when the Kentucky High School Athletics Association hosts the state boys and girls track, baseball and softball tournaments. They vaccines will be available in the green lot at Kroger Field. 

About 80% of the campaign is funded by the CDC and the U.S. Department of Health and Human Services.

Wednesday, May 25, 2022

Study says one in five adult Covid-19 survivors in the U.S. may develop 'long Covid;' for those over 65, it's one in four

Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report illustration

By Melissa Patrick
Kentucky Health News

One in five adult Americans who have recovered from a Covid-19 infection have experienced a health condition that may be related to a previous infection, and that makes prevention efforts and post-Covid assessments critical, says a Centers for Disease Control and Prevention study.

Among people 65 and older, one in four were found to have a post-Covid condition. The study analyzed a database of electronic health records of nearly 2 million U.S. adults between March 2020 and November 2021, comparing those who had been infected with the coronavirus and those who were not. Of those, more than 350,000 had tested positive for the virus.

The researchers assessed the occurrence of 26 clinical conditions previously attributed to post-Covid illness.  They identified a number of post-Covid health problems involving the heart, lungs, kidneys, and vascular, musculoskeletal and neurological systems. People who develop these ongoing conditions after having Covid-19 are often said to have "long Covid," which has not been precisely defined. 

Age groups aside, the study found that the most common health conditions were respiratory symptoms and musculoskeletal pain. Post-Covid patients were also twice as likely as those who had not had the virus to suffer from acute pulmonary embolism and respiratory symptoms.

In addition, the study found that post-Covid patients 65 and older were at greater risk than the younger group of developing neurological conditions and most mental-health conditions.

The study concludes that these findings are consistent with several large studies that indicating “that post-Covid incident conditions occur in 20 to 30 percent of patients.” Also, post-Covid conditions “can affect a patient’s ability to contribute to the work force and might have economic consequences for survivors and their dependents,” and “care requirements might place a strain on health services” in “communities that experience heavy Covid-19 case surges.”

Tuesday, May 24, 2022

Dr. Douglas Scutchfield, an international leader in public health and a mentor to many in Kentucky, died Monday night

UPDATE, June 12: Scutchfield's memorial service will be at 4 p.m. June 22 at UK's Lewis Honors College. In lieu of flowers the family suggests donations to the Scutchfield Endowment Scholarship Fund at Eastern Kentucky University, the UK College of Public Health, or the UK opera program.

F. Douglas Scutchfield, M.D.
Dr. F. Douglas Scutchfield, a public-health leader for the world, the nation and his native Kentucky, died Monday night after being hospitalized for several weeks with pneumonia.

Scutchfield recently served as chair of the accreditation committee of the Public Health Accreditation Board, which accredits local and state health departments, and spurred Kentucky to be a leader in getting its departments accredited. It was one of his latest accomplishments in a life devoted to public health.

A native of Wheelwright in Floyd County and a graduate of Hazard High School and Eastern Kentucky University, Scutchfield earned his M.D. at the University of Kentucky, where he held an endowed professorship in the College of Public Health, of which he was founding director when it was the School of Public Health. He was also a professor in the Department of Family and Community Medicine and the Martin School of Public Policy and Administration, founding director of the Center for Health Services Research and Management, and associate dean of the College of Medicine, where he chaired the Department of Preventive and Environmental Medicine. He founded the Graduate School of Public Health at San Diego State University, was a founder of the College of Community Health Science at the University of Alabama and also taught at the University of California-Irvine.

Scutchfield was an editor of many academic health journals, founding co-editor of the Journal of Appalachian Health and an editor of a new book, Appalachian Health: Culture, Challenges, and Capacity. Here's a discussion of it with the other editor, Randy Wykoff of East Tennessee State University.

Julia Costich, who succeeded Scutchfield as the UK College of Public Health's Peter P. Bosomworth Professor of Health Services Research, told Kentucky Health News, "Public health is about doing things for populations, but Scutch’s gift was relating to individuals—students, colleagues, prominent leaders—as individuals. His generous nature was tempered by a deep need for reciprocation. I think this was part of what drew him to the work of Thomas Merton, who articulated the need for human contact to bridge the spiritual gulf."

