UK Rural and Underserved Health Research Center symposium Nov. 12; topics include opioids, vaccines, hospitals, miners' health

The Rural and Underserved Health Research Center is holding a free half-day symposium to discuss research in a wide range of topics, including: rural opioid misuse and suicide, pneumonia-vaccine disparities, the impact of rural hospital closures on emergency services, and health-care utilization among coal miners with black lung and other respiratory diseases.

The symposium will be held at the University of Kentucky Gatton Student Center, Senate Chamber A268, from 9 a.m. to 11 a.m. Nov. 12. The event is free, but registration is required before Nov. 5. Click here to register. Click here to see the full agenda.

The RUHRC is a grant-funded program that focuses its research on access to healthcare and substance abuse treatment in underserved rural areas of the United States, including Appalachia. The research is meant to better inform health policy makers "with the ultimate goal of reducing inequities in care and improving population health in rural communities," says its website.

Pharmacists play major role in getting rural seniors vaccinated for pneumonia, but shots for the disease are less likely in rural areas

WebMD photo

By Melissa Patrick
Kentucky Health News

Pharmacists play a significant role in getting rural people vaccinated for pneumonia, and presumably other diseases, more so than in urban areas, according to a study by the Rural and Underserved Health Research Center at the University of Kentucky.

The study found pneumonia immunization is less common among seniors in rural areas, and pharmacists could play a major role in closing that gap, the owner of a small pharmacy chain told Kentucky Health News.

Rosemary Smith, a co-owner of six Jordan Drug stores in Eastern Kentucky, said in a telephone interview that the vaccination rate in rural areas is probably lower because they have fewer health-care providers and most of "our people" are not "wellness oriented" -- but almost every community has access to a pharmacist.

"The key is that we see these patients," Smith said. "They may go to their physician two or three times a year, but we see them two or three times a month sometimes. So we are very accessible to them,  especially independents."

The study notes that all 50 states and Washington, D.C. allow pharmacists to provide pneumonia vaccines, and that 93 percent of all Americans live within five miles of a community pharmacy.

Using 2014 data from the Medicare Physician and Other Supplier Public Use Files, the study looked at the rural and urban differences in pneumonia vaccine rates for people 65 and older, and then assessed the impact of pharmacies as an alternative to primary-care providers.

The study found that of the 1.4 million fee-for-service Medicare patients who had received a pneumonia vaccine, 72.5 percent got their vaccine from a primary-care provider and 22.2 percent got it from their pharmacist.

It also found that pharmacists delivered a "significantly greater proportion" of the pneumonia vaccines in rural areas than in urban ones: 29.4 percent and 21.1 percent, respectively. The results suggest that pharmacists could play a major role in increasing vaccination rates in rural areas, especially if they are actively encouraged to do so.

There is a need to do that. The study points out that vaccination rates for pneumonia are 40 percent lower in rural communities than in urban areas: 2.81 percent and 4.66 percent, respectively.

Kentucky's overall pneumonia vaccination rate for seniors was 3.8 percent, with 3.1 percent of the state's eligible population getting the vaccine in rural areas and 4.9 percent in urban areas.

The national rate was 4.26 percent, ranging from 6.3 percent in Colorado to 1.1 percent in Maine.

Why is it important for seniors to get vaccinated for pneumonia? The researchers note that the death rate from pneumonia for seniors doubles, from 20 percent to 40 percent, between the ages of 65 and 85, and despite the recommendation that everyone 65 and older get vaccinated for the disease, fewer than two-thirds do so.

In the interview, pharmacist Smith said patient education and encouragement are important in getting people vaccinated, noting that the Jordan Drug store that provides the most pneumonia vaccines is in a town where the physicians at the local clinic strongly recommend it to their patients.

"The opportunities are there to really move the needle on these vaccinations," said Smith, a founding member of the Kentucky Independent Pharmacist Alliance, which says it represents more than 500 independent pharmacists, with members in all 120 counties.

