Napa County Health Rankings 2015
Have you wondered how the health status of Napa County ranks compared to other California’s other 57 counties? Napa ranked 13/58 on the most recent survey in 2015. Health Outcomes are based on many factors including heath behaviors, clinical care, social and economic factors and physical environment. Here are some of those factors:
| Health Behavior
| Adult Smoking
| Adult Obesity
| Excessive Drinking
|High school graduation
|Per Capita income (2013)
|Median household income (2013)
|Children in poverty
|Air Pollution - particulates
|Severe housing problems
|Persons 65 years and older
|Cancer rate: breast
|Cancer rate: prostate
|Cancer rate: colon
|Cancer rate: lung
|All cancer mortality
|Age adjusted cancer rate (2014)
Before the Affordable Care Act (ACA), California had the largest number of uninsured of any state in the country. Since the ACA, California expanded MediCal to cover all nonelderly adults with incomes below 138% of the federal poverty level ($16,242 for an individual or $27,724 for a family of 3). Enrollment in MediCal grew by 37% between October 2013 and May 2015. Since the ACA, the uninsured rate for the nonelderly in California dropped from 19.1% to 13.4%.
It is not clear why the Napa County’s cancer rates are so high. The numbers are age adjusted and not dependent on our higher percentage of people over 65. The overall cancer incidence in Napa County is second highest for California counties. Air quality (pesticides), alcohol consumption and obesity rates have been considered as factors.
James Cotter, MD MPH
Napa Managing Pain Safely Coalition
James C. Cotter, MD
Napa County formed a Managing Pain Safely Coalition in 2014. We have representatives from physician groups, pharmacists, from intervention and treatment programs and from law enforcement and public safety. It is a broad coalition with members of NCMS, Kaiser Permanente, Ole Health, Queen of the Valley Medical Center, the Veterans Home, emergency department physicians, the County of Napa and Partnership Health Plan.
The committee was formed in response to some alarming statistics about opioid use in this country. There has been a significant increase in opioid deaths in the US with over 6500 deaths in 2010, more than three times higher than deaths due to benzodiazepines, antidepressants and four times higher than cocaine and heroin deaths combined. Almost all prescription drugs involved in overdoses originate from prescriptions we write. About 80% of all opioid prescriptions come from 20% of opioid prescribers.
Our vision statement: The community of Napa manages pain through improving the quality of life and functionality for individuals with pain, and the consistent, safe and transparent use of medications.
The primary aim of this group is to have all Napa prescribers order opioids for the appropriate indications, at safe doses and in conjunction with other treatment modalities.
What can you do?
• Use caution when starting use of opioids.
• Understand that patients who start and remain on opioids for 90 days may be on them for life.
• Always use CURES before starting opioids and on some regular basis for chronic opioid patients.
• Have a signed drug contract that outlines patient responsibilities and consequences.
• Regularly use urine drug screens for patients on chronic opioids (at least once a year).
• See your chronic opioid patients at least twice a year.
• Avoid escalation of total opioid dose beyond 120 mg equivalents of morphine (MED) per day.
• Avoid further escalation for patients already on 120 MED or more.
• Consider multi-disciplinary programs for patients with chronic pain.
Our coalition is in the process of developing opioid treatment guidelines for all Napa county prescribers. We will share these with all Napa County physicians. We welcome your participation in this process.
James Cotter, MD
Regional Medical Director
Partnership HealthPlan of California
The 2015 AMA Annual Meeting
Peter N Bretan, MD, FACS, AMA Alternate Delegate Report
See full coverage of the meeting at AMA Wire®. From MOC to vaccines: Top 10 stories from AMA Annual Meeting
1. More transparent, physician-friendly MOC focus of new policy
Physicians took on the maintenance of certification (MOC) process at the 2015 AMA Annual Meeting Monday, calling for more transparency and education surrounding the process.
2. “Innovation ecosystem” shaping medicine’s future
The AMA is improving the health of the nation by crafting an “innovation ecosystem,” AMA Executive Vice President and CEO James L. Madara, MD, said in his address. This includes the launch of the AMA’s STEPS Forward website, which offers a free series of physician-developed, proven solutions to make physician practices thrive.
3. Doctors call for two-year grace period for ICD-10 implementation
With less than four months to go before the deadline for implementing the ICD-10 code set, physicians agreed to seek a two-year grace period to avoid financial disruptions, during which CMS would refrain from withholding payments because of coding mistakes. This would facilitate a smoother transition that would allow physicians to continue providing quality care to their patients.
4. From Rx monitoring to treatment: Solutions for overdose epidemic
As the nation continues to grapple with its epidemic of opioid misuse, overdose and death, physicians supported additional steps to address this pressing public health issue.
5. Facing challenges strengthens physician-patient bond: AMA president
In his final address as AMA president, Robert M. Wah, MD, congratulated physicians on undertaking numerous challenges this year, including accelerating change in medical education and improving health outcomes for patients with prediabetes and high blood pressure. He also called for true “meaningful use” by interoperability of EMR to harness technology to improve care, instead of it harnessing us.
6. New public health policies patients need to know—and why
Many of today’s precautions for public health and safety had their start with physicians at the AMA. Public health issues that doctors want to tackle next range from barring people younger than 21 from purchasing e-cigarettes to protecting youths with concussions.
7. GME funding, doc shortage tackled in new policy
Physicians passed policy to address insufficient funding for graduate medical education (GME) ahead of a predicted shortage of 46,000-90,000 physicians over the next decade.