Scutchfield and Paul Evans Holbrook Jr. wrote The Letters of Thomas Merton and Victor and Carolyn Hammer: Ad Majorem Dei Gloriam (the Jesuit motto, "For the greater glory of God"), published by the University Press of Kentucky in 2015. The book helped Scutchfield earn the 2017 UK Libraries Medallion for Intellectual Achievement in 2017, which he called "a coda to my academic career." In accepting it, he said his interest in Merton and the humanities reflected a part of his philosophy of being a physician: "I am a firm believer in the importance of humanity to those of us in the health professions. We do not treat a disease; we treat a person, thus we must know the humanness of the individual in front of us, as well as the diagnosis and treatment of their disease."

Two years later, he won the top award from the American Public Health Association, the Sedgwick Memorial Medal for Distinguished Service in Public Health. He was a charter diplomat of the American Board of Family Practice, a fellow of the American College of Preventive Medicine, which he served as a regent and president. He was secretary-treasurer of the Association of Schools of Public Health and a board member of the Public Health Foundation, which presented him with the Theodore R. Ervin Award. He In 2004, he received the Balderson Lifetime Achievement Award of the National Public Health Leadership Network.

Scutchfield was a member of the American Medical Association House of Delegates and served as chair of the AMA Section Council of Preventive Medicine on several occasions. He was vice chair of the AMA’s Council on Medical Education, and represented the AMA as a member of the Accreditation Council on Graduate Medical Education, the Liaison Committee on Specialty Boards, the American Board of Medical Specialties and the Committee on Allied Health Education and Accreditation. He received AMA’s Dr. William Beaumont Award as its outstanding young physician in 1985 and its Distinguished Service Award, the highest recognition of a physician, in 2003.

Scutchfield had an international reputation and was a consultant to government and non-governmental organizations in Panama, China, Saudi Arabia, Israel and Germany, as well as the U.S. But he never forgot Wheelwright, which was one of Kentucky's biggest coal towns when he was growing up, then-Libraries Dean Terry Birdwhistell said in 2017: “As a scholar, teacher, mentor, administrator and public health advocate, he has never forgotten his Floyd County roots even as he became internationally recognized and honored.”

During the pandemic, Scutchfield worried about the damage done to his profession, said Al Cross, director of UK's Institute for Rural Journalism and Community Issues and publisher of Kentucky Health News: "At our last lunch, he and I talked about writing a 'where we go from here' essay as a bookend to the one we published on March 1, 2020: Is our political system properly serving our public-health system? The answer was no, and it got worse, and it hasn’t gotten any better. May Doug Scutchfield’s life inspire us to stand up to officials of all stripes who damage the discipline of public health and thus the health of the public."

Scutchfield is survived by his wife, Phyllis; his son, Alex; and his brother, Scott. Funeral arrangements are pending.

Women, trust your gut if you suspect a stroke; here's how to judge

Stroke is the fourth-most common cause of death in women, and rural women are particularly in danger because stroke victims must get treatment quickly to improve their odds of a good outcome, and that can be harder to find in rural areas, Madelyn Ostendorf reports for Successful Farming

When women have a stroke, they're more likely than men to experience sudden confusion as an initial symptom. Here are some other common symptoms:
  • sudden loss of limb control
  • loss of vision
  • difficulty speaking
  • drooping of one side of the face
Less common but still important signs to watch for are:
  • difficulty reading
  • double vision
  • trouble balancing
  • tingling in the limbs
To assess whether someone, including oneself, is having a stroke, remember the acronym FAST:
  • F: Face drooping. Does one side of the face droop, or is it numb? Ask the person to smile. Is the person's smile uneven?
  • A: Arm weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
  • S: Speech difficulty. Is speech slurred?
  • T: Time to call 911.

May is not just Nurses Month; it's Kentucky Nurses Suicide Prevention Month, writers say; nurse suicide rates keep rising

OPINION by Julie Marfell, Paul Norrod and Lee Anne Walmsley
Nurses are the backbone of health care, supporting and protecting their patients. During the Covid-19 pandemic, nurses have soldiered through an increased workload, short staffing, fear of becoming sick or worse exposing their families to sickness and very ill patients, many of whom died with a nurse by their side and no family members. The load nurses have carried over the past two years is consistently heavy and, with no relief in sight, the backbone is feeling the strain. As nurses continue to move forward, we must find ways to lift this burden. The high price for the burden is losing nurses to suicide.

