October Informed Newsletter

A Fond Farewell – and a Depth of Gratitude

For almost half a century, we’ve partnered with our communities’ doctors and other healthcare providers to create meaningful change in patients’ lives. It’s been our deepest honor to work with you throughout the years as together we’ve helped countless individuals on their journeys of health and well-being. Thanks to you, we’ve been able to boast of networks that have included the most highly skilled, compassionate providers who always put our members first.

Thank you for your clinical expertise. Your intimate knowledge of your patients. Your caring hearts and healing hands. As we cease operations of all lines of business on January 1, 2026, we hope you know how truly we’ve valued your partnership over the decades. From our leadership, our staff and all our members, we offer the utmost gratitude.

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Help us move the needle.

Together we can help people live their healthiest lives. Find reminders, tips and more in this section, to guide improvements in patient outcomes. Help us move the needle.

Shingles Vaccine Recommendations

 Shingles is painful but preventable infection – and your voice is key. Remind your eligible patients to get the shingles vaccine. Here’s the info you need, straight from the CDC.

Patients 50 Years and Older

The CDC recommends two doses of Shingrix, separated by two to six months, for immunocompetent adults 50 years and over. This is recommended even if:

• They’ve had a prior episode of herpes zoster.
• They’ve received a prior dose of Zostavax (an older shingles vaccine).

Also note that it’s not necessary to screen, either verbally or by laboratory serology, for evidence of previous varicella infection.

Immunocompromised Patients 19 Years and Older

The CDC also recommends two doses of Shingrix in adults 19 and older who are, or will be, immunodeficient or immunosuppressed because of disease or therapy. The second dose should be given two to six months after the first. However, if patients would benefit from completing the series in a shorter period, the second dose can be given one to two months after the first.

For much more information about the shingles vaccine, please visit this CDC website. Thanks for your help in getting your patients the protective shots they need.

Hard-to-Treat Blood Pressure: Key Information

 To help your patients with hard-to-treat blood pressure, here’s key information from the American Heart Association^®.

Causes of Difficult-to-Treat Blood Pressure

• Issues with hormones that affect blood pressure.
• Sleep problems (like sleep apnea).
• Obesity.
• Plaque in the vessels that feed into the kidneys.
• Medications that can raise blood pressure.
• Heavy alcohol use.

Monitoring

• Your patients might benefit from wearing automatic blood pressure recorders at home, which record their levels 24/7. They should check their numbers multiple times daily, and they should keep you informed.

Treatment Options

• Lifestyle changes: regular physical activity; maintenance of a healthy weight; well-balanced, low-sodium diet; limited or no alcohol; correct adherence to appropriate medications.
• Medication changes, if needed.

Patients should NOT take drugs or supplements that can increase their blood pressure, like:

• Diet pills and stimulants.
• Natural licorice.
• Antacids that contain sodium.
• Birth-control pills.
• Decongestants.
• Cyclosporine or tacrolimus (drugs used after an organ transplant).
• Nonsteroidal anti-inflammatory drugs such as ibuprofen and celecoxib.
• Herbal agents like ma huang or Ephedra.
• Caffeine.

A final, important note: If a patient’s blood pressure reading is elevated during their checkup, retake their blood pressure again before ending their visit – and document the lowest reading in their medical record.

COPD – Diagnosis, Management and Prevention

 Here’s key information about chronic obstructive pulmonary disease (COPD), from the National Library of Medicine and the National Committee for Quality Assurance (NCQA).

Diagnosis

• Spirometry.
  • GOLD 2024 proposes that a postbronchodilator FEV₁ /FVC<0.7, in the appropriate clinical context, is mandatory to establish a COPD diagnosis.
• Preserved Ratio Impaired Spirometry (PRISm).
  • PRISm is a spirometric pattern characterized by FEV₁/FVC ≥ 0.70 and post-BD FEV₁< 80% pred. The pathogenesis of PRISm is still unclear, but possible causes may include cardiac disease (i.e., lung edema), early stages of obstructive or restrictive lung disease, gas trapping, and/or incomplete inspiration or expiration (insufficient cooperation).
• Lung hyperinflation.
  • Lung hyperinflation is one of the main, if not the leading, mechanisms of dyspnea in those with COPD. It can be static (at rest) or dynamic (during exercise) and it has prognostic value. Bronchodilator treatment benefits are likely related to pharmacological lung “deflation.”
• Interstitial lung abnormalities (ILAs).
  • People with COPD often have ILAs. They’re not always detrimental, but ILAs associated with suspected interstitial lung disease have worse prognoses.