Smith said she thought pneumonia vaccination rates in pharmacies are likely higher than they were in 2014, since more pharmacies now offer them and people are getting used to the idea that they can go to the pharmacy for them, she said there is room to do more. Jordan Drug didn't start offering vaccinations until 2015.

"I had no idea there was such a difference in the vaccination rate between urban and rural," she said. "So I think we can do more and I think as an independent pharmacy group across the state, being the most accessible health care provider, that we will do more and we will take this study to heart."

Many local, independent pharmacies in Kentucky say they're at risk of closing because they are paid such low dispensing fees by pharmacy benefit managers hired by the managed-care organizations that handle Medicaid. A hard-fought bill to address this issue will go into effect July 1. The new law will put the state Medicaid department in charge of setting reimbursement rates for pharmacists, and require the  pharmacy benefit managers to be more accountable for how they spend the $1.7 billion a year they get to process prescriptions. The bill was sponsored by Sen. Max Wise, R-Campbellsville.

The UK study also measured county-level characteristics associated with pneumonia vaccination and found it more likely with "increasing age of residents, greater proportion of female residents, and availability of inpatient hospital services," and less likely in rural and poor areas.

"Given that over 50 percent of the nation’s primary-care health-professional shortage is in rural areas," the study said, limited access to primary-care providers may limit vaccinations, "resulting in a shift to service delivery in pharmacies, as shown in this study."

The study team was led by UK pharmacy professor Jeff Talbert, director of the UK College of Pharmacy's Institute for Pharmaceutical Outcomes and Policy and associate director of the UK Center for Clinical and Translational Science.

Flu and pneumonia, which can result from flu, are 8th largest U.S. cause of death; officials urge all over 6 months to get flu shot

Flu season is here and will last through February or longer, prompting state health officials to encourage Kentuckians to get their flu vaccinations.

“During the holidays families and friends will gather, which increases the potential for exposure to the flu virus," Dr. Jeffrey Howard, the state's acting health commissioner, said in a news release. "We urge everyone who hasn’t received the flu vaccine, particularly those at high risk for complications related to the flu, to check with their regular health care professional, local health departments or other vaccine providers.”

Flu is a "very contagious" disease caused by a virus that spreads from person to person. Symptoms include fever, headache, cough, sore throat, runny nose, sneezing and body aches.

It can also be deadly. Flu and pneumonia are the eighth leading causes of death in the United States, according to the federal Centers for Disease Control and Prevention.

Just this week, Jennifer Earl of CBS News reported that a 20-year-old mother of two in Arizona died unexpectedly and quickly from flu.

Alani "Joie" Murrieta of Phoenix was being treated for the flu with an anti-viral medication called Tamiflu, but her health took a turn for the worse the day after her diagnosis. She was then rushed to the hospital, diagnosed with pneumonia and started treatment, but within two days of when she started feeling ill she was dead.

Murrieta's aunt, Stephanie Gonzales, warned the public to take the flu seriously.

"Don't take life for granted. If you feel sick, go to the doctor. Don't wait until your symptoms are so bad there is no turning back," she told CBS.

Kentucky's flu level as of Friday was classified as "regional," with 104 laboratory-confirmed cases, according to the state's weekly influenza surveillance report. Twelve of the state's 17 regions have had a confirmed case this flu season. As of Dec. 2, there had been no flu-related deaths reported in Kentucky.

NPR reports that the flu season could be "unusually harsh" this year because of several factors.

One is this year's early start to the season, which could make it last longer and infect more people. Another is that Australia had a severe flu season this year and the U.S. typically has a similar experience to what happens in the southern hemisphere.

Australia's bad season stemmed from a strain of the flu virus called H3N2 that tends to make people sicker than other strains, and because the flu vaccine was only about 10 percent effective against that strain this year in Australia. The U.S. is using the same vaccine as Australia, but its effectiveness in the U.S. is still unknown.

