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CMS rolls out its quality initiative
Nov. 3, 2003, marked the first day that Home Health Compare, the Centers for Medicare & Medicaid Services’ (CMS) national quality initiative for home health agencies became active. Home Health Compare’s pilot test began in May 2003, and includes outcomes data on items such as improvement in ambulation, improvement in bathing, acute-care hospitalization, and improvement in toileting. To see the advertisements that CMS is placing nationally, go to: www.cms.hhs.gov/quality/hhqi. You also can choose the link to the Home Health Compare web site to see how consumers will view your agency’s scores as compared to local and national benchmarks.
FDA approves new Alzheimer’s drug
The Food and Drug Administration has approved memantine, a drug sold in Germany for many years, and the first treatment designed specifically for late stages of Alzheimer’s disease. U.S. marketer Forest Laboratories will sell memantine here under the brand name Namenda, for patients with moderate to severe Alzheimer’s symptoms. A Forest spokesperson says the drug should be available in January 2004.
While some patients given memantine experience improvement in memory and thinking skills, the majority of Alzheimer’s patients will experience a slower pace of deterioration, letting patients maintain certain functions a little longer. For example, the drug helped some patients maintain the ability to go to the bathroom independently for six more months, according to studies, a benefit caregivers consider important.
Memantine is the first option for advanced stages of Alzheimer’s. The nation’s four other Alzheimer’s medications — Aricept, Exelon, Reminyl, and Cognex — work in early stages of the disease. About 4 million Americans have Alzheimer’s, and a million of them are believed to suffer severe symptoms.
Study shows caregivers often overestimate pain
A study conducted by the College of Nursing at the University of South Florida in Tampa, shows that caregivers often believe their family member is in greater pain that the patient feels.1 As health care increasingly moves out of hospitals, the care of patients with cancer is provided in the community with the help of family caregivers. In many cases, nurses depend on family caregivers to provide assessment data about patients. This makes the accuracy and dependability of the data given by caregivers particularly important.
The study included 264 newly admitted adult patients with advanced cancer in hospice home care and their primary caregivers. Patients and caregivers completed questionnaires that included numeric rating scales for pain, dyspnea, and the Constipation Assessment Scale. All of the scales were designed to describe the patient’s symptom intensity. The results indicated that caregivers significantly overestimated symptom intensity for all three symptoms.
Results of the study indicate that hospice and home health nurses need to train family caregivers in conducting systematic assessments of pain instead of assuming that they understand the patient’s symptoms. Until then, nurses need to be wary of relying upon family caregiver reports of pain.
1. McMillan SC, Moody LE. Hospice patient and caregiver congruence in reporting patients’ symptom intensity. Cancer Nurs 2003; 26(2):113-118.