Lee Anne Walmsley, Julie Marfell and Paul Norrod 
Suicide is the 11th leading cause of death in the United States. Nurse suicide rates continue to rise with female nurses experiencing higher suicide mortality compared to other occupations. By contrast, male and female nurses are more likely to experience job problems and mental health challenges than the general population which increases the risk of suicide. In Kentucky, approximately 58 nurses have died by suicide since 2016; one is too many.

Nurses need continued support to thrive as a profession. In January, the Kentucky Board of Nursing mandated that all nurses must complete nurse suicide-prevention continuing education. The Kentucky Nurses Action Coalition, with the support of the Kentucky Nurses Association, developed an educational video and program to address suicide prevention for nurses. Visit kentucky-nurses.org for more information. This program teaches nurses how to identify signs of overwhelming stress and hopelessness in themselves and others that are risk factors for dying by suicide. It also emphasizes the importance of self-care to reduce stress and reaching out for help to carry the load and relieve some of the burden.

An increased awareness of the risk for suicide is crucial for the health of the nursing workforce. To remain strong, nurses need to support in all aspects of their work and everyday lives. This includes encouraging and providing opportunities to maintain healthy lifestyles, training in suicide prevention and removing the stigma attached to mental health illnesses. We all must develop an understanding that just like other illnesses, we can prevent mental health problems and treat them with lifestyle changes and medications.

National Nurses Month affords us the opportunity to show our appreciation for nurses and we appreciate the accolades; however, it’s important to remember to thank nurses every day, 365 days a year. If you have a friend or relative who is a nurse, check in with them, and when you ask them how they are doing. please listen. Hear what they are saying and support them. Help them get the help they need to be well. We all need to take care of nurses for without a strong backbone we cannot stand tall.

The National Suicide Prevention hotline is 1-800-273-8255. Text HOME to 741741 to speak anonymously with a crisis counselor. Kentucky Community Mental Health Centers are listed at https://dbhdid.ky.gov/crisisnos.aspx

Julie Marfell, DNP, FNP-BC, FAANP, is president of the Kentucky Nurses Action Coalition and an associate professor in the University of Kentucky College of Nursing; Paul Norrod, DrPH, M.Div., MA-C, RN, is a member of the coalition and an instructor in the College of Nursing; LeeAnne Walmsley, PhD, EdS, MSN, RN, is an assistant professor in the college.

Monday, May 23, 2022

Kentucky's coronavirus surge continued last week, but at a slower rate; vaccine for young children is being lined up for approval

Kentucky Health News graph, from state Department for Public Health data
By Melissa Patrick
Kentucky Health News

Kentucky's surge in coronavirus cases continued last week,  at a slightly slower rate than the week before. Hospitalizations from the virus remain low, and deaths, a lagging indicator, kept declining.

The state's weekly report, for the last Monday-to-Sunday reporting period, showed 8,127 new cases of the virus, an average of 1,161 cases per day. That's 26 percent more than the 920 daily cases the week before, when the state reported a 63% jump in cases. 

Of last week's new cases, 14% were in people 18 and younger. 

The share of Kentuckians testing positive for the virus in the past seven days has gone up for seven weeks in a row, when it was a low of 1.97%. This rate is now 10.52%, up from 9.35% the week before. The figures do not include results of home tests. 

The state attributed 79 more deaths to Covid-19 last week, an average of 11.3 deaths per day. The week before it was around 14 deaths per day. The state pandemic death toll is now 15,909. 

Kentucky's Covid-19 hospital numbers remain low. They reported 264 Covid-19 patients Monday, down 76 from 340 the week earlier, 23 intensive-care unit patients and six patients on mechanical ventilation.

The report shows that nearly 75% of the state's ICU beds are occupied, with the  Northern Kentucky hospital region using 100% of its ICU beds. Only 1.4% of the patients have Covid-19. 

The statewide incidence rate is 23.84 cases per 100,000 people, up from 19.64 cases per 100,000 people last week. Eighteen Kentucky counties have rates above that amount, but Jefferson County is the only one with more than double that rate, at 55.7 cases per 100,000 people. Not one county has a zero case rate. 

The New York Times ranks Kentucky's infection rate 27th among states and Washington, D.C., with a 132% increase in cases in the last 14 days. 

"The United States is currently averaging more than 100,000 known cases per day for the first time since February. Cases are rising in nearly every state, and since many cases go uncounted in official reports, the true toll is likely even higher than these figures suggest," the Times reports.