Health experts say that even an imperfect vaccine is better than no vaccine because it can help prevent or lessen the severity of the illness and also helps to promote "herd immunity" of the population.

The CDC recommends that everyone over six months of age get a flu vaccination, and especially encourages people who may be at higher risk for complications or negative consequences get one. They include:
• Children age six months through 59 months;
• Women who are or will be pregnant during the influenza season;
• Persons 50 years of age or older;
• Persons with extreme obesity (body-mass index of 40 or greater);
• Persons aged six months and older with chronic health problems;
• Residents of nursing homes and other long-term care facilities;
• Household contacts (including children) and caregivers of children younger than 5, particularly contacts of such children, or of adults 50 and older;
• Household contacts and caregivers or people who live with a person at high-risk for complications from the flu; and
• Health care workers, including physicians, nurses, medical emergency-response workers, employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients.

Howard added, “You should also follow the advice your parents gave you to prevent flu and other illnesses that tend to circulate at this time of year – wash your hands frequently, cover your mouth when you cough or sneeze and stay home when you’re sick.”

If you haven't gotten your flu shot yet, this week is an excellent time to get it, with the holidays coming up

State health officials are encouraging Kentuckians to get a flu vaccination during National Influenza Vaccination Week, Dec. 7-13.

"Getting a flu vaccine is an early holiday gift you can give to yourself and your family,” said Dr. Stephanie Mayfield, commissioner of the Department for Public Health. “As the holidays approach, people will be traveling, and families will gather together, increasing the potential for exposure to the flu. We are strongly urging anyone who hasn’t received a flu vaccine, particularly those at high risk for complications related to the flu, to check with local health departments or other providers.”

National Influenza Vaccination Week is a reminder to those people who have not yet received a flu vaccine that the time to get vaccinated continues into winter – through January or later, when flu season typically peaks. Because it takes about two weeks for the body to develop protective antibodies against the flu following vaccination, Kentuckians who have not had a chance to be vaccinated should seek out the opportunity during this season.

Throughout the week, health departments and the federal Centers for Disease Control and Prevention will highlight the importance of vaccinations for those people at high risk, their close contacts and all those who want to be protected against the flu. In addition, good health habits such as washing hands often with soap and warm water; avoiding touching your eyes, nose or mouth; and staying at home from work or school when sick will also be emphasized.

Kentucky’s flu activity level has recently increased to regional, which indicates an upturn in influenza-like illness or outbreaks of flu in some regions of the state.

The best way to protect against the flu is to receive a flu vaccination. The CDC’s Advisory Committee on Immunization Practices recommends flu vaccine for all individuals 6 months of age and older. People who should especially receive the flu vaccine because they may be at higher risk for complications or negative consequences include:

• Children ages 6 months through 18 years;
• Pregnant women;
• People 50 years old or older;
• People of any age with chronic health problems;
• People who live in nursing homes and other long-term care facilities;

• Health care workers;                               
• Caregivers of or people who live with a person at high risk for complications from the flu; and
• Out-of-home caregivers of or people who live with children less than 6 months old.

Kentuckians should receive a new flu vaccination each season for optimal protection. Healthy, non-pregnant people ages 2 through 49 can be vaccinated with either the flu shot or the nasal vaccine spray. Children younger than 9 years old who did not receive a previous seasonal flu vaccination should receive a second dose at least four weeks after their first vaccination.

High-dose flu vaccine is available for persons aged 65 years and older this year.

The CDC says some of the nation’s circulating flu viruses may not be covered well by this year’s vaccine.  That is not unusual. "Despite the possibility of a poor vaccine match for one of the circulating strains, vaccination still provides the best protection against influenza," a state news release said. "The vaccine appears to be a good match for many of the strains which are being transmitted, and because of antibody cross-protection, should help to reduce hospitalizations and deaths, even in persons who may contract the mismatched strain of influenza."