 Management of Stable COPD Patients

• Smoking cessation.
• Biologics.
• Inhaled pharmacologic therapy.

Management of Exacerbation

• Systemic corticosteroids.
• Bronchodilators.

Prevention

• Smoking cessation.
• Vaccination – For vaccination information for stable COPD, please see this table linked here.

Prevention of Chronic Kidney Disease

 View this highly informative chart from the National Library of Medicine, detailing the primary, secondary and tertiary measures to help prevent chronic kidney disease (CKD).

Antidepressant Medication Management

Major depressive disorder (MDD) is common and serious. Here’s what you need to know about antidepressant medication management, from the experts at Johns Hopkins Medicine, the National Library of Medicine and the National Committee for Quality Assurance (NCQA).

Key Points for Providers

• To screen someone for MDD, use the Patient Health Questionnaire (PHQ)-9 screening tool.
• Make sure your patients remain in adherence with their medications. Give them written instructions as needed.
• Regularly monitor their medications’ effectiveness.
• Actively identify and manage any side effects.
• Know that many people with MDD have medical comorbidities.
• Remember: As many as half of all patients with MDD require treatment modifications beyond first-line therapy. Antidepressants differ in their efficacy and tolerability.
• The goal of MDD treatment is remission with good functional and psychosocial outcomes for the patient.
• If a treatment/medication is working, there should be some evidence of symptom improvement after two weeks. If not, you should consider dose adjustment or other interventions.
• Also encourage your patients to attend psychotherapy.
• For those with complex conditions or needs, consider referring them to a psychiatrist.
• Coordinate care and treatment with your patients’ psychologists, psychiatrists and therapists/counselors.
• Remind patients that it may take awhile for them to feel the effects of the medication – they shouldn’t be discouraged if they don’t notice any immediate changes.

Well-Baby and Well-Child Visits

The American Academy of Pediatrics and its Bright Futures initiative created a set of comprehensive guidelines for providers to use for well-baby and well-child visits.

Click here to find a full “periodicity schedule” listing the specific measurements, screenings, examinations, procedures and more to give to babies and children from birth through age 21 years. It’s a convenient PDF, one page front and back, easy to print out.

To see more in-depth information, visit this webpage. Here you’ll find links for each specific well-baby and well-child visit. The links take you to individual pages with plenty of information for you – and for parents – about what each visit entails. Please share these links with your patients’ parents and guardians as you see fit.

Finally, here are a few additional tips:

• Always remind parents and guardians about the importance of these regular visits. Their children shouldn’t miss any of them. They are key even if the child is completely healthy.
• Educate parents and guardians on what to watch for regarding their child’s health and development.
• At the end of each well-baby/well-child visit, before the parents/guardians leave, make sure to schedule the next
• Schedule “catch-up” visits for patients who’ve missed appointments.
• Print out the vaccine schedules for Birth Through 6 Years and 7 Through 18 Years. Put copies up in your office AND provide these to parents/guardians as handouts.

Additional Resource for this Article: National Committee for Quality Assurance (NCQA)

Address patients’ social needs – and help reduce your burnout.

Tackling your patients’ social needs isn’t only good for them – it can also be great for you and your colleagues. Here’s some encouraging information from the American Academy of Family Physicians and the Annals of Family Medicine.

• According to these experts, providers may experience less burnout when their patients’ social needs are better taken care of.
• The inability of providers to connect patients with health-impacting resources beyond the exam room (such as food, transportation, etc.) has often worn providers down.
• But when providers are able to partner with other organizations and resources within the community, to help fill in these gaps, patients’ social needs are better met and the providers’ morale can increase. Providers also often feel increased efficacy when their patients’ holistic needs are met.
• Partnership is crucial, because providers are already so busy with medical needs and often find it difficult to fit additional tasks into their workflows.
• Success often means having social needs resources on-site or nearby, managed by specialized staff either in the clinic or at an outside (but partnering) organization.
• Social needs interventions should always be accessible, timely and tailored to each patient’s situation. Patient involvement and feedback is also key.
• A team approach is usually best: The provider tackles the patient’s medical needs; behavioral health specialists and social workers (either in the clinic or at a partnering organization) address social needs and resources; and the patient drives the direction and feedback.

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