Pfizer-BioNTech has said that an early analysis shows three doses of their coronavirus vaccine was 80% effective in preventing symptomatic infections in children 5 months to 4 years old. 

“Our Covid-19 vaccine has been studied in thousands of children and adolescents, and we are pleased that our formulation for the youngest children, which we carefully selected to be one-tenth of the dose strength for adults, was well tolerated and produced a strong immune response,” Albert Bourla, chairman and CEO of Pfizer, said in a news release.

The Washington Post reports that the U.S. Food and Drug Administration has said its outside experts will meet June 14 and 15 to discuss the Moderna and Pfizer-BioNTech pediatric vaccines.

The Pfizer-BioNTech vaccine is already approved for those 5 and older, although less than one-fourth of Kentucky's younger children have received it, according to the state report that shows only 23% of Kentucky children between the ages of 5 and 11 having received at least one dose of the vaccine. 

White House officials are also warning that the US is at risk of rationing Covid supplies without additional funding. 

"The White House is planning for “dire” contingencies that could include rationing supplies of vaccines and treatments this fall if Congress doesn’t approve more money for fighting Covid-19," Zeke Miller reports for the Associated Press

Dr. Ashish Jha, the White House coronavirus coordinator, has warned that "without more money, vaccines will be harder to come by, tests will once again be scarce, and the therapeutics that are helping the country weather the current omicron-driven surge in cases without a commensurate increase in deaths could be sold overseas before Americans can access them," Miller writes.

Campaign to promote student health this summer to launch Wed.

CDC photo
The Foundation for a Healthy Kentucky and the Kentucky Department of Education is launching a statewide summer wellness campaign to promote five habits to promote student health during the summer. 

"With Memorial Day weekend upon us, marking the unofficial start of summer, this initiative encourages kids to prioritize physical activity, practice healthy eating, monitor chronic conditions, stay up to date on vaccines and manage stress and emotions," says a news release.

 The virtual  event will be held Wednesday, May 25, from 10:30 to 11 a.m. ET. 

Speakers will include Ben Chandler, president and CEO of the foundation; Jim Tackett, KDE healthy schools project director; and high-school students who will talk about their personal healthy routines.

The release says the campaign is needed because one in five children 3 to 17 have a mental, emotional, or developmental disorder and more than 80 percent of the world’s adolescent population is physically inactive.

"Healthy children are better learners and summer is a great time to form healthy habits that will help kids succeed in school," the release says.

The campaign is part of the foundation's "High Five for Health" campaign and is funded by the Department of Education.

Sunday, May 22, 2022

UK program helps pregnant women overcome opioid-use disorder

Gabi Espinosa and Ashlee Vogelsang at the Polk-Dalton Clinic
(University of Kentucky photo by Mark Cornelison)
By Dani Jaffe
University of Kentucky

For expectant mothers, the top priority is to do everything in their power to ensure their baby arrives healthy. For some women, this task is harder than it sounds. In Kentucky, 20 out of every 1,000 babies are born to a mother who is using opioids — the third-highest rate in the country.

Two women who have been through this experience are Ashlee Vogelsang and Gabi Espinosa. Both underwent treatment in UK HealthCare’s Perinatal Assistance and Treatment Home (PATHways) program, housed within UK’s Polk-Dalton Clinic. This program is designed to help pregnant people who are living with substance-use disorders.

Vogelsang lived with opioid use disorder for 13 years. The final time she got in trouble with the law for using drugs was also the moment she found out she was pregnant. She was given no other choice but to seek treatment at The Chrysalis House and enter PATHways for prenatal care — a program that helped save her life.

She was first put into PATHways for traditional treatment and was referred for additional support from its Birth and Recovery Integrating Group Holistic Treatment program. BRIGHT is a woman-centered group treatment program led by a midwife, which meets every Friday for treatment and counseling with a therapist, nursing support and peer support staff.

Her first moments in BRIGHT were filled with fear and anxiety for what was to come, but that soon faded when she realized that she did not have to go through it by herself – a whole staff, support group and midwife were there to help her.

“You don’t know what to expect. But when you come in and have a group of women who all are going through the same thing you are, that just kind of takes away all the fear,” Vogelsang recalled. “It gives you that feeling of not being alone. We’re all there. We’re all pregnant. We’re all trying to recover. You can commiserate with other people, and it just gives you that feeling that it’s going to be OK.”