In addition to flu vaccine, the health department strongly encourages all adults 65 years and older and others in high risk groups to ask their health care provider about the pneumococcal vaccines. These vaccines can help prevent a type of pneumonia that is one of the flu’s most serious and potentially deadly complications. The CDC now recommends that adults 65 years or older receive the pneumococcal conjugate vaccine (PCV13, Prevnar-13) in addition to the pneumococcal polysaccharide vaccine (PPSV23, PneumoVax-23). Getting both vaccines offers the best protection against pneumococcal disease. Between 3,000 and 49,000 deaths are attributed to flu and pneumonia nationally each year, with more than 90 percent of those deaths occurring in people age 65 and older.

First flu case reported in Kentucky; vaccination recommended for everyone over 6 months old, especially some groups

Kentucky's first positive lab-confirmed case of the flu has been reported in Jefferson County this week, according to the state Department for Public Health.

The best way to protect against the flu is to receive a flu vaccine, and it's best to get vaccinated early because the vaccine takes about two weeks to work, the department says. Still, you can get a flu vaccine at any time during the flu season.

"Getting the flu can be debilitating and sometimes life-threatening, and vaccination is the best tool we have to prevent illness. It’s also extremely important to take simple preventive steps to avoid it," Health Commissioner Stephanie Mayfield said in a press release. “You should also follow the advice your mother gave you to prevent flu and other illnesses that tend to circulate at this time of year – wash your hands frequently, cover your mouth when you cough or sneeze, and stay home when you’re sick.”

While the federal Centers for Disease Control and Prevention recommends that anyone over six months old get a flu shot, they especially recommend that these types of people get one because they may be at higher risk:

• Children
• Pregnant women
• People 50 years old or older
• People of any age with chronic health problems
• People who live in nursing homes and other long-term care facilities
• Health-care workers
• Caregivers of or people who live with a person at high risk for flu complications
• Caregivers of or people who live with children less than six months old

You should get a flu vaccination, which is available in either a shot form or a nasal vaccine spray, each season for "optimal protection," says the release.  The spray is recommended for "healthy, non-pregnant people aged 2 through 49," and is the best choice for children 2 to 8, but parents should get the shot for their child if the spray is not available.

The CDC also recommends that children under 9 who did not get a flu shot during the previous season get a second dose four or more weeks after their first vaccination.

A high-dose flu vaccine, designed to provide better protection against the flu, is available this year for those 65 and older, says the release. This age group should also ask their health care provider about the pneumococcal vaccines, which helps to prevent a type of pneumonia, one of the flu's most serious and potentially deadly complications.

Flu and resulting pneumonia cause between 20,000 and 40,000 deaths nationally each year, with more than 90 percent of those deaths occurring in people age 65 and older, the release says. For more information on the flu or the availability of flu vaccine, contact your local health department or visit http://healthalerts.ky.gov.

UK's advanced ventricular-assist device program for heart patients saves and improves lives

Two years ago, John Doty was diagnosed with walking pneumonia, and though antibiotics originally helped, the pneumonia came back with a vengeance, and he went to see a cardiologist. He found out his heart was severely weakened with an ejection fraction of less than 10 percent. "The ejection fraction is a measure of how effectively the heart can pump blood volume into the body, and in a healthy heart, that number falls between 50-65 percent," Allison Perry writes for the University of Kentucky, where Doty received a left ventricular assist device (LVAD) because his heart was so weak.

UK Chandler Hospital is Lexington's only hospital, and one of two in the state, that can perform emergency VAD procedures. "When Mr. Doty was transferred to UK, he was very sick, on a ventilator and requiring two medications to support his blood pressure," said Dr. Navin Rajagopala, a heart failure cardiologist at the UK Gill Heart Institute. "He was going into kidney and liver failure. It was clear that he needed an assist device as soon as possible before the damage to his body was irreversible."

VADs partially take the place of the function of a failing heart. They're more often used for the left ventricle, but some patients need the device for the right ventricle or even two devices to help both ventricles (BiVAD). Because VADs can help the heart rest and heal, some patients receive them after a heart attack or a surgery. People suffering from congestive heart failure might need a VAD for the rest of their lives.