8. A story of hope: New AMA president points to power of physicians
For each story of frustration in the medical profession, “there is a story of vision, perseverance and success,” AMA President Steven J. Stack, MD, said in his inaugural address. “When it comes to something as important as shaping a better, healthier future, it will take every single one of us.” Dr Stack is an ER physician who practices in Lexington, Ky. He was sworn in as the 170th president of the AMA and is the youngest president in the past 160 years.
9. Medical reasons should be the only exemptions from vaccinations
As the debate around vaccinations continues to rage in the public, outbreaks of dangerous preventable diseases have continued to increase. For public health experts, the question has become, “Should individuals be given exemptions from required immunizations for non-medical reasons?” Physicians provided some answers with policy passed on Monday of the HOD.
10. New AMA policy calls for research on violence against physicians
Policy adopted Tuesday supports a new study on methods that will prevent violence against health care professionals while in the workplace. Attacks at hospital and social service settings account for almost 70 percent of nonfatal workplace assaults.
Regarding the California Resolutions:
The following were placed on the Reaffirmation Calendar:
Res 109 Medicare Coverage of Physician Administration of Medications Procured by Patients
Res 205 Doctor hospital Ownership
Res 410 mental Health Crisis Interventions
Res 411 Homeless Veterans
Res 509 Long Acting Reversible Contraception and Teen Pregnancy
The following were adopted by the HOD:
Res 009 Parent to Parent Ed on Child Vaccination
Res 107 Reimbursement for End-of-Life Counseling
Res 116 Study the Impact of the ACA Medicaid Expansion
Res 412 Electronic Cigarettes.
Peter N Bretan, MD, FACS.
The Importance of Vaccinating Your Children
By James C. Cotter, MD
The recent outbreak of measles has stimulated quite a lot of discussion about
immunizations in our country. There is no debate, however, about the value and
safety of childhood immunization. These vaccines save thousands of lives every
year. Vaccination against preventable diseases has been one of the finest
achievements in health care over the last 50 years. I could talk about the value
of more than 15 different vaccines if you give me the chance, but I will focus
on just two right now: measles and pertussis.
Measles is very easy to catch if you are not immunized. The virus can remain
suspended in the air for several hours – you just have to walk by someone with
active measles to catch it. Prior to measles vaccine in 1963, there were 3-4
million cases of measles every year in the US with 500 deaths and 4,000 cases of
encephalitis with 1,000 children getting permanent brain damage from the
encephalitis. Can you imagine having your child’s brain stop developing at age 2
due to measles encephalitis? In my medical practice, I cared for a middle age
man with the brain of a 2 year old caused by measles encephalitis – it is
incredibly sad. Measles vaccine is very safe and very effective with 97-99%
protection against measles after 2 shots.
There were 10,000 cases of pertussis (whooping cough) in the US last year.
Pertussis is very dangerous for children under 12 months. Two thirds of children
get apnea (stop breathing) and one fourth of children who have pertussis require
hospital admission for pneumonia. Adults and adolescents have less serious
complications, but a significant number of adults break their ribs from the
severe coughing caused by Pertussis. Pertussis vaccine loses its effectiveness
over time and requires boosters, even for adults.
So why aren’t all children immunized?
There are several reasons why children may fall behind on their
immunizations: the child may be uninsured; the child may have skipped a well
child visit and missed a scheduled shot; parents may request an alternate
schedule of immunizations to lessen the shot burden at any one visit; or parents
may object to immunizations for personal or religious reasons.
If you or your child does not have health insurance or lacks a medical home,
in Napa, please call the Napa Children’s Health Initiative (707-227-0830); in
Solano County, call one of the many community health centers. They can get your
child insured and connected to a medical home.
Some children just miss shots. They miss a well-child visit or have a mild
illness and skip a shot (immunizations are actually OK even with most mild
illnesses). It is really important to get that first measles shot by age 12
months and to have the whole primary series of immunizations complete by 18
months. Our school system requires the full childhood schedule to be done by
entry into kindergarten.
I can understand the thoughts behind spreading out vaccination over a longer
period of time, but it is not really a good idea. The youngest children are at
the highest risk for complications and death from these illnesses. Many studies
have been done to prove that multiple shots work just as well when they are
combined as if they were done individually. Many immunizations have been
combined into one injection to make it easier for children. The currently
recommended schedule is the result of lots of research to get children the best
protection they can have as soon and as safely as possible.
People who object to immunizing their children are not stupid. In fact, many
are well educated, but they are misinformed. Many people still consider the risk
of autism as their reason not to vaccinate. Andrew Wakefield started that lie
and he was banned from medicine for life and his study in Lancet was retracted
because he made money for himself by linking MMR to autism. People should not
base their medical decisions on Mr. Wakefield’s lies. Studies involving 34
million children have shown that there is no connection between MMR and autism.
There is a school in Beverly Hills with a 75% vaccine refusal rate. I would
not want to live in that neighborhood. Luckily, less than 5% of parents refuse
vaccines for their children in Napa; in Solano County, immunization rate is 95%
completion at kindergarten entry. Nonetheless, refusing these life-saving
vaccines is a serious and potentially dangerous decision. Refusing vaccines puts
your children at risk, but also puts any infants near your children or any
children with compromised immune systems at risk of dying from a preventable
disease. Please talk to your doctor about this. If you want straight information
about vaccine safety, please go to CDC.GOV/vaccines
Please vaccinate your children. It is an act of love for them and everyone