Studies show that being surrounded by a support system of other expecting mothers and a midwife for woman-centered care can make a world of a difference. In fact, midwifery care has been shown to decrease intervention when in labor, improve patient satisfaction and reduce preterm labor rates.

While Vogelsang had no choice but to enter the program, when she was in recovery and found out she was pregnant again, she instantly knew that she wanted to re-enter BRIGHT, this time on her own terms.

“I came back willingly for my second pregnancy in recovery because I know how much I gained the first time,” she said. “I was excited to be there because I knew there would be girls like my friend Gabi that were new to this, and I’d be able to help them through the process because I had already been through this once.”

Today, because of her hard work, dedication and the support she received through PATHways, Vogelsang is a stay-at-home mom, homeschooling her two teenage children and caring for her two little ones, all while furthering her own education at UK.

“I wouldn’t be where I am today, almost four years sober, if it wasn’t for the PATHways group believing in me every step of the way,” she said. “I lived with these people. We all came in different parts, but we came as one person. We all were there for the same end goal. They’re like sisters now.”

And in the future, she would not hesitate to go back again, as she attributes much of her success to the women that helped her through both pregnancies.

“I just love the women at PATHways,” said Ashlee. “And I promise, when I do find myself ready to have another baby, PATHways is where you will find me.”

Gabi Espinosa and her fiancé dreamed of having a family but first wanted to seek treatment and stability. They started on the right track, found themselves in a better home and began treatment on Suboxone, one of three effective medications used to treat opioid-use disorder. But when Gabi found out they were expecting, she knew that she wanted some additional support to help her through the pregnancy. That is how she found PATHways and BRIGHT.

One of the best things about the BRIGHT program for Espinosa is the sense of security it gave her during her pregnancy.

“Going into the BRIGHT program, I was able to see certain people all the time and it stayed consistent. Having to see a whole bunch of different people and doctors can be nerve-wracking, and I don’t feel like that’s very good when you’re in recovery,” she said. “It gives you that trust and lessens your uncertainty because you’re next to women who are all going through the same thing.”

A common misconception about medication for opioid-use disorder is that it’s simply “replacing one drug for another.” OUD is a disease of the brain, not a lack of willpower, and withdrawal from opioids can cause debilitating side effects. Medications for opioid use disorder act on opioid receptors in the brain to both reduce cravings and the effects of illicitly used opioids – in other words, if a person uses opioids while on medication, the euphoria or “high” that usually comes with using the drug will be blocked. Studies show that the vast majority of people who attempt to stop using opioids “cold turkey” or stop medication treatment after a few weeks or months are very likely to relapse.

For pregnant women, having continual access to their medication is a key elements to the program’s success. To date, there have been no overdose deaths in women who are active in the program and using medication.

In the BRIGHT program, the use of a midwife to provide woman-centered care can also help with another hurdle: overcoming the stigma that pregnant women with substance use disorders face with mislabeling and misinformation about them as people, and as mothers.

“I was always worried about how people would see you being in recovery or being on Suboxone while you’re pregnant,” Espinosa said. “But I had all of them to support me, and people don’t look at you the way you think they might. You’re doing what you’re supposed to do for the sake of your child, and you’re a person just like everyone else.”

And like Vogelsang, Espinosa found the group environment BRIGHT provides to be very helpful in overcoming some of her greatest fears during pregnancy.

“I was terrified about how it would go at the hospital. But I wasn’t as terrified when I got to the program, because all the other girls were there with me and I was able to see them have their babies and everything was completely fine,” said Gabi. “That’s what helped put my mind at ease.”

Their partnership between UK, its College of Nursing, and the state Cabinet for Health and Family Services has helped provide treatment to hundreds of other mothers like Espinosa and Vogelsang.

Espinosa said she has looked up to many of the other strong mothers in her program. Seeing them have success and overcome struggles helped her through the most challenging times she faced, and now she hopes to be an inspiration to others as well.

“Now, my fiancĂ© and I are in a beautiful two-bedroom apartment with our baby girl, and we look forward to expanding our family,” she said. “It’s crazy to see how far you’ve come. I know someone is probably looking up to me and it’s hard to believe that sometimes. If I could say one thing to the other women entering the clinic, I would say never give up, and never feel like you’re alone. There are so many people here to back you up. You can do this.”

If you or someone you know is pregnant and dealing with substance use disorder, contact the Polk-Dalton Clinic at (859) 218-6165 to make an appointment for prenatal care.