A viral infection damaged Andy Baker's heart, and though he originally resisted the idea of a VAD, now he says he's "happy to keep the device and has no interest in getting a heart transplant," Perry writes. "I had mixed feelings about it," Baker said about getting the VAD, "but it's given me life again."

VAD treatment can save money for the both the patient and the hospital and allow at-home recovery. VADs can allow people to return to their normal lives, participating in many of the same activities they did previously. in about 5 to 10 percent of cases, the VAD even helps the heart to heal to the point that the device can be removed. That was the situation for Doty, whose device was removed 16 weeks after he got it. "I almost feel like I never had it," Doty said. "It wasn't that great of an imposition, considering that it was keeping you alive."

UK performs about 20 to 30 VAD procedures per year, and recently received its third straight biannual Certificate of Distinction from The Joint Commission, the leading accreditor of U.S. health-care organizations. That "shows just what an outstanding job our physicians, nurses and support staff are doing when it comes to treating patients who require these assist devices," said Dr. Maya Guglin, director of UK's Mechanical Assisted Circulation Program. (Read more)

Flu vaccine recommended for all over 6 months; pneumonia vaccine recommended for those 65 and older and at high risk

Vaccination is the best way to keep from getting the flu, and with two influenza cases already reported in Kentucky, now is the time to schedule your annual flu shot, says the state Department for Public Health.

Kentucky's flu season typically begins in October or November, so many health-care providers have vaccine supplies on hand. Adequate supplies of flu vaccine should be available for this year's season, according to a news release from the department.

It is best to get your flu vaccine early because it takes about two weeks for the vaccination to take effect, but flu shots can be given any time during the flu season.  It is recommended that you have a new flu vaccination each season, and children younger than 9 who did not receive a flu shot last season should get a second dose four or more weeks after their first vaccination, according to the release.

"Getting the flu can be debilitating and sometimes life-threatening, and vaccination is the best tool we have to prevent illness,” said Stephanie Mayfield, M.D., commissioner of the department. She suggested following a few simple steps to reduce the risk of getting the flu and other illnesses: Wash your hands frequently, cover your mouth when you cough or sneeze, and stay home when you’re sick.

The Department for Public Health and the federal Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends flu vaccine for all individuals older than 6 months. The vaccine is especially recommended for people who are at higher risk for complications or negative consequences from the flu. 
 These include:
 • Children 6 months to 19 years
 • Pregnant women 
 • People 50 years old or older
 • People of any age with chronic health problems
 • People who live in nursing homes and other long-term care facilities
 • Health care workers
 • Caregivers of or people who live with a person at high risk for complications from the flu
 • Out-of-home caregivers of or people who live with children less than 6 months old

A variety of vaccine options are available, including injections, nasal vaccine spray, intradermal vaccination and high dose flu vaccines, so many consumers have a choice about how they get vaccinated.  Ask your health care provider which option is best for you.

Flu is a contagious disease caused by the flu virus and spreads from person to person. Symptoms include fever, headache, cough, sore throat, runny nose, sneezing and body aches. Seasonal flu and its complications cause an average of 23,000 deaths  each year in the U.S.

In addition to the flu vaccine, the Department for Public Health also strongly encourages all adults 65 or older and others in high risk groups to ask their health care provider about the pneumococcal vaccine.  This vaccine can help prevent a type of pneumonia, one of the flu's most serious and potentially deadly complications, according to the release.

High risk groups for invasive pneumococcal disease are:

• persons with chronic pulmonary disease
• asthma
• chronic heart disease
• diabetes
• chronic renal disease
• chronic liver disease
• smokers aged 19 through 64 years

Between 20,000 and 40,000 deaths are attributed to flu and pneumonia nationally each year, with more than 90 percent of those deaths occurring in people age 65 and older, according to the release.

For more information on influenza or the availability of flu vaccine, contact your local health department or visit http://healthalerts.ky.gov.