3 Responses

  1. Nicole
    Nicole April 16, 2012 at 8:48 am | | Reply

    This is an interesting article. It is awesome to see how you play a role to the Hispanic community.

  2. judy helmers
    judy helmers April 16, 2012 at 10:26 am | | Reply

    Well, I am white, diabetic, copd,98% of kidney blockage. No insurance. No medicaid. Low income, but not low income enough to get help. So where does that leave me? And no they still will not insure a person with a previous condition and even if they do, the price is so exorbitant that we cannot afford it. Again, it aint all black and white!

  3. rich
    rich May 17, 2012 at 2:11 pm | | Reply

    Was looking through the web to get ideas on research projects and came across this wonderful review. i am the endocrinologist at a large inner city hospital in the northeast, a brisk but doable walk from one of the world’s premier medical centers where I was trained. My population is largely African-American with a significant contribution of Islamic people from Bangladesh and East Africa with a notable number from West Africa. My elderly population has Medicare, those under 65 largely Medicaid or uninsured, the latter getting their care at regional health centers run by the city. Since I tend to inherit people after they have failed other treatment, my biggest barrier has been access to the medicines that enable problem solving once the problems are well established. Analog insulins are not obtainable in the clinic, DPP4 inhibitors or GLP-1 agents which can eliminate a lot of the hypoglycemia I encounter or reverse weight gain are also difficult to come by. Since my people are past the prevention stage, I sometimes need to use Crestor to reach lipid goals but cannot sell that need to the payer. And then we have test strip access.

    The other thing that has puzzled me are the patient relations with the pharmacies. When I was in suburban practice a patient whose prescription was turned down due to formulary substitutions would either call me or the pharmacist would call me. It could be something really simple like replacing one ARB or statin with another but the patient is told by the pharmacy the medicine is not covered, not give alternatives and therefore the patient takes no medicine until the next visit when the circumstance comes to my attention. That should be easily correctable.

    As endocrine attending to a teaching program I am astounded at simple dropped balls. We use analog premix insulin on our formulary to minimize hypoglycemia. It is expensive. Instead of the residents giving prescriptions for human 70/30 to the uninsured, they write for analog mix which the patient then takes to the local pharmacy which gives a price well beyond their means. The patients were on the hospitalist/resident service, i may not have been consulted at all but they were given an office appointment. They arrive and tell me the tale of no insulin since they left the hospital.

    Part of diabetes is of course prevention of body part damage, but the ability to keep people active and productive with established disease makes a great difference as well.

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